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Tuning Pharmacokinetics to Improve Tumor Accumulation of a PSMA-Targeted Phototheranostic Agent Kara Harmatys, Marta Overchuk, Juan Chen, Lili Ding, Ying Chen, Martin G Pomper, and Gang Zheng Bioconjugate Chem., Just Accepted Manuscript • DOI: 10.1021/acs.bioconjchem.8b00636 • Publication Date (Web): 16 Oct 2018 Downloaded from http://pubs.acs.org on October 17, 2018
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Bioconjugate Chemistry
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Tuning Pharmacokinetics to Improve Tumor
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Accumulation of a PSMA-Targeted
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Phototheranostic Agent
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Kara M. Harmatys1,4,†, Marta Overchuk1,2,†, Juan Chen1, Lili Ding1, Ying Chen3, Martin G.
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Pomper3, Gang Zheng*,1-2,4
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†
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1
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Toronto, Ontario M5G 1L7, Canada.
Denotes equal contribution Princess Margaret Cancer Centre, University Health Network, 101 College Street,
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College Street, Toronto, Ontario M5S 3G9, Canada
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3
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States
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Ontario M5G 1L7, Canada
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*
Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164
Johns Hopkins Medical School, 1550 Orleans Street, 492 CRB II, Baltimore, MD 21287, United
Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto,
Corresponding author
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Abstract
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We describe a simple and effective bioconjugation strategy to extend the plasma circulation of a
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low molecular weight targeted phototheranostic agent, which achieves high tumor accumulation
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(9.74 ± 2.26 %ID/g) and high tumor-to-background ratio (10:1). Long-circulating
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pyropheophorbide (LC-Pyro) was synthesized with three functional building blocks: 1) a
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porphyrin photosensitizer for positron-emission tomography (PET)/fluorescence imaging and
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photodynamic therapy (PDT), 2) a urea-based prostate-specific membrane antigen (PSMA)
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targeting ligand and 3) a peptide linker to prolong the plasma circulation time. With porphyrin’s
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copper-64 chelating and optical properties, LC-Pyro demonstrated its dual-modality
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(fluorescence/PET) imaging potential for selective and quantitative tumor detection in
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subcutaneous, orthotopic and metastatic murine models. The peptide linker in LC-Pyro
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prolonged its plasma circulation time about 8.5 times compared to its truncated analog. High
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tumor accumulation of LC-Pyro enabled potent PDT, which resulted in significantly delayed
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tumor growth in a subcutaneous xenograft model. This approach can be applied to improve
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pharmacokinetics of the existing and future targeted PDT agents for enhanced tumor
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accumulation and efficacy.
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Bioconjugate Chemistry
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Background
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Photodynamic therapy (PDT) has emerged as a highly effective tool for cancer ablation without
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the use of ionizing radiation and with minimal off-target toxicity.1 The mechanism of PDT relies
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on the generation of reactive oxygen species (ROS) with a combination of a photosensitizer,
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light and oxygen.2 Current photosensitizers can be separated as hydrophilic agents that clear
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rapidly and act intravascularly or hydrophobic agents that accumulate in the tissues.3 Nonspecific
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uptake of hydrophobic photosensitizers results in off-target light toxicity, which limits the utility
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of this approach. One way to reduce off-target toxicity and improve photosensitizer tumor
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accumulation is to design a cancer cell-targeted agent that would confine ROS generation
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selectively to cancer cells.
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Prostate specific membrane antigen (PSMA) targeting has recently attracted significant attention
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in the oncology community due to the success of PSMA-targeted nuclear imaging and
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therapeutic radionuclide delivery, which is beginning to affect management of patients with
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prostate cancer.4-7 PSMA is a type II transmembrane glycoprotein that is highly overexpressed in
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prostate cancer. Its expression correlates with cancer aggressiveness.8-10 A variety of PSMA-
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targeted photosensitizers have appeared recently.7, 11-16 For example, Chen et al. developed a
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small-molecule PSMA-targeted photosensitizer11, while Nagaya et al. conjugated a near-infrared
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photosensitizer to a monoclonal antibody.17 While the low-molecular-weight photosensitizer
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enables deep tumor tissue penetration and fast targeting kinetics, its rapid clearance resulted in a
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suboptimal efficacy, explaining the need for multiple re-injections followed by PDT. On the
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contrary, the antibody-based photosensitizer exhibited a long circulation time and favorable
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biodistribution18, but poor tissue penetration limited its therapeutic potential.19 To address
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limitations of existing PSMA-targeted photosensitizers we designed an agent that combines the
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virtues of low molecular weight (< 2 kDa) and synthetic accessibility demonstrated by small
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molecules, while maintaining the long circulation time characteristic of antibody-photosensitizer
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conjugates.
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The designed agent consists of a pyropheophorbide a photosensitizer, a highly selective PSMA-
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binding ligand and a peptide-based pharmacokinetic modulator20 (Figure 1). We demonstrate that
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the insertion of a peptide linker significantly prolongs its plasma circulation time and ultimately
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enhances its tumor accumulation. This enables efficient single-dose photodynamic treatment,
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while inherent fluorescence and 64Cu-chelating porphyrin properties allows multimodal imaging
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(fluorescence/PET) of prostate cancer.
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Figure 1. Schematic structure of the theranostic probe LC-Pyro (long-circulating pyropheophorbide a), which is
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comprised of three building blocks: 1) A porphyrin photosensitizer capable of deep-red fluorescence imaging and
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64
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circulation to promote tumor accumulation; and 3) a high-affinity urea-based small-molecule PSMA targeting
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ligand.
Cu-chelated PET imaging; 2) a 9-amino acid d-peptide sequence that imparts water-solubility and prolongs plasma
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Bioconjugate Chemistry
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Results and Discussion
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LC-Pyro synthesis and characterization
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We developed a PSMA-targeted phototheranostic agent that consists of three functional building
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blocks: 1) a porphyrin capable of multimodal fluorescence/PET imaging and photodynamic
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activity, 2) a 9-amino acid d-peptide linker to impart water-solubility and improve the plasma
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circulation time and 3) a urea-based high-affinity PSMA as a targeting ligand (Figure 1). LC-
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Pyro (Long-circulating pyropheophorbide a) and SC-Pyro (Short-circulating pyropheophorbide
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a) were synthesized and confirmed by UPLC-MS analysis with identified ESI+ mass
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spectrometry and corresponding UV-vis absorption. (Figure 2A and Figure S1). LC-Pyro (m/z
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calculated [M]+ 1835.99, found [M]+ 1836.3, [M]2+ 918.0); SC-Pyro (m/z calculated [M]+
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1119.33, found [M]+ 1119.4, [M]2+ 559.6). DCIBzL was previously synthesized and was used as
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an inhibitor ligand in vitro and in vivo to confirm PSMA specificity.21 LC-Pyro absorbance
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(Figure 2B) and fluorescence (Figure 2C) were collected and its measured photodynamic activity
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revealed an increase in generation of ROS with an increase in laser light dose up to 5 J/cm2
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(Figure 2D). Next, for PET imaging and quantitative biodistribution studies, we chelated 64Cu to
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LC-Pyro and evaluated its radiochemical purity by radio-HPLC. The corresponding HPLC traces
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demonstrated peak alignment of porphyrin absorbance and 64Cu radioactivity, indicating
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effective 64Cu labeling of LC-Pyro with no remaining free 64Cu.
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Figure 2. Structures of PSMA conjugates, the photonic properties of LC-Pyro, and the radio-HPLC trace of 64Cu-
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LC-Pyro. (A) Structures of LC-Pyro (Long-circulating pyropheophorbide a), SC-Pyro (Short-circulating
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pyropheophorbide a) and DCIBzL. (B) LC-Pyro absorbance spectrum and (C) fluorescence emission spectrum. (D)
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Reactive oxygen species generation from LC-Pyro in solution with respect to 671-nm laser light dose (n = 3 from
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three independent measurements). (E) Evaluation of radiochemical purity of 64Cu-labeled LC-Pyro by radio-HPLC
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monitored by absorption at 410 nm (left, LC-Pyro signal) and by radioactive detector (64Cu signal). The only peak at
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retention time of 11 min showed both 410 nm and radioactive signal indicated high purity of 64Cu-labeled LC-Pyro.
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PSMA affinity ligand demonstrates high targeting specificity
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Targeted uptake of a photosensitizer by biomarker-overexpressing cancer cells can introduce an
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additional level of selectivity for PDT. Western blot in Figure 3A validated PSMA expression in
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the primary or metastatic lines (ML) modified to express high (PSMA+ PC3 PIP; PC3-ML-
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1124) or low (PSMA- PC3 flu; PC3-ML-1117) levels of PSMA. As cell-penetrating properties of
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porphyrins22 might contribute to LC-Pyro intracellular uptake in vitro beyond the PSMA-
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mediated pathway (Figure S2), we synthesized a FITC-labeled analog (LC-FITC) to investigate
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the targeting selectivity of the peptide-PSMA moiety. Fluorescence microscopy of LC-FITC in
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Figure 3B revealed selective membrane staining in PC3 prostate cells overexpressing PSMA
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(PSMA+ PC3 PIP), whereas negligible fluorescence was observed in cells with low PSMA
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expression (PSMA- PC3 flu) under equivalent incubation settings (3 µM, 3 h) and exposure time.
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LC-FITC also localized to one focus within the perinuclear region, which has been observed
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previously and described to represent the mitotic spindle poles or an endosomal compartment.23
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Addition of 100× excess DCIBzL to LC-FITC achieved successful PSMA binding inhibition,
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indicating target specificity of the conjugated small-molecule ligand. LC-FITC selectivity was
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confirmed by flow cytometry over a 22 h. Fluorescence intensity from LC-FITC uptake
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increased in a time-dependent manner in PSMA+ PC3 PIP cells with a 15-fold higher uptake
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than PSMA- PC3 flu cells (Figure 3C).
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Figure 3. PSMA targeting selectivity and specificity in vitro. (A) Western blot of PC3, PSMA- PC3 flu, PSMA+
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PC3 PIP, PC3-ML-1117 and PC3-ML-1124 cell lysates using anti-PSMA and β-actin antibodies. (B) Representative
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fluorescence micrographs of LC-FITC (3 µM, 3 h incubation) uptake in PSMA- PC3 flu and PSMA+ PC3 PIP cells
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in the presence of 100× excess DCIBzL for target blockade. (C) Representative flow cytometry histogram plots with
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time-dependent quantification of LC-FITC uptake in PSMA- PC3-flu (open black square) and PSMA+ PC3-PIP
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(solid green circle) cells. Scale = 25 µm. Each point represents the median ± SD of three independent
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measurements.
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Peptide linker prolongs plasma circulation time enhancing tumor accumulation of LC-Pyro
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To validate the pharmacokinetic role of the peptide linker in LC-Pyro and its ability to
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accumulate in PSMA+ tumors, we synthesized a truncated derivative, SC-Pyro, where the 9-
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amino acid peptide sequence was replaced by a single lysine residue. Results in Figure 4A
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demonstrated that LC-Pyro exhibited an 8.5-fold longer plasma circulation time (t1/2, slow = 10.00
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h; t1/2, fast = 0.50 h) than SC-Pyro (t1/2, slow = 1.17 h; t1/2, slow = 0.20 h). To ensure that the in vivo
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targeting results were not affected by any difference in binding affinity, the inhibitory activities
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of LC-Pyro, SC-Pyro and DCIBzL against PSMA were determined using a fluorescence-based
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assay. All three compounds demonstrated sub-nanomolar inhibitory capacity, despite
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conjugation of the porphyrin peptide linker to the PSMA inhibitor resulting in an order of
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magnitude lower PSMA inhibitory properties than DCIBzL (Figure 4B). the specificity of LC-
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Pyro to PSMA was confirmed in a subcutaneous PSMA+ PC3 PIP xenograft model by inhibition
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with excess DCIBzL. Excised PSMA+ PC3 PIP tumors revealed less accumulation of LC-Pyro
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when DCIBzL (PSMA blocker) was injected 30 min beforehand (Figure 4C). Additionally, the
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PSMA target specificity in vivo was validated with LC-Pyro absent the PSMA affinity ligand.
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Mice bearing dual subcutaneous PSMA- PC3 flu and PSMA+ PC3 PIP tumors were injected
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with LC-Pyro (-PSMA affinity ligand) followed by whole-animal in vivo fluorescence imaging
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(Figure S3). Negligible accumulation of probe within both the PSMA- and PSMA+ tumors was
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observed after 24 h. Next, to assess the influence of the plasma circulation time between LC-
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Pyro and SC-Pyro on tumor accumulation and biodistribution, equivalent doses of each agent
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were intravenously administered to mice bearing dual subcutaneous PSMA- PC3 flu and
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PSMA+ PC3 PIP tumors followed by whole-animal in vivo fluorescence imaging over 24 h.
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Figure 4D shows a strong diffuse fluorescence signal from LC-Pyro after 1 h with selective
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accumulation to the PSMA+ after 24 h. There is negligible accumulation within both the PSMA-
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and PSMA+ tumors 24 h post-administration of SC-Pyro (Figure 4E and Figure S4), indicating
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the importance of long plasma circulation time for successful tumor accumulation. Ex vivo organ
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distribution in Figure 4F reveals liver and kidney clearance of LC-Pyro, whereas a majority of
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SC-Pyro was metabolized and collected in the gallbladder (Figure 4G). That suggests that SC-
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Pyro cleared rapidly from the body, and therefore, a much higher dose or multiple doses would
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be required to achieve comparable tumor accumulation to LC-Pyro after 24 h. Ex vivo organ
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distribution of LC-FITC after 24 h shows similar organ distribution to LC-Pyro, confirming the
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role of peptide linker in the clearance pathway of the conjugates (Figure S5).
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Figure 4. The pharmacokinetic role of the peptide linker in LC-Pyro for its ability to accumulate in PSMA-
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expressing tumors. (A) Blood clearance curves of LC-Pyro and SC-Pyro (n = 5 each group) in BALB/c mice with
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blood samples collected over 48 h. The profiles fit into a two-compartment model with a half-life of 10.00 h for LC-
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Pyro and 1.17 h for SC-Pyro. (B) Table including the Ki inhibitory activities of SC-Pyro, LC-Pyro and DCIBzL
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against PSMA determined using a fluorescence-based assay. (C) PSMA inhibition in vivo with 150× molar excess
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of DCIBzL intravenously injected 30 min prior to LC-Pyro intravenous injection. Mice were sacrificed 24 h post-
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injection and tumors were excised for ex vivo fluorescence comparison. (D) Representative fluorescence images of
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mice bearing dual PSMA+ PC3 PIP (red arrow) and PSMA- PC3 flu (green arrow) tumors that were intravenously
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injected either with LC-Pyro or (E) SC-Pyro at 0.5, 1, 6 and 24 h post-injection. (F) Fluorescence ex vivo organ
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distribution of mice injected with LC-Pyro or (G) SC-Pyro including PSMA+ PC3 PIP tumor (insets). All images
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displayed are comparable with the same integration time.
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Multimodal imaging of PSMA+ prostate cancer
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After validating targeting of LC-Pyro in a subcutaneous PSMA+ PC3 PIP tumor model, we
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explored its theranostic application in two different mouse models bearing either a primary
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prostate tumor or metastatic prostate cancer. Due to the intrinsic metal-chelation properties of
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porphyrin ring structures, LC-Pyro was chelated to 64Cu, which allowed for in vivo PET imaging
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and biodistribution.24 As demonstrated in Figure 5A with PET/CT imaging, 64Cu -LC-Pyro
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delineated the orthotopic PSMA+ PC3 PIP tumor 17 h post-injection, whereas the PSMA- PC3
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flu tumor did not have significant uptake. Biodistribution revealed over 4-fold selective
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accumulation in PSMA+ PC3 PIP tumor [9.74 ± 2.26 percentage injected dose per gram of tissue
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(%ID/g)] vs. 2.30 ± 0.09 %ID/g in the PSMA- PC3 flu tumor, which showed no distinguishable
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signal from the surrounding healthy prostate tissue or pelvic organs (Figure 5B). 64Cu -LC-Pyro
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accumulated greatest in the liver, kidney and feces, indicative of hepatobiliary and renal
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clearance.
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To investigate further the potential of LC-Pyro to accumulate selectively in PSMA-expressing
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malignant tissues, we performed fluorescence imaging of micrometastasis. In situ fluorescence
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images of fluc+/PSMA+ (PC3-ML-1124) and fluc+/PSMA- (PC3-ML-1117) tumors
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demonstrated selective uptake of LC-Pyro in the PSMA+ tumor nodule (Figure 5C). Those
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observations aligned with the previous data obtained in subcutaneous xenografts. Following in
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situ fluorescence imaging, further verification of LC-Pyro accumulation in metastatic nodules
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and the surrounding tissues was examined by fluorescence microscopy of DAPI-stained tissue
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sections. Robust porphyrin fluorescence signal in the PSMA+ metastatic nodule microstructure
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was observed. Notably, the surrounding muscle tissue demonstrated fluorescence near to that of
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background, further supporting PSMA+ cell selectivity of LC-Pyro.
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Figure 5. 64Cu-LC-Pyro-enabled PET imaging in an orthotopic prostate cancer model and fluorescence detection of
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PSMA+ micrometastases with LC-Pyro. (A) Sagittal PET/CT images from one mouse bearing either a PSMA+ PC3
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PIP or PSMA- PC3 flu orthotopic prostate tumor at 3 h and 17 h after intravenous administration of 64Cu -LC-Pyro.
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(B) 64Cu-labeled LC-Pyro biodistribution in the tumors and the surrounding organs quantified via gamma counting
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(n = 4 for PSMA+ PC3 PIP; n = 3 for PSMA- PC3 flu, **P < 0.01; **P 1,000 mm3 or started ulcerating, as stated under the animal care institutional
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guidelines.
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Statistical analysis
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A two-tailed Student’s t test was used to determine statistical significance. P-values less than
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0.05 were considered significant.
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Acknowledgments
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The authors would like to acknowledge Lili Ding for performing Western blots and assisting
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with flow cytometry measurements; Dr. Il Minn for PSMA binding affinity Ki values
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measurement; Deborah Scollard, Teesha Komal and Dr. Nicholas Bernards for help with
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PET/CT image acquisition and reconstruction and Dr. Warren Folz for MR images (STTARR
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Innovation Centre); Dr. Raymond Reilly, Dr. Zhongli Cai and Dr. Conrad Chan for the
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assistance with radio-HPLC. This study was funded by the Terry Fox Research Institute
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(PPG#1075), the Canadian Institute of Health Research (Foundation Grant #154326), the
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Canadian Cancer Society Research Institute (704718), the Vanier Canada Graduate Scholarship,
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the Canada Foundation for Innovation, the Joey and Toby Tanenbaum/Brazilian Ball Chair in
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Prostate Cancer Research, Prostate Cancer Canada, Natural Sciences and Engineering Research
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Council of Canada, the Princess Margaret Cancer Foundation, and NIH grants CA134675,
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CA184228, CA202199 and EB024495.
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Abbreviations
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LC-Pyro, Long-circulating pyropheophorbide a; prostate-specific membrane antigen; PET,
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positron emission tomography; PDT, photodynamic therapy; kDa, kilodaltons; ROS, reactive
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oxygen species; SC-Pyro, short-circulating pyropheophorbide a; uPLC-MS, ultra-performance
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liquid chromatography mass spectrometry; ESI, electrospray ionization; HPLC, high-
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performance liquid chromatography; J/cm2, Joules per square centimeter; ML, metastatic line;
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PC3, prostate cancer cell line; LC-FITC, long-circulating fluorescein isothiocyanate; SD,
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standard deviation; t1/2, half-life; Ki, inhibitor constant; PET/CT, positron emission
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tomography/computed tomography; %ID/g, percent injected dose per gram; fluc, firefly
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luciferase ; DAPI, 4′,6-diamidino-2-phenylindole; H&E, Hematoxylin & Eosin; TUNEL,
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Terminal deoxynucleotidyl transferase dUTP nick end labeling; HBTU, (benzotriazol-1-yl)-
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N,N,N′,N′-tetramethyluronium hexafluorophosphate; Fmoc, Fluorenylmethyloxycarbonyl
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protecting group; NHS, N-hydroxysuccinamide; FBS, fetal bovine serum; EDTA,
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ethylenediaminetetraacetic acid; DMSO, dimethyl sulfoxide; FACS, Fluorescence-activated cell
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sorting; PBS, phosphate buffered saline; MRI, magnetic resonance imaging; OCT, optical cutting
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temperature; mg/kg, milligrams per kilogram; LP, longpass; rpm, revolutions per minute; mCi,
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millicuries; Cy5, cyanine 5.
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Associated Content
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The Supporting Information is attached.
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Flow cytometry, fluorescence mouse imaging and biodistribution, 64Cu-LC-Pyro PET/CT
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imaging and organ gamma counting, PDT histological organ toxicity, blood clearance of YC-9.
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Author Information
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Corresponding Author
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*E-mail:
[email protected] 492
Notes
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The authors declare no conflict of interest.
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Author Contributions
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Kara M. Harmatys and Marta Overchuk have contributed equally to the manuscript.
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