Ectopic prolactinoma in the clivus: a case report.

We report the case of an ectopic pituitary adenoma in a 65-year-old man with an empty sella who initially presented with right ptosis and eyelid edema and headache. Neuroimaging studies revealed a large tumoral process at the height of the clivus, with partial destruction of surrounding bone structure. He underwent transphenoidal surgery and histopathologic examination, including immunohistochemical studies, revealed a prolactin-producing pituitary adenoma. A careful review of the literature was done.

Imaging osteomyelitis with streptavidin and indium-111-labeled biotin.

UNLABELLED: Animal studies of infection imaging by a two-step protocol have shown that important improvements in target to nontarget ratios are possible. In this protocol, unlabeled streptavidin is administered and allowed sufficient time to accumulate in the lesion, probably by nonspecific processes, and to clear elsewhere. Thereafter, 111Inbiotin is administered. A fraction of the labeled biotin may be retained in the lesion because of biotin's high affinity for streptavidin while most of the activity is cleared through the kidneys. METHODS: Radioscintigraphy with unlabeled streptavidin followed with 111Inlabeled biotin was performed in 15 patients with chronic osteomyelitis. As controls, each patients received either 111In-labeled biotin without the preadministration of streptavidin or 111In-labeled nonspecific IgG. RESULTS: Regions of focal uptake were identified in all patients receiving streptavidin followed by radiolabeled biotin as early as 10 min postadministration of radioactivity, and retention of label was evident through 24 hr. Coincident regions of abnormal accumulation were apparent with 111In-IgG, but only in delayed images. Moreover, with 111In-biotin alone, without the preadministration of streptavidin, focal accumulations were detected in areas similar to that identified with the two-step protocol. Although, these observations were only in the earliest images. CONCLUSION: The results of this preliminary clinical investigation suggest that a two-step protocol with unlabeled streptavidin and radiolabeled biotin may be an alternative for the detection of infection.

Technetium-99m labeling of DNA oligonucleotides.

UNLABELLED: Single-stranded RNA and DNA oligonucleotides may be useful as radiopharmaceuticals for antisense and other in vivo applications if convenient methods for stably attaching radionuclides such as 99mTc can be developed. METHODS: To radiolabel DNA with 99mTc, we have used the hydrazino nicotinamide (SHNH) moiety developed elsewhere. The diethylenetriaminepentacetic acid (DTPA) chelate was used to label DNA with 111In for comparison. Complementary 22-base, single-stranded oligonucleotides were obtained, each with a primary amine attached to either 3' or 5' end with a biotin moiety on the opposite end. The DNA was conjugated with SHNH by a N-hydroxysuccinimide derivative with DTPA by the cyclic anhydride. RESULTS: Reversed-phase HPLC analysis showed that essentially complete conjugation was achieved in both cases. The purified SHNH-DNA was radiolabeled with 99mTc by transchelation from glucoheptonate at labeling efficiencies of up to 60% and DTPA-DNA with 111In acetate at up to 100% efficiency. After labeling, the ability of the DNAs to bind to streptavidin through the biotin moieties and to hybridize with their complementary DNA in saline was retained for both radiolabels as determined by size-exclusion HPLC analysis. HPLC radiochromatograms of serum incubates showed a shift to 99mTc, but not 111In, to a high molecular weight, strongly suggesting serum protein binding in the former case only. Low-molecular weight degradation products were seen with 111In, but not with 99mTc and may be related to the use of phosphodiester-linked oligonucleotides. As a further measure of label stability, the DNAS were bound to streptavidin-conjugated magnetic beads and incubated in fresh 37 degrees C human serum. Less than 4% of 99mTc and 14% of 111In was lost in 24 hr. CONCLUSION: Amino-modified, single-stranded DNA can be stably radiolabeled with 99mTc by the SHNH moiety without loss of function.

Recombinant metallothionein-conjugated streptavidin labeled with 188Re and 99mTc.

Consideration is now being given to the use of avidin (or streptavidin) and biotin for radiotherapy of tumor. Accordingly, the goal of this study was to radiolabel a mouse metallothionein-streptavidin fusion protein with 188Re and to compare its properties to those of the same fusion protein radiolabeled with 99mTc. A recombinant metallothionein-streptavidin fusion protein was radiolabeled by transchelation with 99mTc- and 188Re-glucoheptonate. Labeling efficiency, which was not optimized for either radionuclide, was approximately 60% for 99mTc and 20% for 188Re. Radiochemical purity was demonstrated by size exclusion HPLC both by nearly quantitative shifts of the 188Re label to higher molecular weight upon the addition of biotinylated antibody and by the absence of a shift with biotinsaturated 188Re-metallothionein-streptavidin. Stability of the labels in 37 degrees C serum was evaluated by comparing the HPLC radiochromatograms of serum samples both before and after the addition of biotinylated antibody. The 188Re label behaved like 99mTc in that the same peaks were evident, including one prominent peak due to labeled cysteine. Recoveries during HPLC analysis of serum samples showed that oxidation rates to perrhenate and pertechnetate were identical. However, instability to cysteine challenge was greater for 188Re; for example, the loss of label to cysteine after 24 h under one set of conditions was 41% for 188Re and 22% with 99mTc. Analysis by HPLC of liver and kidney homogenates from mice administered the labeled antibodies were qualitatively and, in large measure, quantitatively independent of label. Biodistributions at 5 h in normal mice were statistically identical between the two labels in blood and in most tissues. In conclusion, streptavidin may be radiolabeled with radiorhenium using recombinant mouse metallothionein as a bifunctional chelator, and under one set of labeling conditions at least, 188Re showed similar in vitro and in vivo behavior to that of 99mTc labeled to the same fusion protein.

Influence of endogenous biotin on the biodistribution of labelled biotin derivatives in mice.

Previously, this laboratory reported that in mice pre-targeted with unlabelled streptavidin, the biodistribution of 111In administered on one biotin derivative (EB1) was superior to that of another derivative (DB2). In addition, a Scatchard analysis showed that the affinity constant of 111In-EB1 is lower by seven orders of magnitude from that of 111In-DB2. Therefore, this paper considers the role that endogenous biotin may play in these observations. Both 111In-labelled EB1 and DB2 were bound to streptavidin and incubated at 37 degrees C in mouse blood with increasing concentrations of d-biotin. As determined by Sephadex G-50 chromatography, only an 8-fold molar excess of d-biotin relative to labelled streptavidin was required to displace 90% of label in the case of EB1, whereas even a 20-fold molar excess provided no detectable displacement of DB2. That this displacement was also occurring in vivo was established in a mouse model bearing an infected thigh: increasing the serum biotin level (by intraperitoneal administration of d-biotin) had no effect on the biodistribution of 111In when administered on DB2; however, the target to non-target ratio decreased in the case of EB1. We have also observed that the biodistribution is no longer favourable when EB1 is administered radiolabelled with 99Tcm. When 111In was substituted with 99Tcm on EB1, chromatography of blood samples showed that similar displacement was occurring; however, in this case, the displaced label bound to serum proteins.(ABSTRACT TRUNCATED AT 250 WORDS)

Can a cysteine challenge assay predict the in vivo behavior of 99mTc-labeled antibodies?

Recent investigations have shown that transchelation to cysteine in a principal mode of in vivo instability of 99mTc-labeled antibodies. In this investigation, a cysteine challenge assay was used to measure the in vitro instability of 99mTc directly labeled to two IgG antibodies (B72.3 and C110) via two established direct labeling methods employing mercaptoethanol and stannous ion for antibody reduction and by a novel method using glutathione for this purpose. For both antibodies, the greatest instability to cysteine occurred with stannous ion reduction. The stability of glutathione-reduced B72.3 was indistinguishable from mercaptoethanol-reduced B72.3 whereas glutathione-reduced C110 showed stability roughly intermediate between that of the other reducing agents for this antibody. Results obtained in normal mice were in the direction predicted by the assay: for both antibodies, urinary clearance of 99mTc was fastest in mice receiving antibodies labeled via stannous ion reduction, presumably because of the increased transchelation of label to cysteine in vivo. Urinary clearance was slower and identical in mice receiving B72.3 labeled via glutathione or mercaptoethanol whereas clearance in the case of glutathione-reduced C110 was intermediate between that of the other two reducing agents. At both time points, higher radioactivity levels were observed in kidneys and lower levels in blood and most other tissues for both antibodies in the case of stannous ion reduction as expected for the label of greatest instability. In the B72.3 case, with only one exception, tissue and blood levels following administration of glutathione-reduced antibody were indistinguishable from that following administration of mercaptoethanol-reduced antibody. In the C110 case, significant differences in activity levels were observed in several tissues between glutathione- and mercaptoethanol-reduced antibodies. In conclusion, the relative in vivo behaviour of 99mTc when administered to mice while labeled to two IgG antibodies were successfully predicted based on the results of an in vitro cysteine challenge assay.

Investigations of ascorbate for direct labeling of antibodies with technetium-99m.

UNLABELLED: Recently, a method for the direct labeling of antibodies with 99mTc was described in which sulfhydryls were reportedly generated by reduction of antibody disulfides with ascorbic acid. Thereafter, these proteins may be labeled at high efficiency with 99mTc following reduction of pertechnetate with dithionite. This investigation was initially conducted to evaluate the mechanism of the increased stability towards cysteine challenge reported for the label and subsequently to determine the role of ascorbate in the labeling process. METHODS: It was possible to reproduce the reported high labeling efficiencies by increasing the dithionite concentration fivefold, presumably because of variabilities among lots of commercial sodium dithionite. RESULTS: Despite success in labeling, it was not possible to confirm that antibody reduction followed the treatment with ascorbate. Using both Ellman's reagent and 2,2' dithiodipyridine as indicators, we were unable to detect sulfhydryls on one IgG antibody treated at ten times the suggested ascorbate-to-antibody molar ratio. It was estimated that the number of sulfhydryls generated could not have been more than 1% (dithiodipyridine) to 2% (Ellman's). Furthermore, radiolabeling efficiencies for two IgG antibodies and stabilities of the label to cysteine challenge were unchanged when the ascorbate was eliminated. The number of sulfhydryls generated by treatment of the antibody with dithionite at 1-2 times the concentration required for adequate labeling was about 1% (dithiodipyridine) to 5% (Ellman's). CONCLUSION: For the conditions of this investigation and for the antibodies employed, ascorbate apparently played no more than a minor role at best in the labeling process. If antibody reduction occurred, this most likely was a result of residual dithionite presented to the protein along with the reduced 99mTc.

Improved tumor localization with (strept)avidin and labeled biotin as a substitute for antibody.

Because of its short physical half life, the use of anti-tumor antibodies radiolabeled with 99mTc has necessitated early (i.e. 2-6 h post-administration) imaging. It is possible that at these early times localization of antibodies in certain tumors may be largely due to non-specific processes. If so, other proteins or agents may be preferred for early imaging of solid tumors. We have investigated tumor localization with labeled biotin administered subsequent to unlabeled and unconjugated streptavidin. Nude mice bearing anti-CEA tumors (LS174T) received 10 micrograms of 111In-labeled anti-CEA antibody (C110) or 111In-labeled streptavidin with sacrifice 5 h later. In an examination of pretargeting, other animals received 50 micrograms of unlabeled streptavidin followed 3 h later with 1 micrograms of 111In-labeled biotin (EB1) and sacrifice 2 h later. The biodistribution of labeled streptavidin was similar to that of labeled specific antibody except for lower blood and higher kidney levels. Tumor levels were also lower with labeled streptavidin but, because of still lower levels in liver and blood, the tumor/normal tissue ratios were improved. When unlabeled streptavidin was administered and followed by labeled biotin (pretargeting), tumor levels were further reduced modestly; however, normal tissue levels were greatly reduced such that the tumor/blood and tumor/liver ratios were 10.6 and 2.2 vs 1.5 and 0.5 for the specific antibody. Improvements were seen in all tissues sampled with the exception of kidney and muscle. A further control of labeled biotin alone (without the preinjection of streptavidin) showed minimal accumulations in all tissues with the exception of kidneys.(ABSTRACT TRUNCATED AT 250 WORDS)

Directly and indirectly technetium-99m-labeled antibodies--a comparison of in vitro and animal in vivo properties.

To investigate the in vivo and in vitro properties of 99mTc when labeled to antibodies via one direct and one indirect method, the B72.3 and C110 IgG antibodies were radiolabeled directly via stannous ion reduction and indirectly via the hydrazino nicotinamide chelator and compared in vitro and in vivo. Antibody avidity (but not immunoreactive fraction) appeared to be independent of labeling methods for both antibodies. Following stannous ion reduction, antibodies were fragmented by denaturing SDS PAGE although only slight evidence of fragmentation was found in vivo. The direct label was instable to transchelation to cysteine and glutathione in vitro and in vivo. Following intravenous administration, urinary excretion of activity was threefold greater for the direct label and was almost exclusively labeled cysteine and glutathione. Significant differences in the biodistribution of 99mTc were also observed: liver levels were lower, kidney levels were higher and clearance of label from blood and tissues was faster for the direct label. At Day 1, tumor accumulation was threefold lower for the direct label although most normal tissues were also lower. In conclusion, when labeled to two antibodies by one direct method, 99mTc is unstable towards transchelation relative to one indirect method. These relative instabilities greatly influenced the biodistributions in mice and may influence the quality of images obtained in patients.

Investigations of N-linked macrocycles for 111In and 90Y labeling of proteins.

To simplify the synthesis of macrocyclic chelators, commercially available macrocyclic amines were condensed with halogenated acetic acid to prepare the five chelators 12N4 (DOTA), 14N4 (TETA), 15N4, 9N3 and 12N3. Only 12N4 and 9N3 showed efficient labeling of the free chelator with 111In and 90Y. Serum stability studies at 37 degrees C with In-labeled DTPA, 12N4 and 9N3 showed no loss of label over 2 days whereas, with 90Y, only 12N4 showed stabilities comparable to DTPA. The 12N4 chelator was derivatized by attaching biotin on one N-acetate group to stimulate the attachment to protein. The serum stability for both 111In and 90Y was identical to that of biotin derivatized DTPA and lower than that of the free chelators. Biodistribution studies in normal mice of a model protein (avidin) labeled with 90Y via biotinylated 12N4 and biotinylated DTPA showed identical distribution at 1 day except in bone where the %ID/g for the macrocyclic-conjugated protein (3.4 +/- 0.5, N = 8) was significantly (P less than 0.001) lower than that of the DTPA-conjugated protein (9.4 +/- 0.9, N = 7). In conclusion, macrocycles may be readily synthesized from the macrocyclic amines and several show useful stabilities with In and Y. When N-linked to a protein, the Y biodistribution was found to be superior to that of the corresponding DTPA-coupled protein.

New indium-111 labeled biotin derivatives for improved immunotargeting.

Investigations into the use of streptavidin-conjugated antibodies and labeled biotin to improve radioimmunotargeting have shown background levels drastically reduced over the conventional approach. Nevertheless, accumulation of 111In-biotin in normal tissue as well as streptavidin-independent accumulation in tumor, was observed. In this work, the effect of altering the biotin molecule to reduce this nonspecific uptake without decreasing specific localization has been investigated. Three EDTA and DTPA derivatives of biotin have been synthesized and investigated along with a commercial biotin derivative (DTPA-B2). The labeled biotin chelates were administered i.p. to normal mice implanted with avidin beads in one thigh. A wide variation in biodistribution was seen among the biotin derivatives. The most favorable results were obtained with biotinyl-hydrazino-EDTA (EDTA-B1), which showed the lowest accumulation in normal tissues but equivalent uptake in the target with respect to the other compounds. Averaged over 8 tissues sampled, the target-to-nontarget ratio was 140 vs 9 for EDTA-B1 vs DTPA-B2 (N = 6) at 24 h post administration. Similar observations have been made in culture with two tumor cell lines: positive accumulation of both DTPA-B2 and EDTA-B1 was measured in tumor cells independent of streptavidin-antibody conjugate, however in the case of the latter derivative, this accumulation was 3-5 fold lower. These studies show that modification of the biotin species can alter accumulation in normal tissues as well as the antibody-streptavidin independent accumulation in tumor tissue.

Investigations of avidin and biotin for imaging applications.

The attractive properties of avidin (streptavidin) and biotin, in particular their strong affinities (Kd = 10(-15)M), may be used to advantage in imaging applications. These molecules have been used in this preliminary investigation to improve the targeting of 111In in animals. Antibodies have been conjugated with biotin and administered unlabeled while, at a later time, the radiolabel was administered attached to DTPA-coupled avidin or streptavidin. An alternative procedure was also considered whereby the antibodies were conjugated with avidin and administered before the administration of radiolabeled biotin. Using a model in which the target consisted of conjugated agarose beads deposited in the peritoneum of mice, it has been shown that the target/nontarget radioactivity ratios may be significantly improved with respect to the conventional procedures through the use of this approach.

The use of diaminodithiol for labeling small molecules with technetium-99m.

To investigate the labeling of small molecules with 99mTc by the bifunctional chelate approach, we have synthesized both a fatty acid and an estrone derivative containing a chelator of the N2S2 type. In the case of the fatty acid, this was a diaminodithiol (DADT) while for the estrone, a diaminodisulfide (DADS) was attached. The estrone derivative (5-(2-methylene estrone 3-methyl ether)-3,3,10,10-tetramethyl-1,2-dithia-5,8-diazacyclodecane hydrochloride, DADS-E) was prepared by alkylation of DADS while the fatty acid derivative (N-(11-undecanoic acid)-N,N'-bis(2-methyl-2-mercaptopropyl) ethylenediamine hydrochloride, DADT-FA) was synthesized by alkylation of DADS followed by reduction. DADS-E was labeled in ethanol at elevated temperatures while DADT-FA was labeled at room temperature, both by stannous reduction. Paper chromatography showed both to be labeled and reverse-phase HPLC showed multiple peaks for both. Serum stability studies were performed by incubation at 37 degrees C with aliquots removed at 1 min and 1 day for analysis by size-exclusion HPLC. Initially, little pertechnetate or binding to serum proteins was observed whereas after 1 day the majority of activity in both cases was protein bound with 20 and 38% pertechnetate appearing for DADT-FA and DADS-E respectively. In conclusion, small biologically active molecules may be labeled with 99mTc through an attached diaminodithiol or diaminodisulfide group.

Serum stability and non-specific binding of technetium-99m labeled diaminodithiol for protein labeling.

Previously we investigated the use of DTPA-coupled proteins to simplify labeling with 99mTc but especially to improve the stability of the label. These investigations have now been extended to include several N2S2 ligands such as N,N'-bis(2-methyl-2-mercaptopropyl)ethylenediamine (DADT) and a novel ligand of similar structure with a propylene bridge between two amines, 2-hydroxy-N,N'-bis(2-methyl-2-mercaptopropyl)propylenediamine++ + (DADT-3C-2OH). The condition of labeling of free ligand (pH, buffer and tin concentration) was optimized to provide 100% chelation with 99mTc at reasonable ligand concentrations (100 micrograms/mL or less). Labeling was determined by paper chromatography, reverse-phase and size-exclusion HPLC. After incubation in fresh serum, 37 degrees C for 24 h, repeat analysis showed less than 5% dissociation of the chelate. By contrast, the DTPA chelate shows instability towards oxidation during this period. DADT derivatized on an ethylene carbon showed almost identical serum stability as DADT itself whereas when derivatized on a nitrogen greater instabilities were apparent. Using identical labeling conditions, free DADT was chelated in the presence of IgG at different ligand: protein molar ratios. Non-specific binding of 99mTc to IgG at a 10:1 DADT-HM:IgG molar ratio was as little as 5% and was essentially zero at a 2:1 DADT:IgG molar ratio when labeling was by transcomplexation from 99mTc-EDTA. The DADT-3C-2OH ligand showed superior performance both in regard to serum stability and the absence of non-specific binding. In conclusion, the N2S2 ligands form more stable chelates with 99mTc than does DTPA with reduced non-specific binding and may therefore represent an attractive alternative for labeling proteins with 99mTc by the bifunctional chelate approach.

Characterization of indium-111 labeled recombinant tissue plasminogen activator for the imaging of thrombi.

The in vitro functional properties of recombinant tissue plasminogen activator (rt-PA), its biodistribution in mice, and its pharmacokinetics and clot localization properties in dogs have been investigated after labeling rt-PA with 111In. The rt-PA was coupled with the bicyclic anhydride of DTPA using standard methodology. Amidolytic and fibrinolytic assays showed retention of protein activity when rt-PA was conjugated with an average of one DTPA group or less per molecule. Size exclusion HPLC showed each preparation to be radiochemically pure with 111In bound exclusively to the attached DTPA groups. Biodistribution in mice showed major accumulation of activity in the liver and kidneys. After administration of 0.5-1.0 mg of the labeled protein to dogs, blood activity decreased with a half time of approximately 5 min in agreement with previous reports of rapid blood clearance. Largely because of decreased blood levels, clot: blood ratios of labeled protein increased rapidly, in one study reaching 6.3 after 31 min, and satisfactory images of fibrin thrombi were obtained. The rt-PA may be labeled with 111In without destroying the ability of the protein to localize in clot and images of forming clot can be obtained with this agent within 1 h after administration.

DTPA-coupled antibodies labeled with yttrium-90.

Yttrium-90 has been described as one of the best radionuclides for tumor therapy when chelated to tumor-associated antibodies. This evaluation is based on the superior properties of this radionuclide (suitable half-life, pure beta-ray emitter of intermediate energy, stable daughter, and suitable chemical properties) and because it is available as a radionuclide generator product by decay of its 28-yr parent 90Sr. We have determined that 90Y obtained from one such generator is suitable for labeling antibodies coupled with DTPA. Furthermore, we have shown that the dissociation rate of [90Y]DTPA-IgG in serum at 37 degrees C is similar to that of [111In]DTPA-IgG at about 8-9%/day. Biodistribution studies of 111In- and 90Y-labeled to DTPA-coupled IgG show that the labels distribute nearly identically at 1 hr postadministration, although differences in distribution are apparent at 24 hr. It is possible that these differences reflect the redistribution of the labels following catabolism at the site of localization.

A simple in vitro method of screening panels of monoclonal antibodies for tumor binding.

We have developed a simple in vitro method of evaluating the relative binding properties of anti-tumor antibodies to human tumor and normal tissues. Cryopreserved surgical explants of tissues as 1 mm cubes are incubated in microtiter plate wells containing media and radiolabeled antibody. We show that the accumulation of antibody in tumor tissue is a specific process which may be reduced by preincubation with saturating levels of unlabeled specific antibody. Evaluation of 7 anti-breast and 4 anti-colorectal tumor antibodies against their respective tumor tissues showed good reproducibility of repeat measurements and up to a 100-fold difference in accumulation among different antibodies to the same tissue. Equivalent results were obtained with the same tissues employed fresh and after cryopreservation. Because of the simplicity of the assay, panels of antibodies may be screened against the large numbers of tumor and normal tissues required to identify superior antibodies for human trials.