Wang_2021_Eur.J.Nucl.Med.Mol.Imaging_48_4259

PURPOSE: In this study, a novel aluminium-[(18)F]fluoride (Al(18)F)-labelled 1,4,7-triazacyclononane-N,N',N''-triacetic acid (NOTA)-conjugated fibroblast activation protein inhibitor (FAPI) probe, named Al(18)F-NOTA-FAPI, was developed for fibroblast activation protein (FAP)-targeted tumour imaging; it could deliver hundreds of millicuries of radioactivity using automated synthesis. The tumour detection efficacy of Al(18)F-NOTA-FAPI was further validated in both preclinical and clinical translational studies. METHODS: The radiolabelling procedure of Al(18)F-NOTA-FAPI was optimized. Cell uptake and competitive binding assays were completed with the U87MG and A549 cell lines to evaluate the affinity and specificity of the Al(18)F-NOTA-FAPI probe. The biodistribution, pharmacokinetics, radiation dosimetry and tumour imaging efficacy of the Al(18)F-NOTA-FAPI probe were researched in healthy Kunming (KM) and/or U87MG model mice. After the approval of the ethical committee, the Al(18)F-NOTA-FAPI probe was translated into the clinic for PET/CT imaging of the first 10 cancer patients. RESULTS: The radiolabelling yield of Al(18)F-NOTA-FAPI was 33.8 +/- 3.2% using manual synthesis (n = 10), with a radiochemical purity over 99% and the specific activity of 9.3-55.5 MBq/nmol. The whole body effective dose of Al(18)F-NOTA-FAPI was estimated to be 1.24E - 02 mSv/MBq, which was lower than several other FAPI probes ((68)Ga-FAPI-04, (68)Ga-FAPI-46 and (68)Ga-FAPI-74). In U87MG tumour-bearing mice, Al(18)F-NOTA-FAPI showed good tumour detection efficacy based on the results of micro PET/CT imaging and biodistribution studies. In an organ biodistribution study of patients, Al(18)F-NOTA-FAPI showed a lower SUVmean than 2-[(18)F]-fluoro-2-deoxy-D-glucose (2-[(18)F]FDG) in most organs, especially in the liver (1.1 +/- 0.2 vs. 2.0 +/- 0.9), brain (0.1 +/- 0.0 vs. 5.9 +/- 1.3), and bone marrow (0.9 +/- 0.1 vs. 1.7 +/- 0.4). Meanwhile, Al(18)F-NOTA-FAPI did not show extensive bone uptake, and was able to detect more lesions than 2-[(18)F]FDG in the PET/CT imaging of several patients. CONCLUSION: The Al(18)F-NOTA-FAPI probe was successfully fabricated and applied in fibroblast activation protein-targeted tumour PET/CT imaging, which showed excellent imaging quality and tumour detection efficacy in U87MG tumour-bearing mice as well as in cancer patients. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000038080. Registered 09 September 2020. http://www.chictr.org.cn/showproj.aspx?proj=61192.