Delineation of the border zone of ischemic rabbit myocardium by a technetium-labeled nitroimidazole.

Delineation of viable ischemic myocardium is an important problem in nuclear cardiology. To determine the feasibility of using a technetium-labeled nitroimidazole as an indicator of ischemic myocardium at risk of infarction, we characterized the distribution of a 2-nitroimidazole-derivatized PnAO ligand and its 99mTc complex, 99mTcO(PnAO)-1-CH2-(2NI) (BMS-181321) in the ischemic territory of the left anterior descending (LAD) coronary artery of the rabbit. In preliminary experiments, the performance of 14C-deoxyglucose (14C-2DG) and 14C-misonidazole was assessed relative to apparent regional relative myocardial blood flow (rMBF) indicated by 99mTc-teboroxime using double-label autoradiography in the rabbit LAD occlusion model. After demonstrating that 14C-2DG and 14C-misonidazole are selectively retained in the lateral border of the ischemic territory, BMS-181321 was co-injected intravenously, with either 14C-2DG or 14C-misonidazole, 20 min after LAD occlusion. In a separate experiment, 99mTcO(PnAO)-6-CH3, a complex with the same lipophilicity (log k' 0.26 vs. 0.31) as BMS-181321 but which lacks the 2NI moiety, was co-injected with 14C-2DG. After 30 min, the rabbits were sacrificed and 14C/99mTc autoradiograms were obtained from the same tissue sections. The autoradiograms revealed that BMS-181321 was retained with the same microregional distribution as both 14C-2DG and 14C-misonidazole in the border zone of the ischemic LAD territory. The selective retention of BMS-181321 depends on the presence of the nitroimidazole group, since 99mTcO(PnAO)-6-CH3 has a uniformly low myocardial distribution in contrast to the enhanced uptake of co-injected 14C-2DG. These data demonstrate that BMS-181321 is selectively retained in hypoxic myocardium and demarcates the ischemic border zone in a manner similar to 14C-2DG and 14C-misonidazole.

SPECT imaging of ischemic myocardium using a technetium-99m-nitroimidazole ligand.

UNLABELLED: This investigation evaluates the efficacy of a 99mTc-labeled nitroimidazole (BMS-181321) in identifying oxygen-deprived tissue in two canine models of myocardial ischemia. METHODS: For both models (A and B), epicardial microvascular oxygen pressure (mPO2) was monitored by measuring the oxygen-dependent quenching of phosphorescence lifetime of Palladium mesotetra (4-carboxyphenyl) porphine. In Model A (beagles, n = 5), BMS-181321 was administered intravenously and a distal branch of the left anterior descending coronary artery (LAD) was ligated completely 40 sec later. Ten minutes later, the ligature was released establishing tissue reoxygenation. In Model B, flow through the LAD was reduced until the mPO2 was about 2 Torr. After bolus administration of BMS-181321 (50-60 mCi), coronary ischemia was continued for a residence period of up to 4 hr. RESULTS: With Model A, SPECT reconstructions revealed a small ischemic area in three of five dogs, however, a transmural accumulation of the compound was evident in the autoradiograms from all dogs. In the two animals in which the defect was not observed by SPECT, the ischemic episode had nominal effects on the ratio of +/- dp/dt (< 4% change as compared to baseline values). In Model B, SPECT reconstructions showed positive images of the oxygen-deprived area within the mid- to apical regions of the left ventricle (n = 5). Autoradiographic analysis showed a transmural association with cells resulting in an ischemic-to-nonischemic ratio of 3.5 +/- 0.4 (n = 4) for animals with similar residence times. CONCLUSION: The results from both models suggest that BMS-181321 provides a noninvasive marker of regional ischemia in the heart and that this compound may have clinical utility for detection of coronary artery disease.

BATO complexes derived from dimethoxy dioximes: synthesis, characterization and biodistribution.

To prepare less lipophilic BATO complexes, two new methoxy-substituted dioximes were synthesized: cis-4,5-dimethoxycyclohexane-1,2-dione dioxime (DMCDO) and 1,4-dimethoxybutane-2,3-dione dioxime (DMDMG). 99mTcCl(DMCDO)3BMe (BMe = methylboronic acid) was prepared and characterized. Reversed-phase HPLC analyses of 99mTcCl(DMCDO)3BMe and 99mTcCl(DMCDO)3-p-TBA (p-TBA = p - tolylboronic acid) indicated that both of these complexes were mixtures of four enantiomeric pairs of diastereomers. Attempted preparation of a BATO complex from DMDMG gave a mixture of products. In rats, 99mTcCl(DMCDO)3BMe displayed more rapid liver and renal clearance than 99mTcCl(CDO)3BMe, but 99mTcCl(DMCDO)3BMe and 99mTcCl(DMCDO)3-p-TBA displayed low uptake in both heart and brain.

Relationship between in vitro transendothelial permeability and in vivo single-pass brain extraction.

UNLABELLED: In vitro transendothelial permeability was compared to in vivo rat single-pass cerebral extractions to evaluate which method would best estimate the blood-brain barrier (BBB) permeability of several SPECT imaging agents. METHOD: Six 99mTc complexes and seven non-Tc complexes were tested in vitro using monolayers of primary bovine brain microvessel endothelial cells and in vivo using the rat single-pass cerebral extraction model. In vitro transendothelial permeability indices (PI) were determined by measuring the average percent of radioactivity traversing the monolayers as a function of time. In vivo single-pass cerebral extractions were determined using an indicator fractionation method. RESULTS: A positive correlation between extraction and PI was found for the non-Tc complexes (r2 = 0.96). The CBF imaging agents 99mTc-ECD and 99mTc-PnAO have high values for E and PI, demonstrating that these agents penetrate the BBB and have a high membrane permeability, while the heart imaging agent 99mTc-sestamibi had low values for both E and PI. The low PI and E values for 99mTc-sestamibi are consistent with a low brain uptake for this agent, except in cases of disruption of the BBB. In contrast to 99mTc-ECD, 99mTc-PnAO and 99mTc-sestamibi, which had concordant values for E and PI, two highly lipophilic boronic acid adducts of technetium dioxime (BATOs), 99mTc-teboroxime and 99mTcCl(DMG)3(2)MP, had low negative values for PI, but high values for E. In addition, after 3 hr of incubation, the monolayer-to-medium concentration ratio of the BATOs was 642:1 and 744:1, respectively. This compares with values of 89:1 (99mTc-PnAO), 25:1 (99mTc-ECD) and 34:1 (99mTc-sestamibi). CONCLUSION: These data suggest that the high in vivo single-pass extraction of the BATOs may be explained by a hydrophobic interaction with the luminal surface of the capillary endothelial cell plasma membrane. We conclude that a high single-pass extraction cannot necessarily be used to infer high BBB or membrane permeability.

Imaging ischemic tissue at risk of infarction during stroke.

Autoradiograms obtained after middle cerebral artery occlusion (MCAO) in spontaneously hypertensive rats show that the 99mTc complex of a 2-nitroimidazole-derivatized propylene amine oxime (BMS-181321) is selectively retained in acutely ischemic brain before disruption of the blood-brain barrier (BBB), but not in the ischemic infarct. BMS-181321 is therefore a marker of ischemic tissue at risk of infarction and its uptake, unlike that of x-ray and magnetic resonance contrast agents, does not require disruption of the BBB. In keeping with this conclusion, we have found that the single-pass cerebral extraction fraction of BMS-181321 is 0.67 at normal rat whole-brain blood flow. Sequential single-photon emission computed tomographic images obtained from cats after MCAO show that the initial distribution of BMS-181321 approximates regional CBF and that selective retention subsequently produces a positive image within the ischemic territory. BMS-181321 is the first Tc complex able to indicate not only ischemia, but also ischemic tissue at risk of infarction. Use of this novel Tc complex to monitor biochemical events during ischemia may contribute to the clinical management of acute stroke.

A novel [99m]technetium-labeled nitroheterocycle capable of identification of hypoxia in heart.

A novel [99m]technetium-labeled nitroimidazole was preferentially taken up and retained by hypoxic cardiac muscle. In rat hearts perfused with O2 or N2 equilibrated cell-free medium, uptake of the infused nitroheterocycle and its subsequent washout displayed biphasic kinetics. For both uptake and washout, the early phase was very rapid whereas the late phase was much slower. The amount of radioactivity retained after 40 min of clearance was about two-fold greater in hypoxic hearts than in normoxic hearts. Cardiac myocytes and mitochondria isolated from rat heart also accumulated the nitroheterocycle. Association of the compound with heart cells was inversely related to the level of available oxygen and was independent of intracellular energy level or mitochondrial redox state in the presence of oxygen. The results indicate that this [99mTc]labeled nitroimidazole may serve as a sensitive marker of hypoxic myocardium.

[99mTc] Teboroxime and [99mTc]Cl(DMG)3B2MP: binding characteristics andmetabolism of two [99mTc]BATOs in blood and tissues.

Studies were performed in vitro and in vivo to evaluate the binding properties and metabolism of [99mTc]Cl(CDO)3BMe (Teboroxime) and [99mTc]Cl(DMG)3B2MP in blood and target tissues of rats. Both radiopharmaceuticals displayed rapid binding (within 1-3 min) with high affinity to plasma proteins and blood cells. The amounts of radioactivity associated with blood components became progressively greater with time of exposure to either compound. There was a higher proportion of the radiopharmaceuticals associated with blood components during in vivo conditions, likely due, at least in part, to clearance of the free fraction from the plasma pool. Exposure of both compounds to blood results in axial ligand exchange of the chloro atom to a hydroxyl. The results suggest that it is the free species that is extracted primarily by tissues.

The single-pass cerebral extraction and capillary permeability-surface area product of several putative cerebral blood flow imaging agents.

We have determined cerebral blood flow (CBF) and the single-pass cerebral extraction (E) of several putative agents for external imaging of CBF. Simultaneous measurements of blood flow and extraction were performed in 106 rats. For all agents, comparison of linear and exponential regressions of E on CBF indicates that this relationship can be described as linear over the range of flows studied. Analysis of covariance indicates that the extraction of 123I-IMP, 67Cu-PTSM and 99mTc-HMPAO is higher than that of 99mTc-Cl(DMG)3(2MP) and 99mTc-ECD, particularly at flows above the normal range. Accordingly, for 123I-IMP, 67Cu-PTSM and 99mTc-HMPAO, the slope of the linear regression equation for the relationship between brain capillary permeability surface area product (PS) and CBF is higher than that for 99mTc-Cl(DMG)(3)2MP and 99mTc-ECD. PS varies as a linear function of CBF over the range of flows studied. At a CBF level that corresponds to normal regional CBF for human cortex, 0.5 ml/g/min, all the agents have a single-pass extraction of approximately 70% or greater. While all the agents detected changes in CBF in the normal to ischemic range, at higher flows 123I-IMP, 67Cu-PTSM and 99mTc-HMPAO showed substantially greater fidelity to true CBF than 99mTc-Cl(DMG)(3)2MP and 99mTc-ECD.

Measurement of myocardial blood flow using a co-injection technique for technetium-99m-teboroxime, technetium-96-sestamibi and thallium-201.

We have compared apparent myocardial blood flow (MBFapparent) indicated by 99mTc-teboroxime, 96Tc-sestamibi and 201TI to true MBF indicated by radiolabeled microscopheres using a technique for the co-injection of four radionuclides in the same animal. Studies were performed using rats in a single-pass model to obtain global MBF and using dogs in a multiple-pass model to determine regional MBF. To provide a wide range of MBF, adenosine was administered intravenously and the left anterior descending coronary artery was then ligated in the dogs, or hypercapnia was induced by decreasing respiratory frequency in the rats. The microsphere formula for determining MBF was applied to all agents. When MBFapparent was plotted as a function of true MBF, the ability of each agent to measure changes in true MBF was demonstrated by the proximity of the plotted function to the line of identity. For both the single and multiple-pass studies, statistical analysis of the nonlinear relationship between MBFapparent and true MBF showed that 201TI and 99mTc-teboroxime approximate true MBF better than 96Tc-sestamibi (p less than 0.001) under the conditions used in the present studies. In the single-pass studies, 99mTc-teboroxime approximated true MBF better than 201Tl (p less than 0.05), but in the multiple-pass experiments, 201Tl approximated true MBF better than 99mTc-teboroxime in only one dog (p less than 0.01) with no difference in the other two. Determination of the permeability-surface area product, PS, for each agent shows that the higher fidelity to true MBF obtained with 201Tl and 99mTc-teboroxime is related to substantially greater PS values for these agents relative to 96Tc-sestamibi.

Absorbed radiation dose to humans from technetium-99m-teboroxime.

Tissue distribution data obtained in nine normal volunteers were used to estimate the radiation dose to humans after intravenous administration of 99mTc-teboroxime (Cardiotec). Organ uptake as percent of injected dose was measured using quantitative SPECT. Non-linear regression analysis was performed on the organ time-activity data using SYSTAT software. Cumulative activities in these organs were determined by calculating the area under the respective curves after accounting for the physical decay of the radionuclide. The absorbed dose to individual organs was estimated using the MIRDOSE 2 program. The gallbladder and the upper large intestine (ULI) are the target organs and will receive respectively 26.5 and 33.2 muGy/MBq (98 and 123 mrad/mCi) 99mTc-teboroxime under the assumption that the gallbladder empties every 6 hr. The dose to the gallbladder decreases at shorter emptying intervals; with intervals of 3, 4, and 5 hr, the respective doses to the gallbladder are 18.2, 21.0 and 23.7 muGy/MBq (67.4, 77.8, and 87.9 mrad/mCi) 99mTc-teboroxime. However, the dose to ULI remains almost constant at 123 mrad/mCi and will be the limiting factor.

Technetium labeling of monoclonal antibodies with functionalized BATOs: 2. TcCl(DMG)3CPITC labeling of B72.3 and NP-4 whole antibodies and NP-4 F(ab')2.

BATO (boronic acid adduct of technetium dioximes) complexes, TcCl(dioxime)3BR, were prepared in which the boron substituent (R) was the protein-reactive 2-carboxy-4-phenyl isothiocyanate (CPITC). The 99Tc complexes, where the dioxime was either dimethylglyoxime (DMG) or cyclohexanedione dioxime (CDO), were prepared and characterized. The 99mTc complex TcCl(DMG)3CPITC was prepared from a freeze-dried kit and used to label B72.3 (anti-TAG.72) and NP-4 (anti-CEA) whole antibodies, and the NP-4 F(ab')2 fragment. SDS-PAGE electrophoresis indicated that the labeling reagent was strongly bound to antibody. The labeled antibodies displayed high binding to affinity columns and good tumor uptake in GW39 tumor-bearing mice.

Chloro----hydroxy substitution on technetium BATO [TcCl(dioxime)3 BR] complexes.

The neutral, seven coordinate complexes of technetium known as the BATO (Boronic acid Adducts of Technetium diOximes) complexes have shown their utility as myocardial and cerebral perfusion agents. The axial chloride ligand of the BATO complexes [99mTcCl(dioxime)3 BR] is labile to substitution by a competitive anion; under physiological conditions, the axial chloride ligand can be replaced by a hydroxy group. The chloro and hydroxy analogs have different biodistributions and single-pass cerebral extraction efficiencies. The influence of structure on the rate of the in vitro chloro/hydroxy exchange process has been studied. The mechanism of axial ligand exchange was found to be SN1-CB, which proceeds by way of a transient, neutral six coordinate complex. Evidence is presented which indicates that chloro/hydroxy exchange is not the mechanism by which BATO complexes are retained in the brain.

A neutral lipophilic technetium-99m complex for regional cerebral blood flow imaging.

Technetium-99m-DMG-2MP (Chloro[bis[2,3-butanedionedioxime(1-)-0][2,3- butanedionedioximato (2-)-N,N',N'',N''',N'''',N'''''] (2-methylpropyl borato (2-))technetium]), also known as SQ 32097 is a member of a family of neutral lipophilic compounds generally known as boronic acid adducts of technetium dioxime complexes (BATOs). After i.v. administration, the concentration of [99mTc]DMG-2MP in various regions of the brain appears to be proportional to blood flow. In rats, 1.1% ID was in the brain at 5 min postinjection when the blood contained less than 3% ID. Over 24 hr excretion was 59% in the feces and 23% in the urine. The activity in monkey brain at 5 min was 2.8% ID and it cleared with a t1/2 of 86 min. Autoradiographs of monkey brain sections showed excellent regional detail with a gray/white ratio of 3.6 at 10 min. The distribution of [99mTc]DMG-2MP in the monkey brain corresponds to the known cytoarchitectural pattern of cerebral glucose metabolism. The properties of [99mTc]DMG-2MP make it a potentially useful agent for cerebral perfusion imaging in man.

A neutral technetium-99m complex for myocardial imaging.

Technetium-99m-CDO-MeB [Bis[1,2-cyclohexanedione-dioximato(1-)- O]-[1,2-cyclohexanedione dioximato(2-)-O]methyl-borato(2-)- N,N',N'',N''',N'''',N''''')-chlorotechnetium) belongs to a family of compounds generally known as boronic acid adducts of technetium dioxime complexes (BATOs). It has an intrinsic affinity for the myocardium, with negligible lung activity and rapid blood clearance. The uptake of 3.44% ID in rat heart at 1 min postinjection for [99mTc]CDO-MeB versus 3.03% for 201TI indicates high extraction of [99mTc]CDO-MeB by the myocardium. In dogs an ischemic defect is clearly seen in SPECT images obtained 10 min after injection of [99mTc]CDO-MeB. Tissue distribution data in rats show that [99mTc]CDO-MeB is excreted primarily in the feces and to a lesser extent in the urine. Approximately 80% of the activity is excreted within 24 hr after injection.