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☆
HN
O
Tc-Demotensin6
NH-bAla-Arg-Dab-Pro-Tyr-Tle-Leu
OC
OC
99m
[
Figure 12.14 Structures of
O
N
HN
Tc
CO
Tc][Tc(CO)3(NT-XI)],
NH-Lys-(yCH2NH)-Arg-Pro-Tyr-Tle-Leu
O
O
+
O
HN
NH
Tc
N
N
O
H
H
2
2
99m
99m
Tc-labelled neurotensin imaging agents.
(3,4,5-trihydroxy-1-cyclohexene-1-carboxylic acid) was introduced to obtain a more  hydrophilic peptide; and in NT-XIX, Tyr-11 was replaced by 2,6-dimethyltyrosine (Dmt). All  the NT derivatives exhibited high binding anities in human colon adenocarcinoma cell  line HT-29, and the dissociation constants (K
) were calculated to be: NT-II, 0.3 ± 0.2 nM; 
D
NT-XI, 0.5 ± 0.3 nM; NT-XII: 2.0 ± 1.6 nM; [NT-XVIII], 4.5 ± 1.7 nM; and NT-XIX: 15.0 ± 6.0 nM.  The metabolic stability of the NT derivatives in human plasma at low concentrations (in  the nanomolar ranges) showed that NT-II had a biologic T
 of a few minutes, NT-XI and 
1/2
NT-XII of approximately 21 hours, and NT-XVIII and NT-XIX had very little degradation in  24 hours, respectively. The tumor uptake of NT-II of NT-XII NT-XIX was 0.4 ± 0.1, 4.6 ± 1.2,  and 5.2 ± 0.5% ID/g at ve hours p.i. in HT-29 tumor-bearing mice. The uptake of NT-XI  and NT-XVIII was approximately 1.7 and <1% ID/g at the same time point, respectively.  The derivative NT-XIX appears to have a better metabolic prole in conjunction with its  reduced kidney uptake. Human studies of NT-XI exhibited the ability of the NT derivative  to detect NT-expressing tumors[230].
In another approach, NT derivatives were conjugated to the acyclic tetramine chela-
tor for [
99m
Tc]dioxotechnetium labelling. The analogues that were developed were the 
following:
Demotensin 1: N Demotensin 2: N Demotensin 3: N Demotensin 4: N Demotensin 5: N Demotensin 6: N
-Gly-Arg-Arg-Pro-Tyr-Ile-Leu-OH[231]
4
-Gly-Lysψ[CH2NH]Arg-Pro-Tyr-Ile-Leu-OH,[231]
4
-Gly-Lysψ[CH2NH]Arg-Pro-Tyr-Tle-Leu- OH[231]
4
-Gly-Argψ[CH2NH]Arg-Pro-Tyr-Tle-Leu- OH[231]
4
-(β)Ala-Arg-Dab-Pro-Tyr-Ile-Leu-OH[232]
4
-(β)Ala-Arg-Dab-Pro-Tyr-Tle-Leu-OH[232]
4
In these derivatives, similar modications were made to improve their metabolic sta­bility, such as the reduction of the Arg-Arg bond in Demotensin 4 and its replacement  with lysine in Demotensin 2 and 3. Also, the replacement of isoleucine with tert-leucine  in Demotensins 3, 4, 6 was performed. In Demotensins 5 and 6, the 2,4 diaminobutyric  acid replaced Arg 9. All the Demotensin derivatives exhibited high binding anities in  the HT-29 cell line, and the IC
 values of Demotensin 1–6 against [
50
125
I-Tyr3]NT were cal­culated to be 0.32 ± 0.02, 0.41 ± 0.02, 1.50 ± 0.01, 0.85 ± 0.07, 0.03± 0.01 and 0.08 ± 0.02 nM,  respectively. The 
99m
Tc-Demotensins were evaluated for their in vivo biodistribution 
Chapter 12:
99m
Tc Radiopharmaceutical Chemistry 405
properties and their metabolic stability. Metabolic stability in murine plasma showed that 
[
Tc]TcN-PNP3-Cys-Gly-CCK8
[ [ [ Glu
8
99m
Tc-Demotensins 3 and 4 were stable up to one hour, while 
shorter half-life of t
Similarly, 
99m
values for
99m
Tc-Demotensin 6 was >90% stable for two hours in murine plasma, whereas 
Tc-Demotensin 5 degraded with a half-life of t
99m
Tc-Demotensins 3 and 4 were 3.52 ± 0.66 and 4.94 ± 0.52% ID/g at one hour 
= 20–25 minutes and 
1/2
99m
Tc-Demotensin 1 of t
∼ 15 minutes. The tumor uptake 
1/2
99m
Tc-Demotensin 2 had a 
= 3–5 minutes[231]. 
1/2
p.i., respectively, in HT-29 tumor-bearing mice, while in human NTS1-R-expressing WiDr  tumor-bearing mice, their tumor uptake was found to be 3.95 ± 0.64 and 4.72 ± 0.72, % ID/g 
at one hour p.i., respectively[231]. Tumor uptake in WiDr-bearing mice for 
99m
Tc-Demoten-
sins 5 and 6 were 1.68 ± 0.15 and 4.30 ± 0.45% ID/g at one hour p.i., respectively[232].  A pilot study in human patients revealed that 
99m
Tc-Demotensin 6 (Figure12.14) could 
detect tumors in brain metastases[233].
12.8.7 CCK-2 Receptor Imaging Agents
The overexpression of cholecystokinin (CCK) type-2 receptors (or B receptors or gas­trin receptors) has been observed in the majority of medullary thyroid carcinomas as  well as in some other carcinomas (e.g. small-cell lung and ovarian). In the eorts to 
develop
Ala-Tyr-Gly-Trp-Met-Asp-Phe-NH (CCK-8: Asp-Tyr-Met-Gly-Trp-Met-Asp-PheNH [D-Glu chelator (Nα-His-Ac-MG), and the respective tracers [ Tc-EDDA-HYNIC-MG (Figure12.15) and [ stability in serum. Competition experiments of the unlabelled peptide conjugates on  AR42J membranes versus [ conjugates under study. In AR42J tumor-bearing nude mice, the highest tumor uptake  was observed in the tracer [ Tc-Tricine-HYNIC-MG (2.2% ID/g) and then [ four hour s p.i., while the kidney uptake observed was 101.0% ID/g, 53.8% ID/g, and 1.8%  ID/g, respectively[234]. To improve kidney uptake, the shortened peptide analogue,  which lacks Glu
99m
Tc-probes for CCK2R imaging, the minigastrin (MG: Leu-Glu-Glu-Glu-Glu-Glu-
) peptide and its derivatives or the cholecystokinin 
2
) peptide were employed. The peptide 
1
]MG was conjugated to HYNIC (HYNIC-MG) and to the Nα-histidinyl acetate
125
I][iodoTyr12]-gastrin I showed a high CCK2R anity for all 
99m
Tc]Tc-EDDA-HYNIC-MG (8.1% ID/g), followed by [
2–6
, [HYNIC0,DGlu1,desGlu
2
99m
Tc]Tc-Tricine-HYNIC-MG, [
99m
Tc]Tc(CO)3(Nα-His-Ac-MG) exhibited high 
99m
99m
Tc]Tc(CO)3(Nα-His-Ac-MG) (1.2% ID/g) at 
2–6
]MG (HYNIC-MG11), was developed. The tracer 
99m
Tc]
Tc]
NH-R
N
N
N
L
Tc
L
99m
Tc]TcHYNIC-MG, MG: R=[DGlu1]MG ,
99m
Tc]TcHYNIC-MG11:R=[DGlu1,desGlu
99m
Tc]TcHYNIC-cyclo-MG1: cyclo
1
2-6
,desGlu
,D-Lys9]MG, L=EDDA/tricine,
Figure 12.15 Structures of
O
L
L
2-6
]MG
1,9
[g-D-
99m
Tc-labelled CCK-2 receptor imaging agents.
N
N H
R=[Gln1]gastrin: R=[Gly
406 Handbook of Radiopharmaceuticals
O
NH-R
O
N
Tc
N
O
H
2
2
0
-D-Glu1]MG:
99m
Tc-SG6
99m
Tc-Demogastrin2
O
O
+
N
P
Tc
P
N
O
99m
O
O
S
N H
O
NH-Gly-CCK
2
99m
[
Tc]Tc-EDDA-HYNIC-MG11 (Figure12.15) synthesized exhibited serum stability of 89.4% 
at 24 hours (the respective stability of [
99m
Tc]Tc-EDDA-(HYNIC-MG) was 90.5% at 24 hours).  A high binding anity of HYNIC-MG11 for the CCK2R was displayed in displacement  studies against [
125
I][iodoTyr12]-gastrin I, with IC50 value <2 nM as well as [
(HYNIC-MG11) exhibited in a saturation assay K
 of 3.97 nM. [
D
99m
Tc]Tc- ED DA-(HYNIC- M G11) 
99m
Tc]Tc- ED DA-
exhibited unaltered tumor uptake of 7.11 ± 0.22 %ID/g at four hours p.i., while kidney  uptake was reduced by 98% in comparison with the respective biodistribution results of 
99m
[
Tc]Tc- ED DA-(HYNIC- M G)[235].
Also, the development of tetramine derivatives of minigastrin was reported. Demo­gastrin derivatives 1–3 contain the following sequences: Demogastrin 1, [N MG; Demogastrin 2, N
0–1
,Gly0-D-Glu1]MG; and Demogastrin 3, [N′
4
0
,D-Glu1]MG, with the 
4
0
,D-Glu1]
4
tetramine ligand N,N′,N″,N′′′-tetra-(tert-butoxycarbonyl)-6-X-1,4,8,11-tetraazaundecane 
(where in N
respective dioxotechnetium complexes 
; X=carboxy and N′4; X=p-(carbomethoxy)acetyl]aminobenzyl)[236]. The 
4
99m
Tc-Demogastrin 1–3 prepared were stable 
for two hours in mouse plasma, but complete degradation was observed in urine. The 
99m
carrier-added tracers
ities in AR42J cell membranes, and their K and 1.01 ± 0.09 nM, respectively. Tumor uptake values of 
99g
Tc/
Tc-Demogastrin 1–3 were evaluated for their binding an-
 values were found to be 1.05 ± 0.13, 1.02 ± 0.07, 
D
99m
Tc-Demogastrins1–3 were 
6.13 ± 3.28, 5.50 ± 0.85, and 4.20 ± 1.22 %ID/g at one hour p.i., respectively, in AR42J tumor­bearing mice. At the same time, high kidney uptake values of 78.97 ± 1.60, 83.92 ± 14.45,  and 78.18 ± 11.85% ID/g, respectively, were observed. 
99m
Tc-Demogastrin 2 (Figure12.15)  was also evaluated in a medullary thyroid carcinoma patient, where all the known lymph  node lesions were clearly detected[236]. Similarly, two other gastrin radioligands were  developed–the full-length [ truncated [
99m
Tc][Tc-N4-D-Glu10]gastrin(10 –17) (
99m
Tc][Tc-N4-Gln1]gastrin (
99m
Tc-SG6) (Figure12.15) and the 
99m
Tc-DG4)–and were compared to 
99m
Tc-
Demogastrin 2. Competition binding studies of the ligands SG6, Demograstrin 2 and DG4  in A431-CCK2R(+) cell membranes against [ and the IC
 values of the ligands were found to be 9.3 ± 0.9, 10.7 ± 1.3, and 0.9 ± 0.1 nM, 
50
125
I][iodoTyr12,Leu15]gastrin were performed, 
respectively. The tumor uptake of the radiotracers in A431-CCK2R(+) xenografts was  found to be 12.89 ± 4.69% ID/g for  and 0.99 ± 0.13% ID/g for 
99m
99m
Tc-Demogastrin 2, 10.25 ± 3.51% ID/g for 
Tc-DG4 at one hour p.i.. The in vivo mouse plasma stability was  measured 5 minutes p.i. and found to be:  intact; and 
99m
Tc-DG4, 10% intact. However, prior administration of neutral endopepti-
99m
Tc- Demogastrin 2, 60% intact; 
99m
Tc-SG6, 
99m
Tc-SG6, 40% 
dase (NEP) and angiotensin-converting enzyme (ACE) inhibitors phosphoramidon (PA)  and Lisinopril (Lis), respectively, signicantly increased the tracers’ stability, as follows: 
99m
Tc- Demogastrin 2, 85% intact; 
tumor uptake was also improved to 18.21 ± 5.97% ID/g (PA + Lis) for 
18.46 ± 3.56% ID/g (PA only) for  four hour s p.i.. The kidney uptake of 
The development of cyclized MG was also reported, where the tracers [ HYNIC-cyclo-MG1 (cyclo-MG1: cyclo HYNIC-cyclo-MG2 (cyclo-MG2: cyclo
99m
Tc-SG6, 70% intact; and 
99m
Tc-SG6, and 8.91 ± 1.61% ID/g (PA + Lis) for 
99m
Tc-Demogastrin 2 and 
1,9
[γ-D-Glu1,desGlu
1,9
[γ-D-Glu1,desGlu
99m
Tc-DG4, 80% intact. Their 
99m
99m
Tc-SG6 was high[237].
2–6
,D-Lys9]MG) and [
2–6
,D-Lys9, Nle11]MG) were 
Tc-Demogastrin 2, 
99m
Tc-DG4 at 
99m
Tc]Tc- ED DA-
99m
Tc]Tc- ED DA-
developed (Figure12.15). The in vitro stability in human plasma was found to be 
Chapter 12:
99m
Tc Radiopharmaceutical Chemistry 407
88.6–97.6% intact peptide after 24 hours of incubation. The dissociation constant (KD) of  tracers [
99m
Tc]Tc-EDDA-HYNIC-cyclo-MG1 and [ to be 19.1 and 21.2 nM, respectively. The tumor uptake values of [ cyclo-MG1 and [
99m
Tc]Tc-EDDA-HYNIC-cyclo-MG2 were 3.61 and 3.17% ID/g one hour p.i., 
99m
Tc]Tc-EDDA-HYNIC-cyclo-MG2 was found 
99m
Tc]Tc- ED DA-HYNIC-
respectively[238].
Using a dierent approach, the natural octapeptide CCK8 was conjugated to a tet-
radentate (PN
GC), and the respective [ yield. Its binding anity was K
S) chelator N-(N-(3-diphenylphosphinopropionyl) glycyl)cysteine (Phos-
2
99m
Tc][TcO(Phos-GC-CCK8)] complex was synthesized in high 
=32.0 ± 5 nM in A-431 cells, its tumor uptake in A-431 
D
tumor-bearing mice was 2.01 ± 0.80% ID/g at two hours p.i., and it displayed both renal  and hepatobiliary excretion[239]. The development of nitridotechnetium complexes  for CCK2R was reported as well, where CCK8 was derivatized with a cysteine residue  (Cys-Gly-CCK8) that was used in the tracer [
99m
Tc][TcN(N,S-Cys-Gly-CCK8)(PNP3)]+ (PNP3=N,N-bis(dimethoxypropylphosphinoethyl)methoxyethylamine) (Figure12.15). Its  binding anity in A-431 cells was found to be K
=19.0 ± 4.6 nM (B
D
∼ 1 06 sites/cell), and 
max
its tumor uptake in A-431 tumor-bearing mice was <1 %ID/g at one hour p.i., while high intestinal activity was observed[240].
 
The vitamin folic acid has been eectively applied for the development of diagnostic  radiopharmaceuticals to target folate receptor (FR)-positive tumors such as ovarian, non- small-cell lung, endometrial, breast, and renal cell carcinoma. One of the early eorts  describes the conjugation of folate to DTPA chelator for standard 
99m
as for [
99m
[
Tc][Tc(CO)3]+-labelling. Intravenous administration of [
Tc]Tc(CO)3(DTPA-folate) to athymic mice bearing KB cell tumor xenografts resulted  in tumor uptake of 2.9 ± 0.8 and 3.3 ± 0.2% ID/g at four hours p.i., respectively. Further­more, high kidney uptake of 21 ± 3 and 46 ± 5% ID/g in each kidney was observed at the  same time point, due to physiologic FR presence in the renal tubules[241, 242]. Also, a  folate-containing peptide with the sequence pteroic acid (Pte), D-Glu, β-diaminopropionic acid, Asp, and Cys (EC20) was developed, where the latter three amino acids function as 
a tetradentate (NNN S) chelator for 
99m
Tc-labelling[243]. 
99m
of two oxotechnetium(V) complexes characterized as syn and anti isomers (Figure12.16).  The FR binding anity of  vivo tumor uptake of 
99m
Tc-EC20 in KB cells was measured to be KD=3.2 nM. The in
99m
Tc-EC20 in mice bearing FR-positive M109 cells was 17.2 ± 1.02%  ID/g at four hours p.i., with kidney uptake of 138 ± 12.4% ID/g at the same time point.  Currently, 
99m
Tc-EC20 (
99m
Tc-etarfolatide, Endocyte Inc.) is being studied as a companion 
diagnostic imaging agent to the therapeutic folate-targeted agent vintafolide in multiple
clinical trials[244].
A series of [
99m
Tc][Tc(CO)3-folate] complexes was developed (Figure12.16), where 
folate was conjugated to the PAMA tridentate chelator via a hexylamine linker on 
either the γ- or α-glutamate, [ α-folate)]; and by a similar design, [
99m
Tc][Tc(CO)3(PAMA-γ-folate)] and [
99m
Tc][Tc(CO)3(PAMA-pteroate)], was synthesized 
99m
Tc-labelling as well 
99m
Tc]Tc-DTPA-folate and 
Tc-EC20 consists of a mixture 
99m
Tc][Tc(CO)3(PAMA-
408 Handbook of Radiopharmaceuticals
O COOH
O COOH
A-folate
H2N
H2N
HN
HN
O
N
N H
N
N
O
N
N H
N
N
O
99m
[
Tc]Tc-EC20
O COOH
99m
[
Tc]Tc(CO)3(His-folate), X=C
99m
[
Tc]Tc(CO)3(TzHis-folate), X= N
Figure 12.16 Structures of
COOH
O
O
O
N
N
H N
O
H
O
99m
N
O
Tc-labelled folate imaging agents.
Tc
N H
2
COOH
S
N
H2N
X
N
Tc
OC
OC
CO
99m
[
O
O
O
HN
H2N
Tc]Tc-PAMA-folate
N
N
N
O
O
CO
N
Tc
CO
N
CO
N H
O
O
N
O
O
99m
[
Tc]Tc-IDA-folate
H
[
O
99m
N
N
Tc
N
N
Tc]Tc-DP
4
CO
CO
CO
O
CO
CO
Tc
CO
lacking glutamate[245]. The 
99m
Tc-folates were also prepared in a kit-like method, where  the PAMA conjugates were placed in a kit with the Isolink components, with very high  radiochemical yields (>92%). The binding anities of [
99m
[
Tc][Tc(CO)3(PAMA-α-folate)], and [
determined (by the Rosenthal analysis) with K
99m
Tc][Tc(CO)3(PAMA-pteroate)] in KB cells were 
D
99m
Tc][Tc(CO)3(PAMA-γ-folate)], 
 values of 2.09, 2.51, and 14.52 nM, respec-
tively. Biodistribution studies in KB-tumor-bearing mice revealed tumor uptake of 
2.33 ± 0.36, 1.24 ± 0.19, and 0.43 ± 0.17% ID/g at four hours p.i. for the three radiofolates,  respectively, with kidney uptake of 18.5 ± 0.7, 12.4 ± 1.9, and 3.3 ± 0.4% ID/g, respectively,  and signicant hepatobiliary clearance for all the tracers[246]. Importantly, selective  FR-blockade in the kidneys was accomplished after administration of antifolates prior  to radiofolate administration, while the FR-mediated uptake of radioactivity in KB  tumor xenografts was retained[247]. Similar results were obtained with the tracers 
99m
[
Tc][Tc(CO)3(IDA-γ-folate)] and [
99m
Tc][Tc(CO)3(DPA-γ-folate)], with tumor uptake in KB- bearing mice of 2.67±0.27 and 0.94±0.10% ID/g at four hours p.i., respectively, and with  high cell binding of 40–55% in KB cells as well[248]. In a dierent design, N(τ )-histidine­folate (His-folate) and its isostructural click 1,2,3-triazole (TzHis-folate) analogue were  synthesized, where the γ-glutamate of folate was conjugated via a butylamine linker to  the chelator, and the respective [
99m
Tc]Tc(CO)3(His-folate) and [
99m
Tc]Tc(CO)3(TzHis-folate) 
tracers were prepared (Figure12.16). Their tumor uptake in tumor-bearing mice was 
4.29±0.67 and 4.84±0.10% ID/g at four hours p.i., while their accumulation in the kidney  was 24.56±3.17 and 27.33±3.61% ID/g, respectively[249].
In a recent report, [
by ligand-exchange reaction from [
99m
Tc]Tc-folate-GGCE (folate-Gly-Gly-Cys-Glu) was developed 
99m
Tc]Tc-tartrate at >95% radiolabelling eciency.  The structure of the technetium complex was not described, but it is assumed that the  tetrapeptide, GGCE, is the 
99m
Tc-chelator. Its binding anity (KD) was measured to be 
Chapter 12:
99m
Tc Radiopharmaceutical Chemistry 409
5.19 nM. The KB-tumor uptake of 
99m
Tc-folate-GGCE was 16.4, 23.2, and 17.6% ID/g, at one,  two, and four hours p.i., respectively, and the kidney uptake was 57.04±18.58 %ID/g at  four hour s p.i.[250]. Also, the [ pared by direct labelling at >95% radiochemical yield[251]. The binding anity (K
99m
[
Tc]Tc-TEPA-folate was found to be 5.00± 0.06, 27.46± 0.01, and 25.85± 0.005 nM in 
99m
Tc]Tc-tetraethylenepentamine(TEPA)-folate was pre-
D
) of 
KB, U-87MG, and MDA-KB-468 cells, respectively. The tumor uptake of the tracer in KB  tumor-bearing mice was 4.26± 1.3% ID/g, kidney uptake was 16.0 ±1.2% ID/g, and liver  uptake was 16.0 ±2.0 %ID/g at four hours p.i.[251]. Furthermore, [
99m
Tc]Tc- (DO3A-EA)­folate was synthesized by direct labeling at high eciency, where DO3A-EA is 1,4,7-tris  (carboxymethyl)-10-(4-aminoethyl)-1,4,7,10-tetraazacyclododecane linked to folic acid via  its γ-carboxyl group. The in vitro receptor binding anity (K
) was found to be 4.2 ± 0.8, 
D
22.54 ± 0.002, and 16.68 ± 0.01 μM in KB, U-87MG, and OAW, respectively. KB tumor uptake  in tumor-bearing mice was 6.26 ± 0.4 at four hours p.i.. Both renal and hepatobiliary  clearance were observed[252].
12.8.9
The development of a SPECT tracer based on  tive, given the wide usefulness of the PET agent 2-deoxy-2-[ of [
99m
Tc-Labelled Glucose Derivatives
99m
Tc-labelled glucose derivatives is attrac-
18
F]uoro-d-glucose. Series 
99m
Tc][Tc(CO)3-glucose] tracers were developed for this purpose by rational drug  design. Glucose derivatives were designed for conjugation to a tridentate chelator such  as iminodiacetate (IDA) at positions, C-1, C-2, C-3, and C-6 (Figure12.17). The C-1 glucose  derivatives were separated by an ethyl spacer from IDA[253], while the C-2 and C-6[254]  derivatives had C3, C8, and triethyleneglycol spacers. Furthermore, glucose derivatives  were designed for conjugation to histidine, bisimidazolylamine, and PAMA chelators at  position C-3, as well[255]. The tracers [
99m
Tc][Tc(CO)3(L-Glucose)] (L=IDA, His, PAMA)  were evaluated in a dose-dependent manner for their ability to be transported via  GLUT1 glucose transporters in HT29 colon cancer cells, where their uptake was found  not to be mediated by GLUT1. The analogous Re-complexes were evaluated for compet­itive inhibition of hexokinase, where only the C-2 derivatized glucose complexes with  extended spacer functionalities were found to be active; in particular, Re(CO) C8-glucose)] and [Re(CO)
(2-deoxyglucose-(PEG)3IDA)] exhibited Ki values of 5.8 ± 0.9 mM 
3
(2-IDA-
3
and 0.25 ± 0.01 mM, respectively. The competitive inhibitors, though, were not recognized  as substrates of hexokinase[256]. Similar C-1 glucose derivatives [ glucose)] and [
99m
Tc][Tc(CO)3(1α-IDA-2-deoxyglucose)] were evaluated in B16F1 melanoma-
99m
Tc][Tc(CO)3(1β-IDA-
bearing mice, where low tumor uptake was observed of 0.31 ± 0.23 and 0.40 ± 0.28% ID/g  at one hour p.i., respectively[257].
Another series of [
99m
Tc]Tc(CO)3-glucose and -glucosamine tracers were devel­oped, conjugated at the C-1 or C-2 position to various chelators[258, 259] including  hydroxypyridone[24], DPA, PAMA, and Schi-based chelators[260–263], as well as the  cyclopentadienyl chelator (Figure12.17)[264]. From these complexes, the Re analogue  Re(CO)
(2-glucosamine-Cp) was evaluated for competitive inhibition of hexokinase, 
3
which exhibited Ki=330 ± 70 μM, although the complex was not recognized as a substrate 
410 Handbook of Radiopharmaceuticals
OH
OH
HO
99m
[
HN
[
[
99m
HO
99m
O
Tc]Tc(CO)3(1a-IDA-2-deoxyglucose)
N
N
Tc
OC
CO
OC
Tc]Tc(CO)3(3-His-glucose)
OH
HO
HO
O
N
OC
Tc]Tc(CO)3(2-DPA-glucosamine)
O
CO
O
CO
Tc
N
O
HO
O
N
Tc
CO
O
O
NH
O
N
CO
OH
OH
O
CO
O
O
OH
OH
Figure 12.17 Structures of
OH
O
OH
99m
[
Tc]Tc(CO)3(1b-IDA-glucose)
O
HO
O
N
Tc
N
Tc]Tc(CO)3(3-PAMA-glucose)
OH
O
NH
O
n
N
N
Tc
OC
CO
99m
[
Tc]Tc(CO)3(2-NNO-(CH2)n-glucosamine)
Tc-labelled glucose derivatives.
[
HO
OC
OC
99m
HO
HO
OC
HO
99m
O CO
O
O
O
OH
O
OH
CO
N
Tc
CO
O
CO
O
O
OH
OC
OH
HO
HO
HO
HO
HO
99m
[
Tc]Tc(CO)3(2-IDA-X-glucose)
X=(CH
OC
O
Tc
N
OC
O
O
99m
[
Tc]Tc(CO)3(6-IDA-glucose)
OH
O
O
N H
O
O
X
O
N
O
Tc
OC
CO
, (CH2)8, CH2CH2(OCH2CH2)2,
2)3
O
O
HO
HO
O
N
N
Tc
S
99m
[
Tc]TcECDG
OH
O
O
CO
O
OH
OH
HO
O
O
N H
S
OH
99m
[
99m
[
O
O
OC
N
Tc
OC
O
CO
99m
[
Tc]Tc(CO)3(3-IDA-glucose)
OH
HO
HO
99m
[
Tc]Tc(CO)3(2-cp-glucosamine)
OH
OH
GT
Tc]Tc-4AcTG,4AcTG=2,3,4,6-Ac-1-thioglucose, Tc]Tc-1-TG, 1-TG=1-thioglucose
OH
HO
O
O
NH
O
OC
O
S
Tc
S
O
S
CO
S
OH
OH
TGGT
TG
O
OH
Tc
CO
of hexokinase[264]. The tracers [
99m
Tc][Tc(CO)3(2-glucosamine-NNO)] with NNO-type  chelators exhibited no specic GLUT1 transport in LCC6-HER2 human breast cancer  cells. In addition, the Re analogues were not recognized as substrates of HK; however,  Re(CO)
(2-glucosamine-CO-C7-NNO) behaved as a competitive inhibitor of HK with Ki of
3
70 ± 20 μM[260]. Furthermore, the tracer [
99m
Tc][Tc(CO)3(2-glucosamine-DPA)] was eval-
uated in B16F10 murine melanoma tumor-bearing mice and exhibited tumor uptake of 
0.47 ± 0.09% ID/g at two hours p.i.[265]. The tracer [
99m
Tc][Tc(CO)3(TzHis-C4-2-glucose)]  was developed by “click” conjugation from a C-2 glucose derivative with a butyl spacer.  The tracer was administered in lung carcinoma-bearing mice, and it exhibited tumor  uptake values of 0.55 ± 0.05 and 0.35 ± 0.01% ID/g at one and two hours p.i., respec­tively[266].
Using a dierent approach, the tracer [
D-glucosamine) ([
99m
Tc]Tc-ECDG) (Figure12.17) was developed, and in vitro studies
showed that its cellular uptake was mediated by a 
99m
Tc]oxotechnetium-ethylenebis(L-cysteinyl-
d-glucose transport mechanism and
that ECDG was a substrate of hexokinase (HK)[267]. Biodistribution in human A549 lung  cancer-bearing mice showed a low tumor uptake of [
at four hour s p.i.. Furthermore, it was shown that [
99m
Tc]Tc-ECDG of 0.41 ± 0.16% ID/g 
99m
Tc]Tc-ECDG was capable of assess-
ing the therapeutic response of tumor-bearing mice post-treatment[268]. An initial 
Chapter 12:
99m
Tc Radiopharmaceutical Chemistry 411
clinical trial in seven human patients showed that the tumor uptake of [ three to four times that of normal tissue uptake[269]. Also, the tracer [ D-isomer-glucosamine (DG) was reported. In vitro, it was shown that [ DG and [ human breast tumor-bearing mice, the tumor uptake of [
18
F]FDG exhibited similar uptake values in MCF-7 tumor cells. In vivo, in MCF-7 
99m
Tc]Tc–DTPA–DG and [18F]FDG 
99m
Tc]Tc-ECDG was 
99m
Tc]Tc- DTPA-D 
99m
Tc]Tc– DT PA–
was 1.59 ± 0.04 and 1.42 ± 0.12% ID/g, and the tumor-to-blood ratio was 3.24 ± 0.65 and 
7.12 ± 2.12 at four hours p.i., respectively[270]. Furthermore, 
99m
Tc-1-thio-β-d-glucose ([ direct labeling in high radiochemical yields (Figure12.17). The  ated for their tumor cell uptake in comparison to [
99m
Tc-labelled thioglucose (TG) analogues were developed; in particular, 
99m
Tc]Tc1-TG) and [
99m
Tc]Tc-5- thio- d -glucose were prepared by 
99m
Tc tracers were evalu-
18
F]FDG, where they exhibited tumor  uptake with a mechanism analogous to that of glucose, although the tracers exhibited  higher accumulation in the cell membranes compared to [
18
F]FDG[271, 272]. [
99m
Tc]Tc-1-TG  was evaluated as an imaging tool for the diagnosis of joint inammatory disorder[273].  Similarly, 1-thio-β- 99m by ligand exchange from 
d-glucose 2,3,4,6-tetra-acetate (4AcTG) was labelled with technetium-
99m
Tc-tartrate. [
99m
Tc]Tc-4AcTG exhibited high uptake in  bacteria and tumor cells expressing GLUT1 transporters, as well as in vivo uptake in infec­tion (Staphylococcus aureus) and RMA lymphoma in mice, with values of 1.81 ± 0.11 and 
3.54 ± 0.12 %ID/g at two hours p.i., while the uptake values of [
18
F]-FDG were 0.68 ± 0.19 
and 0.93 ± 0.26% ID/g, respectively[274].
In another study, three 
(S-DG), mercaptoacetyltriglycinyl-
d-deoxyglucose (MAMA-BA-DG), were labelled by ligand exchange from 
tate in high radiochemical purities. Biodistribution of [
99m
and [
Tc]Tc-MAMA-BA-DG was performed in MA891 breast tumor-bearing mice, where 
d-glucosamine (DG) derivatives, N-thioacetyl-d-glucosamine
d-glucosamine (MAG
-DG), and MAMA-butanamide-
3
99m
Tc]Tc-S - DG , [
99m
Tc-glucohep-
99m
Tc]Tc- MAG3-DG, 
their tumor uptake was 1.06 ± 0.18, 0.82 ± 0.06, and 0.21 ± 0.03% ID/g at four hours p.i.,  respectively, while the respective tumor-to-blood ratio at the same time-point was 
0.82 ± 0.15, 0.94 ± 0.13, and 0.94 ± 0.16[275]. In another study, two glucose derivatives  were prepared by conjugation of the MAG
of β-
d-glucosamine (DG)[276] and β-d -glucopyranose-4-phenylamine (PhDG)[277]. 
The respective tracers [
99m
Tc]Tc- MAG3-DG and [
 chelator at the glucopyranose C-1 position 
3
99m
Tc]Tc- MAG3-PhDG were evaluated in 
Ehrlich tumor-bearing mice with tumor uptake of 0.79 ± 0.14 and 0.50 ± 0.04% ID/g for 
99m
[
Tc]Tc- MAG3-DG and [
99m
Tc]Tc- MAG3-PhDG at two hours p.i., respectively[276]. The  HYNIC-glucosamine (HYNIC-DG) derivative was labelled by two dierent methods,  and the respective tracers [
99m
Tc]Tc-(HYNIC-DG)-Tricine-TPPTS and [
99m
Tc]Tc- (H Y N IC-
DG)-EDDA were produced. The tumor uptake in S180 murine sarcoma-bearing mice of 
99m
Tc]Tc-(HYNIC-DG)-Tricine-TPPTS and [
99m
Tc]Tc-(HYNIC-DG)-EDDA was 0.44 ± 0.13 and 
0.46 ± 0.06% ID/g at two hours p.i., respectively[278]. Dithiocarbamate-Glucose-1 deriva­tives were prepared by “click” conjugation of a C-1 derivatized glucose, which formed the  respective [
99m
Tc][TcN(dithiocarbamate-glucose-1)2] tracers. The tracers were evaluated  in S180 murine sarcoma-bearing mice, and the maximum tumor uptake was found for the  tracer with the longer propyl linker of 4.30 ± 0.61% ID/g with blood activity of 4.15 ± 0.53%  ID/g at two hours p.i.[279].
412 Handbook of Radiopharmaceuticals
12.8.10
O
′-NNO-thymidine)
99m
Tc-Labelled Thymidine Derivatives
Targeting thymidine kinase with radiotracers has been used as an approach to diagnose  cancers. In addition, imaging of the non-invasive herpes simplex virus type-1 thymidine  kinase (HSV1-tk) gene expression has wide interest for research on gene therapy and for  conrmation of gene delivery.
In a series of thymidine analogues developed, 5′-carboxamide thymidine was  conjugated to the chelators IDA and PAMA with various spacers of length 0–30 Å, which  were complexed with the [M(CO)
]+ core (M=
3
99m
Tc, Re) (Figure12.18). The Re-complexes  were tested in vitro for their ability to inhibit human cytosolic thymidine kinase (TK)  with Ki values ranging from 4.4 to 334 μM[280, 281]. By replacing the 5-methyl moiety  of thymidine with a 5-ethyl moiety, the respective Re(CO)
(IDA-5′-carboxamide 5-ethyl-
3
2′-deoxyuridine) complex was found to be a selective competitive inhibitor of HSV1-TK  (Ki=4.56 μM)[282]. In addition, a series of N3- and C3′-functionalized thymidine ana- logues conjugated by various spacers with tridentate chelators that formed neutral,  anionic, and cationic [M(CO)
3
]+ (M=
99m
Tc, Re) chelates were developed (Figure12.18). A  series of N3-functionalized thymidine analogues linked by various spacers to tridentate  chelators that form neutral chelates with [Re(NO)(CO) Re complexes, as well as some of the 
99m
Tc tracers, were evaluated as potential substrates 
]2+ were prepared. The respective 
2
for hTK1 by monitoring the formation of the monophosphorylated product, where it was  shown that all the complexes were substrates to the enzyme, with the C3′-functionalized  thymidine analogues exhibiting higher anity for the enzyme[283–286]. In vitro cell internalization experiments performed in a human neuroblastoma SKNMC cell line  revealed low uptake of the 
99m
Tc tracers, dependent on their lipophilicity; hence it was  assumed that they are taken up by diusion rather than by facilitated transport[283].  A series of thymidine analogues that were functionalized at positions C5′, C2′, and N3  were linked by various spacers to dipicolylamine and complexed with [Re(CO)
]+. Also, 
3
a series of N3-functionalised thymidine derivatives linked to bis(quinolin-2-ylmethyl) amino and bis(thiazol-4-ylmethyl)amino tridentate chelators were developed. The Re­complexes were tested against A549 lung carcinoma cell line for their cytotoxicity, and 
OH
O
NH
N
O
O
O
OC
O
N
Tc
OC
O
OC
O
99m
[
Tc]Tc(CO)3(C5′-IDA-thymidine) [
H N
4
O
HO
O
N
N
O
OH
O
99m
Tc]Tc(CO)3(N3-TzHis-thymidine)
H2N
N
N
N
OC
Figure 12.18 Structures of [M(CO)3]-thymidine derivatives, M=
Chapter 12:
99m
O
O
Tc
CO
99m
CO
Tc or Re.
O
O
OC
99m
[
Tc]Tc(CO)3(C3
NH
Tc
HO
CO
N
N
CO
NH
N
O
O
N
Tc Radiopharmaceutical Chemistry 413
some of these derivatives were found to be quite potent, in particular the N3- and C5′-
HO
CO
O
OH
functionalized derivatives, while low inhibition of TK1 was displayed[287, 288].
Using a dierent approach, a [
99m
Tc]oxotechnetium-MAMA-propyl-N3-thymidine  derivative was developed; however, it exhibited a low anity for TK1 and low tumor  uptake in vivo in a radiation-induced brosarcoma (RIF) tumor mouse model[289].
12.8.11 Estrogen Receptor Imaging Agents
The development of tors (ERs) overexpressed in ER-positive tumors is of importance in nuclear medicine, 
especially for the diagnosis of breast cancers. A number of organometallic technetium  and rhenium [M(CO) oped, with various chelators, such as a bidentate dithioether (SS) system, a tridentate  dithioether-carboxylate (SSO) system, PAMA, and pyrazolyldiamine (pzNN), as well as  cyclopentiadienyl (Figure12.19)[35, 290–292]. The pyridine-2-yl-hydrazine (HYPY) ligand  was conjugated to 17α-ethynylestradiol, and the respective Re(CO) plex was evaluated for its relative binding anity (RBA) to the estrogen receptor, and  high ER binding was displayed (RBA=38%)[293]. The respective pyridin-2-yl-hydrazine  acetic acid (NNO) tridentate chelator was conjugated to 17α-ethynylestradiol, and the  analogous Re(CO) eects in ER binding were evaluated after hydrogenation of the triple bond of the com­plex Re(CO)
(NNO-E17) to its double-bonded and single-bonded analogues, where it 
3
was shown that the Z-ethenyl (double-bonded) derivative exhibited higher binding  to ERβ (RBA=24%)[294]. Preclinical evaluation of the tracer [ (Figure12.19) in tumor-bearing mice exhibited low but specic uptake in estrogen recep­tor-expressing tumors (0.67% for MCF-7 tumors and 0.77% for endometrial tumors at 
three ho urs p.i.)[295].
99m
Tc-labelled imaging agents for the detection of estrogen recep-
]+-complexes (M=Re, 
3
(NNO-E17) complex exhibited RBA=20% to ERα[294]. The linkage 
3
99m
Tc) of 17α-ethynylestradiol have been devel-
(HYPY-E17) com-
3
99m
Tc]Tc(CO)3(NNO - E17) 
Figure 12.19 Struc-
tures of [M(CO)
]-
3
OH
estradiol derivatives,
99m
M=
Tc or Re.
99m
[
Tc][Tc(CO)3(NNO-ethynyl-E17)]
Re
CO
CO
OC
Re(CO)3(cp-tamoxifen-OCH2CH2NMe2)
414 Handbook of Radiopharmaceuticals
NH
N
HN
HO
CO
O
O
99m
[
Tc][Tc(CO)3(cp-ethynyl-E17)]
HO
Tc
OC
OC
O
N
OH
OH
OC
OC
Re(CO)
Tc
OC
CO
Re
CO
(aryl-cp) for ER
3
OH