Os tumores neuroendócrinos são raros, ocorrem principalmente no trato gastrointestinal, mas outros sistemas são acometidos como pele, pulmões e sistema nervoso. São ricos em receptores de somatostatina (SM) do tipo 2 (SSTR2) e podem secretar hormônios em excesso. Peptídeos análogos sintéticos da SM são de grande utilidade por possuírem meia vida maior do que a SM e, assim, podem ser utilizados para melhora clínica destes pacientes devido sua ação inibitória tumoral. A marcação destes peptídeos com radioisótopos permite a obtenção de imagens, de boa relação custo-eficácia comprovada, e realização de terapia. O peptídeo utilizado, DOTA-Tyr3-octreotato (DOTATATO), possui afinidade ao receptor SSTR2 muito maior do que o utilizado comercialmente hoje, é facilmente radioiodado e possui biodistribuição favorável para diagnóstico e terapia devido à presença do quelante DOTA. Estudamos a influência de vários fatores na pureza radioquímica do composto marcado além da estabilidade da marcação e biodistribuição em camundongos Swiss e Nude, normais e com tumor de células AR42J, além da estimativa de dose absorvida. Observamos fácil e estável radioiodação do peptídeo à razão molar peptídeo/radioiodo (131I) de 2,73, que gerou espécie radioquímica com tempo de retenção de 22,7 minutos na cromatografia líquida de alta eficiência e que apresentou biodistribuição e dosimentria favoráveis para a realização de imagens e terapia dos pacientes com tumores neuroendócrinos, ao contrário do que dados antigos da literatura mostravam nos compostos radioativos sem quelante associado. Outras razões molares não se mostraram eficientes, com outras espécies radioquímicas e biodistribuição desfavorável. Um estudo dosimétrico em pacientes com tumores neuroendócrinos pode ser realizado num futuro próximo. / Neuroendocrine tumors are rare and affect mainly the gastrointestinal tract but other systems are also affected like the skin, lungs and the nervous system. They are rich in type 2 somatostatin (SM) receptors (SSTR2) and may secrete hormones in excess. Synthetic SM derivative peptides are of great utility because presented bigger half life when compared to SM and can be used to clinical improvement of these patients due to its tumoral inhibitory action. The labeling of these peptides with radioisotopes allowed the acquisition of images with favourable cost-efficiency relationship and use in therapy. The peptide, DOTATyr3- octreotate (DOTATATE), has much more affinnity for the SSTR2 receptor than the peptide commercially used nowadays, is easily radioiodinated and has a favourable biodistribution for diagnosis and treatment due to the presence of the chelator DOTA. We have studied the influence of various factors on the radiochemical purity of the labeled compound as labeling stability, absorbed dose estimation and biodistribution in normal and AR42J cell tumor-bearing Swiss and Nude mice. We observed easy and stable peptide radioiodination at peptide/radioiodine (131I) ratio of 2.73 that produced a radiochemical species with retention time of 22.7 minutes at high performance liquid chromatography and presented a favourable biodistribution and dosimetry for imaging and therapy of patients with neuroendocrine tumors, just the opposite result observed the radioiodinated compounds without a chelator as described in the literature. Other molar peptide/radioiodine ratios did not showed good results, with various radiochemical species and unfavourable biodistribution. A possible dosimetric study in patients with neuroendocrine tumors may be carried out in the near future.

In radionuclide therapy it is still common to administer standard activities or to scale administered activity with blunt parameters such as body weight or surface area. This is not ideal because, due to considerable variation in kinetics, large safety margins have to be applied to avoid radiation damage to healthy organs, which causes under-treatment of many patients. To base the administered activity on individual dosimetry, as in other therapy modalities using ionizing radiation, will essentially solve this problem. However, dosimetry in radionuclide therapy is resource-demanding and debilitating for the patient because it involves a number of measurements to determine the kinetics of the therapy radionuclide and needs to be optimized for clinical feasibility. First, the ability to measure radioactivity distributions of radionuclides for therapy was investigated. SPECT measurements of 177Lu, which was later used clinically, showed good spatial resolution and a reasonable quantitative accuracy. A new method to calculate absorbed dose to solid risk organs and tumours was developed and applied in the clinic. Kinetic data were obtained by repeated SPECT measurements. Radiation concentration determined in small volumes of interest could then be multiplied by a constant to obtain absorbed dose because it was shown that cross-fire was negligible in organs with high activity concentration. The new dosimetry method, compared to other methods, was found to give better results with less effort. In addition, a method to calculate absorbed dose to bone marrow was developed and clinically implemented. In 200 patients, individual kinetics and absorbed dose were studied and variations were found to be large. Kidney was the dose-limiting organ in almost all patients (98.5%). Keeping the kidney dose < 23Gy, about half of the patients could receive 5, or up to 10 treatments instead of the stipulated 4.

Os tumores neuroendócrinos são raros, ocorrem principalmente no trato gastrointestinal, mas outros sistemas são acometidos como pele, pulmões e sistema nervoso. São ricos em receptores de somatostatina (SM) do tipo 2 (SSTR2) e podem secretar hormônios em excesso. Peptídeos análogos sintéticos da SM são de grande utilidade por possuírem meia vida maior do que a SM e, assim, podem ser utilizados para melhora clínica destes pacientes devido sua ação inibitória tumoral. A marcação destes peptídeos com radioisótopos permite a obtenção de imagens, de boa relação custo-eficácia comprovada, e realização de terapia. O peptídeo utilizado, DOTA-Tyr3-octreotato (DOTATATO), possui afinidade ao receptor SSTR2 muito maior do que o utilizado comercialmente hoje, é facilmente radioiodado e possui biodistribuição favorável para diagnóstico e terapia devido à presença do quelante DOTA. Estudamos a influência de vários fatores na pureza radioquímica do composto marcado além da estabilidade da marcação e biodistribuição em camundongos Swiss e Nude, normais e com tumor de células AR42J, além da estimativa de dose absorvida. Observamos fácil e estável radioiodação do peptídeo à razão molar peptídeo/radioiodo (131I) de 2,73, que gerou espécie radioquímica com tempo de retenção de 22,7 minutos na cromatografia líquida de alta eficiência e que apresentou biodistribuição e dosimentria favoráveis para a realização de imagens e terapia dos pacientes com tumores neuroendócrinos, ao contrário do que dados antigos da literatura mostravam nos compostos radioativos sem quelante associado. Outras razões molares não se mostraram eficientes, com outras espécies radioquímicas e biodistribuição desfavorável. Um estudo dosimétrico em pacientes com tumores neuroendócrinos pode ser realizado num futuro próximo. / Neuroendocrine tumors are rare and affect mainly the gastrointestinal tract but other systems are also affected like the skin, lungs and the nervous system. They are rich in type 2 somatostatin (SM) receptors (SSTR2) and may secrete hormones in excess. Synthetic SM derivative peptides are of great utility because presented bigger half life when compared to SM and can be used to clinical improvement of these patients due to its tumoral inhibitory action. The labeling of these peptides with radioisotopes allowed the acquisition of images with favourable cost-efficiency relationship and use in therapy. The peptide, DOTATyr3- octreotate (DOTATATE), has much more affinnity for the SSTR2 receptor than the peptide commercially used nowadays, is easily radioiodinated and has a favourable biodistribution for diagnosis and treatment due to the presence of the chelator DOTA. We have studied the influence of various factors on the radiochemical purity of the labeled compound as labeling stability, absorbed dose estimation and biodistribution in normal and AR42J cell tumor-bearing Swiss and Nude mice. We observed easy and stable peptide radioiodination at peptide/radioiodine (131I) ratio of 2.73 that produced a radiochemical species with retention time of 22.7 minutes at high performance liquid chromatography and presented a favourable biodistribution and dosimetry for imaging and therapy of patients with neuroendocrine tumors, just the opposite result observed the radioiodinated compounds without a chelator as described in the literature. Other molar peptide/radioiodine ratios did not showed good results, with various radiochemical species and unfavourable biodistribution. A possible dosimetric study in patients with neuroendocrine tumors may be carried out in the near future.

O desenvolvimento de moléculas radiomarcadas com alta especificidade para um órgão ou tumor tem contribuído para a obtenção de um diagnóstico de precisão em medicina nuclear.Um caso particular são os peptídeos radiomarcados para a localização de tumores neuroendócrinos como os derivados sintéticos da somatostatina.Atualmente, o DTPA-octreotideo-111In é o radiofármaco mais utilizado com o propósito de visualizar tumores que expressem receptores para somatostatina. Contudo, o uso do indio-111 como radionuclídeo oferece limitações em relação a sua disponibilidade (produto de ciclotron), suas características físicas como meia-vida (67 horas) e emissor de fótons de média energia (171 keV e 245 keV) que não favorecem a obtenção de imagens tipo SPECT (Single Photon Emission Computed Tomography). As propriedades físicas favoráveis do tecnécio-99m (99mTc) fazem dele o radioisótopo mais adequado para substituir o indio-111 (111In) na marcação desses peptídeos. Este trabalho avaliou a preparação e marcação do reagente liofilizado HYNIC-Tyr3-octreotato (HYNIC-octreotato) com 99mTc, baseado em metodologia descrita na literatura, utilizando tricina e EDDA (ácido etilenodiaminadiacetico) como coligantes. Foram estudados os parâmetros de marcação (tempo de incubação, temperatura, volume e atividade do pertecnetato de sódio) e estabilidade do liofilizado. Adicionalmente, estudou-se a influência de pré-congelamento com nitrogênio (N2) líquido na estabilidade do liofilizado, bem como a influência de manitol na pureza radioquímica e biodistribuição do complexo. Os estudos de estabilidade revelaram que o método de liofilização utilizado, empregando o pré-congelamento com nitrogênio líquido possibilitou a obtenção de um reagente liofilizado com estabilidade de 4 meses quando armazenado sob refrigeração. A estabilidade do reagente liofilizado obtido sem pré-congelamento com nitrogênio líquido foi semelhante à obtida com o pré-congelamento.Os estudos de marcações determinaram as melhores condições de marcação, para as quais se obteve pureza radioquímica maior que 90%.A presença de manitol na formulação não influenciou na formação do complexo HYNIC-Octreotato-99mTc, conforme avaliação realizada por CLAE e estudos cintilográficos de distribuição do composto em coelhos.Estudos de biodistribuição invasivos realizados em camundongos Nude com tumor (células AR42J de tumor pancreático) e camundongos Swiss normais, bem como estudos cintilográficos realizados em coelhos e camundongos Nude revelaram cinética de distribuição rápida, acúmulo renal e captação tumoral significativa do peptídeo radiomarcado. Os resultados dos estudos de marcação com 99mTc, produção de reagente liofilizado e biodistribuição sugerem que o radiofármaco HYNIC-octreotato-99mTc apresenta potencial para aplicação em diagnóstico de tumores neuroendócrinos em medicina nuclear. / The development of radiolabeled molecules with high specificity for an organ or tumor has been contributed to the precise diagnostic in nuclear medicine. Somatostatin labeled derivatives constitutes a particular example of labeled peptide applied in the localization of neuroendocrine tumors. Nowadays, the 111In-DTPA-octreotideo is the radiopharmaceutical applied in diagnostic procedures for the visualization of tumors with high expression of somatostatin receptors. However, the 111-indium is a radionuclide that presents some limitations related to availability (cyclotron production), half-life (67 hours) and the emission of medium energy photons (171 keV e 245 keV), not favorable to the acquisition of images in SPECT (Single Photon Emission Computed Tomography). The favorable physical properties of the 99m-technetium (99mTc) make this radionuclide the more favorable to substitute the 111-indium on peptide labeling procedures. This work studied the preparation and labeling of a lyophilized kit of HYNIC-Tyr3-octreotate (HYNIC-octreotate) with 99mTc, base on previously described procedures and using tricine and EDDA (ethylendiaminediacetic acid) as coligands. It was studied the labeling parameters (incubation time, temperature, volume and perthecnetate activity) and the stability of the lyophilized preparation. Additionally, it was studied the influence of the pre-freezing using liquid nitrogen in the stability of the lyophilized preparation, as well as the influence of manitol in the labeling yield and biological distribution of the complex. The stability studies showed that the lyophilization using liquid nitrogen pre-freezing resulted in a lyophilized preparation with stability over 4 month when stored under refrigeration. The stability of the lyophilized preparation obtained without liquid nitrogen pre-freezing was similar.The labeling studies determined the best labeling conditions, resulting in a radiochemical yield superior than 90%. The use of manitol in the formulation did not influence the formation of the complex 99mTc-HYNIC-Octreotate, as evidenced in HPLC and in the scintigraphic studies of the complex biodistribution in rabbits. Invasive biodistribution studies using xenographed Nude mice (pancreatic tumor cells AR42J) and healthy Swiss mice, and scintigraphic studies in rabbits showed the fast kinetic distribution, renal uptake and significative tumoral uptake of the labeled peptide. The results of labeling studies with 99mTc, the production of the lyophilized kit and the biodistribution studies suggest that the 99mTc-HYNIC-Octreotate is a potential radiopharmaceutical to be applied in the diagnostic of neuroendocrine tumors in nuclear medicine.

O desenvolvimento de moléculas radiomarcadas com alta especificidade para um órgão ou tumor tem contribuído para a obtenção de um diagnóstico de precisão em medicina nuclear.Um caso particular são os peptídeos radiomarcados para a localização de tumores neuroendócrinos como os derivados sintéticos da somatostatina.Atualmente, o DTPA-octreotideo-111In é o radiofármaco mais utilizado com o propósito de visualizar tumores que expressem receptores para somatostatina. Contudo, o uso do indio-111 como radionuclídeo oferece limitações em relação a sua disponibilidade (produto de ciclotron), suas características físicas como meia-vida (67 horas) e emissor de fótons de média energia (171 keV e 245 keV) que não favorecem a obtenção de imagens tipo SPECT (Single Photon Emission Computed Tomography). As propriedades físicas favoráveis do tecnécio-99m (99mTc) fazem dele o radioisótopo mais adequado para substituir o indio-111 (111In) na marcação desses peptídeos. Este trabalho avaliou a preparação e marcação do reagente liofilizado HYNIC-Tyr3-octreotato (HYNIC-octreotato) com 99mTc, baseado em metodologia descrita na literatura, utilizando tricina e EDDA (ácido etilenodiaminadiacetico) como coligantes. Foram estudados os parâmetros de marcação (tempo de incubação, temperatura, volume e atividade do pertecnetato de sódio) e estabilidade do liofilizado. Adicionalmente, estudou-se a influência de pré-congelamento com nitrogênio (N2) líquido na estabilidade do liofilizado, bem como a influência de manitol na pureza radioquímica e biodistribuição do complexo. Os estudos de estabilidade revelaram que o método de liofilização utilizado, empregando o pré-congelamento com nitrogênio líquido possibilitou a obtenção de um reagente liofilizado com estabilidade de 4 meses quando armazenado sob refrigeração. A estabilidade do reagente liofilizado obtido sem pré-congelamento com nitrogênio líquido foi semelhante à obtida com o pré-congelamento.Os estudos de marcações determinaram as melhores condições de marcação, para as quais se obteve pureza radioquímica maior que 90%.A presença de manitol na formulação não influenciou na formação do complexo HYNIC-Octreotato-99mTc, conforme avaliação realizada por CLAE e estudos cintilográficos de distribuição do composto em coelhos.Estudos de biodistribuição invasivos realizados em camundongos Nude com tumor (células AR42J de tumor pancreático) e camundongos Swiss normais, bem como estudos cintilográficos realizados em coelhos e camundongos Nude revelaram cinética de distribuição rápida, acúmulo renal e captação tumoral significativa do peptídeo radiomarcado. Os resultados dos estudos de marcação com 99mTc, produção de reagente liofilizado e biodistribuição sugerem que o radiofármaco HYNIC-octreotato-99mTc apresenta potencial para aplicação em diagnóstico de tumores neuroendócrinos em medicina nuclear. / The development of radiolabeled molecules with high specificity for an organ or tumor has been contributed to the precise diagnostic in nuclear medicine. Somatostatin labeled derivatives constitutes a particular example of labeled peptide applied in the localization of neuroendocrine tumors. Nowadays, the 111In-DTPA-octreotideo is the radiopharmaceutical applied in diagnostic procedures for the visualization of tumors with high expression of somatostatin receptors. However, the 111-indium is a radionuclide that presents some limitations related to availability (cyclotron production), half-life (67 hours) and the emission of medium energy photons (171 keV e 245 keV), not favorable to the acquisition of images in SPECT (Single Photon Emission Computed Tomography). The favorable physical properties of the 99m-technetium (99mTc) make this radionuclide the more favorable to substitute the 111-indium on peptide labeling procedures. This work studied the preparation and labeling of a lyophilized kit of HYNIC-Tyr3-octreotate (HYNIC-octreotate) with 99mTc, base on previously described procedures and using tricine and EDDA (ethylendiaminediacetic acid) as coligands. It was studied the labeling parameters (incubation time, temperature, volume and perthecnetate activity) and the stability of the lyophilized preparation. Additionally, it was studied the influence of the pre-freezing using liquid nitrogen in the stability of the lyophilized preparation, as well as the influence of manitol in the labeling yield and biological distribution of the complex. The stability studies showed that the lyophilization using liquid nitrogen pre-freezing resulted in a lyophilized preparation with stability over 4 month when stored under refrigeration. The stability of the lyophilized preparation obtained without liquid nitrogen pre-freezing was similar.The labeling studies determined the best labeling conditions, resulting in a radiochemical yield superior than 90%. The use of manitol in the formulation did not influence the formation of the complex 99mTc-HYNIC-Octreotate, as evidenced in HPLC and in the scintigraphic studies of the complex biodistribution in rabbits. Invasive biodistribution studies using xenographed Nude mice (pancreatic tumor cells AR42J) and healthy Swiss mice, and scintigraphic studies in rabbits showed the fast kinetic distribution, renal uptake and significative tumoral uptake of the labeled peptide. The results of labeling studies with 99mTc, the production of the lyophilized kit and the biodistribution studies suggest that the 99mTc-HYNIC-Octreotate is a potential radiopharmaceutical to be applied in the diagnostic of neuroendocrine tumors in nuclear medicine.

Η Σωματοστατίνη (SRIF) είναι μια ορμόνη του υποθαλάμου. Ραδιοεπισημασμένα ανάλογα της χρησιμοποιούνται στη σπινθηρογραφική απεικόνιση όγκων που υπερεκφράζουν υποδοχείς της (στοχευμένη διάγνωση). Μειονεκτήματα της στοχευμένης διάγνωσης είναι η υψηλή και παρατεταμένη εντόπιση της ακτινοβολίας στους νεφρούς και η πρόσληψη των ραδιοπεπτιδίων από όργανα μη στόχους. Στόχος της παρούσας διατριβής είναι η ανάπτυξη νέων αναλόγων της SRIF τα οποία να πληρούν τις απαραίτητες προϋποθέσεις ώστε να καταστούν νέα διαγνωστικά μέσα. Αναπτύχθηκαν 33 νέα συνθετικά παράγωγα της SRIF. Σε πρώτη φάση συνετέθησαν απλά ανάλογα της SRIF. Ακολούθησε αξιολόγηση και σε αυτά τα οποία παρουσίαζαν ικανοποιητική συμπεριφορά σε σχέση με την συγγένεια τους με τον υποδοχέα και την πολικότητα τους συζεύχθηκε τετρααμινικός υποκαταστάτης για σύμπλεξη ραδιομετάλλου. Συνετέθησαν επίσης διμερή ανάλογα της SRIF και γλυκοπεπτιδικά ανάλογα. Τα πεπτίδια συντέθηκαν εφαρμόζοντας τεχνικές της Fmoc/tBu μεθοδολογίας. Ο συνδυασμός των μεθόδων που εφαρμόστηκαν οδήγησε στη λήψη των επιθυμητών δομών σε υψηλές αποδόσεις και καθαρότητα. Από τα αποτελέσματα των μελετών ανταγωνιστικής δέσμευσης τα οποία έγιναν σε μεμβράνες κυττάρων AR4-2J, αποδείχτηκε ότι όλα τα ανάλογα διαθέτουν πολύ υψηλές τιμές IC50. Ικανοποιήθηκε επίσης η απαίτηση για αύξηση της πολικότητας τους. Τα νέα ανάλογα πληρούν καταρχήν τις απαραίτητες προϋποθέσεις ώστε να καταστούν υποψήφια νέα διαγνωστικά μέσα και να βρουν κλινική εφαρμογή. Αναμένεται τα τελικά ραδιοπεπτίδια να οδηγούν σε μειωμένη πρόσληψη της ακτινοβολίας από τα όργανα μη στόχους και να εμφανίζουν αυξημένη απέκκριση από τους νεφρούς. Από προκαταρτικά πειράματα βρέθηκε ότι τα πιο πάνω επετεύχθησαν. / Somatostatin is a hyrothalamic regulatory peptide hormone with a pan-antisecretory profile. A large variety of human tumors are expressing multple somatostatin receptors. Synthetic somatostatin analogues radiolabelled with a variety of metallic radionuclide’s are used for the diagnosis and staging of sstr positive tumors but there is the main problem of high accumulation of the radiopeptides on non target organs and the high renal uptake of the radioactivity which leads to nephrotoxicity. Aim of this study was the development of new SRIF analogues as candidate useful clinical tools for the diagnosis and staging of sstr positive tumors. There have been developed thirty three new SRIF analogues and a glycoaminoacid suitable for use in SPPS. First, new analogues of [Tyr3]Octreotate were developed and the best of them, these that satisfied the relation between polarity and binding affinity to the sstr2, were coupled with a tetraaminic chelator ligand for the future complexation of a radionuclide. In other approach peptide dimers were developed. New glycopeptides were also developed. All analogues were synthesized on the solid phase applying several techniques of Fmoc/tBu strategy in high yield and purity. The binding affinity of the new SRIF analogs was checked with experiments of competitive binding with membranic preparations of AR42J cells, positive on SRIF receptors. All the new analogues are able to bind the sstr2 with high affinities. The new analogues accomplish the pre-condition to become new and useful clinical tools after their radiolabelling in the field of peptide-receptor imaging. It is expected that the new molecules will be able to have increased renal excretion via the kidneys and low non target accumulation. From preliminary experiments was shown that the above were succeeded.