Immunoscintigraphy of metastases with radiolabelled human antibodies.
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Biomedical subjects
Publications and source records attributed to M V Pimm.
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The rate of catabolism of a radiolabelled monoclonal anti-CEA antibody has been compared with that of control IgG1 in control nude mice and in mice with CEA producing xenografts and antigen negative xenografts. The rate of catabolism of antibody, but not of IgG, was increased 3-4 fold in mice with xenografts localizing the antibody, but not in mice with antigen negative tumours. There was no evidence of immune complex formation and/or clearance of antibody from the serum of xenografted mice and the current interpretation of these findings is that following tumour immune directed fixation, antibody is subsequently catabolized faster than in the general metabolic pool. The present data indicates that this is about six times as rapid as in the animal as a whole on a weight to weight tissue basis.
The immunoreactive fraction of an anti-CEA monoclonal antibody preparation has been progressively decreased by the addition of increasing proportions of impurity in the form of immunologically inert mouse immunoglobulin. Following radioiodination, the immunoreactive fractions of the preparations were determined and their localization in a human tumour xenograft in nude mice was assessed. There was a progressive decline in tumour localization, from tumour to blood ratios of 2:1 with unadulterated antibody to 0.6:1 with preparations only 15% with respect to the initial antibody. These findings demonstrate that the immunoreactive fraction of monoclonal antibody preparations is a major limiting factor in tumour localization and this has implications for experimental and clinical applications of monoclonal antibodies.
Three monoclonal anti-CEA antibodies, designated 161, 198 (both IgG1) and 228 (IgG2a) have been labelled with 111In via DTPA chelation and assessed for localization in human gastro-intestinal carcinomas as xenografts in athymic nude mice. Following reaction of the antibodies with DTPA anhydride, efficiency of chelation of 111In varied between the antibodies with mean values of 30%, 52% and 62% with 161, 198 and 228 respectively. Gel filtration chromatography with all three labelled antibodies showed radiolabel predominantly coincident with IgG with little radioactivity in either high molecular weight form or as free 111In. However, the efficiency of binding of radiolabelled antibodies to CEA producing tumour cells varied, with maxima of 42%, 65% and 20% for 161, 198 and 228. In vivo, in mice, 111In was excreted at virtually identical rates (half times approx. 12 days) with all three preparations and this was similar to the clearance of indium injected as 111In-indium chloride, but 111In-DTPA was rapidly eliminated (half time approximately 5 h). After injection into mice with CEA producing xenografts of colon carcinoma HT29 and LS174T and gastric carcinoma MKN 45, circulating radiolabel was still predominantly in the form of labelled antibody with little or no detectable immune complexes or 111In labelled transferrin. Tumour localization of all three antibodies was visualized by gamma camera imaging with target: non target ratios of up to 5:1. Dissection of mice with MKN45 gastric carcinoma xenograft showed 16%, 19.5% and 13% of the injected dose of 111In from 161, 198 and 228 antibodies in each g of tumour tissue.(ABSTRACT TRUNCATED AT 250 WORDS)
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The distribution in athymic nude mice of radiolabelled monoclonal antibody 791T/36 has been assessed during continuous infusion from subcutaneously implanted Alzet Osmotic Minipumps. During prolonged administration (up to 15 days) blood levels continued to rise. At 15 days, distribution of radiolabel was virtually identical to that seen after a single parenteral dose. Blood levels were in good agreement to those expected from whole body levels indicating satisfactory entry of antibody into the vascular compartment. Gel filtration chromatography of osmotic minipump contents and circulating radiolabel showed that the antibody had retained its structural integrity. In mice with human tumour xenografts examined a 5-day infusion of a mixture of 131I-791T/36 antibody and 125I-control IgG2b, blood levels of both radiolabels were comparable to those expected from whole body levels and there was effective tumour localization of the antibody to 2.5 times that of control IgG. These studies have demonstrated that prolonged administration of monoclonal antibody is feasible, that antibody enters the vascular compartment satisfactorily and that it can then localize in tumour deposits.
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One hundred twenty-three patients with suspected primary or recurrent gynecologic cancer were imaged after infusion with radiolabeled antitumor monoclonal antibody (791T/36). Overall sensitivity of tumor detection was 87% and specificity was 75%. Indium 111- and iodine 131-labeled antibody were compared, the former yielding a higher specificity for tumor detection. This antibody shows potential for routine tumor detection, particularly in cases of suspected recurrent cancer, but the development of antimouse antibodies is a drawback to this technique still to be overcome. The specific targeting of cytotoxic agents with this antibody is in progress.
The biodistribution of radiolabelled methotrexate and immune complexes of methotrexate and a murine monoclonal anti-methotrexate antibody has been compared in mice. Complexes formed in-vitro with the antibody, but not with control immunoglobulin. The complexes were, characteristically, acid labile. In-vivo, blood levels, organ distribution and whole body catabolism of methotrexate in immune complexes were similar to those of free antibody, and markedly different from those of free drug. These findings suggest the feasibility of prolonging the survival of drugs and altering in-vivo distribution using complexes with monoclonal antibodies.
The design and evaluation of drug-antibody conjugates for tumor therapy is considered with respect to the use of the anti-human osteogenic sarcoma monoclonal antibody designated 791T/36. Conjugates have been constructed by linking antibody to methotrexate; the agent has been linked to antibody, either directly or via a human serum albumin bridging agent. In each case, conjugates have been assessed for retention of antibody reactivity with osteogenic sarcoma target cells by comparing their capacity with that of unmodified antibody in competing with fluorescein isothiocyanate-labeled 791T/36 binding, as measured by flow cytometry. Retention of drug cytotoxicity was evaluated by in vitro cytotoxicity and colony inhibition assays. Conjugates with acceptable retention of drug and antibody reactivities were then examined for in vivo suppression of human tumor xenografts.
Monoclonal antibody 791T/36, prepared against a tumour-associated 72,000 dalton glycoprotein, reacted with cells from primary and metastatic colorectal carcinomas. I-131 or In-111-labelled antibody localized in xenografts of colorectal carcinomas established from in vitro clonogenic populations. Clinically, with I-131-labelled antibody, 8/11 colonic tumours imaged positively. Imaging was negative in four patients with benign colon disease. 5/11 rectal tumours were positively imaged, but excreted I-131 in the bladder obscured tumours in several studies. In-111-labelled antibody gave superior images and positively imaged primary and metastatic sites in 13/14 patients. Prospectively in the detection of recurrent disease, I-131 or In-111-antibody detected 29/33 separate sites in 24 patients. Seven negative patients remain disease free. There were 3 false positives; overall sensitivity was 88%, with 70% specificity. Specific localization of radiolabel was confirmed immunochemically and by counting radioactivity in resected specimens. Antibody conjugates with methotrexate, vindesine and daunomycin retained drug activity and antibody function, including xenograft localization and conjugates were therapeutically effective against xenografts. 791T/36 antibody has potential for immunodetection of primary and recurrent colorectal carcinoma and for targeting of therapeutic agents.
The radiolabeled monoclonal antibody 791T/36 raised against a human osteosarcoma was injected into 20 patients with known or suspected bone tumors. Gamma camera images were acquired at 48 or 72 hours after injection, and assessed for antibody localization. Positive images were obtained in all five osteosarcomas and four other primary malignant sarcomas. Two of the four other primary bone tumors gave positive images. Three patients with trauma had negative images as did one patient with Paget's disease. Two patients with suppurative disease gave positive images. The antibody localized in the majority of malignant sarcomas tested. In one tumor where tissue was available, a tumor:non-tumor ratio of 2.8:1 was measured. Repeat imaging was performed in five patients. Immunoscintigraphy using the monoclonal antibody 791T/36 has shown tumor localization in patients with bone and soft tissue sarcomas.
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An IgG1 mouse monoclonal antibody directed against CEA has been digested with papain to yield F(ab)2 and Fab fragments. Following radioiodination, intact antibody and fragments showed specific binding to cells of a CEA-producing tumour, although the immune reactivities of the fragments were lower than that of intact antibody. Gamma scintigraphy of nude mice bearing CEA-producing human tumour xenografts and injected with 131I-labelled fragments showed earlier and superior imaging of tumours than did 131I-intact antibody, and this was most marked with the Fab fragment. Sequential dissection analyses showed that this was due to earlier and higher tumour-to-blood ratios with fragments than with intact antibody, but in absolute terms the degree of localization of both fragment types was significantly lower than that of intact antibody.
Cells from two adenocarcinomas, an adenoma and a metastatic node were isolated in soft agar. Expression of antigens, CEA, Y haptenic blood group and 791T-p72, defined by a range of candidate antibodies for tumour targeting was assessed. All of the cells expressed low levels of CEA but high levels of the Y haptenic blood group antigen although there was enormous inter and intraclonal variation. Of particular interest was the membrane expression of 791T-p72 antigen on all of the dividing tumour cells as previous studies had shown that 791T/36 antibody reacted with tumour stromal elements rather than malignant cell surfaces. The DNA content was abnormal in all of the cells whether they were derived from diploid or aneuploid primary tumours. They all grew readily in athymic mice and at least one monoclonal antibody, 791T/36, localised efficiently within these xenografts. Clonogenic cells therefore expressed the three tumour-associated antigens, several at higher levels than observed in the primary tumour. Monoclonal antibody 'cocktails' should therefore allow antibody mediated drug cytotoxicity to be effective at eradicating rapidly dividing tumour cells.
Preliminary clinical studies have been carried out to determine whether the monoclonal antibody 791T/36 would localize in primary lung cancer to an extent sufficient for external detection by gamma scintigraphy. Radiolabelling of the antibody with 131I permitted visualization of three out of eight (38%) tumours using planar imaging with 99Tcm-labelled blood pool subtraction. Radiolabelling of the same antibody with 111In permitted visualization of tumour uptake in nine out of 13 (69%) tumours, without the need for image subtraction. Single photon emission computed tomography (SPECT) studies of seven patients demonstrated concentration of 111In-labelled antibody at the tumour site in each case, four of which were visualized on the planar images. The present study demonstrates localization of the 791T/36 antibody in primary lung carcinoma and confirms the superiority of 111In over 131I as a radiolabel for antibody imaging, especially when emission tomography is performed. These data indicate that further work will be required to determine whether this antibody will be a suitable carrier for cytotoxic agents in the therapy of lung cancer.
Two monoclonal antibodies (anti-791T/36 and anti-791T/48) prepared against an osteogenic sarcoma cell line (791T) following xenogeneic immunization, reacted against the immunizing tumor, but not against normal cells from the tumor-donor, using an indirect 125I-protein A binding assay. Both antibodies cross-reacted with a small number of other osteogenic sarcomas and a few unrelated cell lines from an extensive panel, but the specificity of these cross-reactions was different. Both antibodies were labelled with 125I to detect direct binding to target cells, and the specificity of their reactivity was essentially identical to that observed in the indirect assay. Direct binding of each labelled antibody was inhibited by pretreating target cells with its unlabelled counterpart, but the two antibodies could not inhibit each other. The binding of anti-791T/36 was also not inhibited by pretreating the target cells with sera from the 791-T-tumor donor, which were shown to contain antibody reacting with the autochthonous tumor. It is concluded that 791T has two distinct tumor-associated antigens recognized by the monoclonal antibodies, and furthermore that at least one of these antigens is independent of those recognized by the patient from which the tumor cell line was derived. The efficacy of anti-791T/36 antibody labelled with radioactive iodine was demonstrated for localizing tumor deposits growing in immunodeprived mice.
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