[18F]FLUDA – A promising PET probe for the non-invasive assessment of the A2A adenosine receptor

Introduction: The A2A adenosine receptor (A2AAR) is expressed in brain, vasculature and immune cells. According to the alterations of the A2AAR expression in multiple diseases, it is a highly attractive diagnostic and therapeutic target. We developed the A2AAR-specific PET radiotracer [18F]FLUDA and investigated it in healthy mice and piglets, in a rotenone-based mouse model of Parkinson’s disease (RMMPD) and in transgenic mice overexpressing the human A2AAR in heart (TG) [1 3].

Methods: On the basis of a one-pot two-step radiofluorination procedure, a remotely controlled automated radiosynthesis of [18F]FLUDA using the TRACERlab FX2N synthesis module was developed. In vitro autoradiography was performed with cryosections of tissue from animal models. In vivo stability was investigated in mouse by radio-HPLC analyses of blood plasma and brain homogenates. The biodistribution was investigated by dynamic PET/MR studies in healthy mice and piglets under control and blocking conditions (vehicle vs. blocking with 2.5 mg/kg tozadenant and/or 1.0 mg/kg istradefylline) and in both mouse models. The binding potential (BPND) in vivo was calculated using the simplified reference tissue modelling with the cerebellum as reference region. A single dose acute toxicity study was performed in Wistar rats according to the ICH guideline M3(R2). PET-derived radiation dosimetry was estimated in piglets.

Results: A reliable and reproducible procedure for the automated production of [18F]FLUDA was successfully established (Fig. 1A) [4]. In vitro autoradiography revealed highly selective binding and high affinity of [18F]FLUDA towards the A2AAR of the three species (KD values 0.7-5.9 nM, Fig. 1B). At 15 min after i.v. injection of [18F]FLUDA in mice, the parent fraction accounted for about 100% in brain and 71% in plasma. PET studies confirmed the specific binding of [18F]FLUDA in vivo to the striatal A2AAR in mice and piglets (BPND=3.9 and 1.3, Fig. 1C). The availability of A2AAR in the Parkinson’s disease model was not significantly different from the control. The cardiac overexpression of human A2AAR resulted in a significantly higher accumulation of activity compared to control (1.4-fold higher ratio of the area-under-the curves obtained for myocard and blood, 1-10 min p.i., p=0.001). Toxicity studies revealed no adverse effects up to a dose of 30 µg/kg of FLUDA (approx. 4,000-fold of expected human dose). The estimated effective dose of [18F]FLUDA in humans is 16.4 µSv/MBq, which is in the range of other 18F-labeled radiotracers [5].

Conclusion: We have demonstrated that [18F]FLUDA is suitable for the determination of the availability of A2AAR in the brain in vitro and in vivo. No safety concerns are expected upon administration of [18F]FLUDA according to toxicity and dosimetry data. These results encourage the clinical translation of [18F]FLUDA.

Acknowledgement: This work (project no. 100226753) was funded by the European-Regional-Development-Fund (ERDF) and Sächsische-Aufbaubank (SAB).

References: [1] T.H. Lai and M. Toussaint et al., EJNNMI 2021, 48:2727–2736; [2] D. Gündel and M. Toussaint, Pharmaceuticals 2022, 15; [3] D. Gündel et al., Int. J. Mol. Sci. 2022, 23, 1025; [4] T.H. Lai et al., J. Label. Compd. Radiopharm. 2022, 65:162–166; [5] B. Sattler et al., J. Nucl. Med. 2020, 61:1014.