Designed ankyrin repeat proteins (DARPins) are a class of engineered scaffold proteins (ESPs) with a molecular weight of approximately 15 kDa and a picomolar affinity for tumor antigen targets. Proof-of-concept studies have demonstrated the potential of DARPin radioimmunodiagnostics in humans. However, a high accumulation of activity in the kidneys limits their use in conventional radionuclide therapy. A peptide nucleic acid (PNA)-based pretargeted approach was successfully applied to Affibody molecules, another class of ESP. We hypothesized that this method could also enable the controlled conversion of DARPins into pretargeting probes. In this proof-of-principle study, we tested this hypothesis using the human epidermal growth factor receptor type 2 (HER2)-targeting DARPin G3 as a model. Methods: We performed site-specific coupling of PNA to the DARPin using sortase A-mediated ligation. The DARPin G3 was modified at the C-terminus with a sortase A recognition sequence. A GGG-modified hybridization probe (HP1) containing a 15-base PNA sequence was attached to G3 using sortase A, creating the primary agent G3-HP1. To evaluate cell binding specificity and biodistribution, G3-HP1 was labeled with 125I. The complementary PNA-based secondary probe HP2 containing the DOTA chelator was labeled with 177Lu. In vitro studies were performed in HER2-expressing cell lines. Biodistribution and in vivo targeting and pretargeting specificity were evaluated in mice with HER2-positive SKOV-3 and HER2-negative Ramos xenografts. In vivo pretargeting of [177Lu]Lu-HP2 using G3-HP1 was head-to-head compared with Affibody molecule-mediated pretargeting using ZHER2:342-HP1 and with direct targeting using [177Lu]Lu-DOTA-G3. Results: [125I]I-G3-HP1 demonstrated specific binding to HER2-expressing cells with picomolar affinity. [177Lu]Lu-HP2 showed HER2-specific and PNA-dependent binding to G3-HP1-pretreated cells with subnanomolar affinity. Biodistribution studies confirmed HER2-specific tumor uptake of [125I]I-G3-HP1. The uptake of [177Lu]Lu-HP2 in xenografts was HER2-dependent and PNA-mediated in the case of G3-HP1 preinjection. The pretargeting approach increased the tumor uptake 8-fold compared with direct targeting using [177Lu]Lu-DOTA-G3. Pretargeting substantially decreased the uptake in the kidneys (-9-fold), liver (-370-fold), and spleen (6.5-fold). The biodistribution and the tumor uptake of [177Lu]Lu-HP2 were strikingly similar in the cases of Affibody-and DARPin-based pre-targeting. Conclusion: Sortase A-mediated coupling enables the development of a PNA-based pretargeting system for DARPin G3, expanding the application of this approach to another class of ESPs.

Radiolabeled targeting agents have emerged as valuable tools for the treatment of disseminated cancer. Monoclonal antibodies (mAbs) are widely employed as carriers for diagnostic and therapeutic radionuclides due to their exceptional specificity and affinity. However, their prolonged circulatory half-life can diminish diagnostic efficacy and increase radiation exposure to non-target tissues in therapeutic applications, resulting in dose-limiting toxicities. To overcome this limitation, pretargeting technologies emerge as promising strategies to enhance tumor-to-background ratio and reduce radiation exposure of healthy tissues. Our previous work introduced a pretargeting concept leveraging the specific interaction between two peptide nucleic acid (PNA) probes, HP1 and HP2, as the recognition mechanism. This early iteration of the PNA-based concept showed limited efficacy when used with mAb-based vectors. To improve its performance, we re-engineered the primary and secondary targeting agents by incorporating newly designed PNA-probes. As the primary targeting agent, we functionalized trastuzumab (T), a well-characterized human epidermal growth factor receptor 2 (HER2)-targeting IgG1 mAb, with a 9-mer PNA probe (HP9). Both FcIII-based covalent UV-light crosslinking and enzyme-mediated glyco-engineering click-chemistry methods were applied to generate trastuzumab-PNA conjugates T-FcIII-HP9 and T-gly-HP9, respectively. As a radionuclide-carrying secondary agent, we utilized a 9-mer complementary PNA probe, HP16, which forms a stable duplex with HP9 as well as displaying favorable in vivo kinetics. Biacore and flow cytometry assessment of the HP9-conjugated trastuzumab agents demonstrated retained HER2-binding properties. The secondary HP16 probe, labeled with either a dye or a radionuclide, showed cell surface accumulation contingent on the presence of HP9 on the primary HER2-targeting agents. In vivo, T-gly-HP9 exhibited significantly longer blood circulation half-life and superior tumor uptake compared to T-FcIII-HP9. Further, therapeutic dosing with [177Lu]-HP16 of trastuzumab-HP9 pretargeted HER2+ tumor models resulted in significantly delayed disease progression and extended survival compared to untreated subjects. Furthermore, pretargeted [177Lu]-HP16 exhibited comparable efficacy to [177Lu]-trastuzumab in both delaying disease progression and prolonging survival. In conclusion, the optimization of our PNA-based pretargeting system has resulted in exceptional in vivo targeting characteristics and therapeutic efficacy, validating the potential of this novel approach.

Targeting the gastrin-releasing peptide receptor (GRPR) with the bombesin analogue RM26, a 9 aa peptide, has been a promising strategy for cancer theranostics, with recent success in radionuclide imaging of prostate cancer. However, therapeutic application of the short peptide RM26 would require a longer half-life to prevent fast clearance from the circulation. Conjugation to an albumin-binding domain (ABD) is a viable strategy to extend the in vivo half-life of peptides and proteins. We previously reported an ABD-fused RM26 peptide targeting GRPR (ABD-RM26 Gen 1) that showed prolonged and stable tumor uptake over 144 h; however, the observed high kidney uptake indicated that the conjugate’s binding to albumin was reduced and that this could be an obstacle for its use as a delivery system for targeted therapy, especially for radiotherapy. Here, we have designed, produced, and preclinically evaluated a series of novel ABD-RM26 conjugates with the aim of improving the conjugate’s binding to albumin and decreasing the kidney uptake. We developed three second-generation constructs with varying formats, differing in the relative positions of the targeting moieties and the radionuclide chelator. The produced conjugates were radiolabeled with indium-111 and evaluated in vitro and in vivo. All constructs displayed improved biophysical characteristics, biodistribution, and lower kidney uptake compared to previously reported first-generation molecules. The ABD-RM26 Gen 2A conjugate showed the best biodistribution profile with a nearly 6-fold reduction in kidney uptake. However, the ABD-RM26 Gen 2A conjugate’s binding to GRPR was compromised. This conjugate’s assembly of albumin- and GRPR-binding moieties might be used for further development of drug conjugates for targeted therapy/radiotherapy of GRPR-expressing cancers.

Antibody radionuclide conjugates are an emerging modality for targeted imaging and potent therapy of disseminated disease. Coupling of radionuclides to monoclonal antibodies (mAbs) is typically achieved by applying non-site-specific labelling techniques. With the ambition of reducing variability, increasing labelling efficacy and stability, several site-specific conjugation strategies have been developed in recent years for toxin- and fluorophore-mAb conjugates. In this study, we studied two site-specific labelling strategies for the conjugation of the macrocyclic chelating agent, DOTA, to the anti-Leucine Rich Repeat Containing 15 (LRRC15) mAb DUNP19. Specifically, one approach utilized a DOTA-bearing peptide (FcIII) with a strong affinity for the fragment crystallizable (Fc) domain of the human IgG1 of DUNP19 (DUNP19LF-FcIII-DOTASS), while the other leveraged a chemo-enzymatic technique to substitute the N-linked bi-antennary oligosaccharides in the human IgG1 Fc domain with DOTA (DUNP19LF-gly-DOTASS). To assess if these methods impact the antibody's binding properties and targeting efficacy, comparative in vitro and in vivo studies of the generated DUNP19-conjugates were performed. While the LRRC15 binding of both radioimmunoconjugates remained intact, the conjugation methods had different impacts on their abilities to interact with FcRn and FcγRs. In vitro assessments of DUNP19LF-FcIII-DOTASS and DUNP19LF-gly-DOTASS demonstrated markedly decreased affinity for FcRn and FcγRIIIa (CD16), respectively. DUNP19LF-FcIII-DOTASS demonstrated increased blood and tissue kinetics in vivo, confirming loss of FcRn binding. While the ablated FcγR interaction of DUNP19LF-gly-DOTASS had no immediate impact on in vivo biodistribution, reduced immunotherapeutic effect can be expected in future studies as a result of reduced NK-cells interaction. In conclusion, our findings underscore the necessity for meticulous consideration and evaluation of mAb labelling strategies, extending beyond mere conjugation efficiency and radiolabeling yields. Notably, site-specific labelling methods were found to significantly influence the immunological impact of Fc interactions. Therefore, it is of paramount importance to consider the intended diagnostic or therapeutic application of the construct and to adopt conjugation strategies that ensure the preservation of critical pharmacological properties and functionality of the antibody in use.

Affibody-mediated PNA-based pretargeting shows promise for HER2-expressing tumor radiotherapy. In our recent study, a 15-mer ZHER2:342-HP15 affibody-PNA conjugate, in combination with a shorter 9-mer [177Lu]Lu-HP16 effector probe, emerged as the most effective pretargeting strategy. It offered a superior tumor-to-kidney uptake ratio and more efficient tumor targeting compared to longer radiolabeled effector probes containing 12 or 15 complementary PNA bases. To enhance the production efficiency of our pretargeting system, we here introduce even shorter 6-, 7-, and 8-mer secondary probes, designated as HP19, HP21, and HP20, respectively. We also explore the replacement of the original 15-mer Z-HP15 primary probe with shorter 12-mer Z-HP12 and 9-mer Z-HP9 alternatives. This extended panel of shorter PNA-based probes was synthesized using automated microwave-assisted methods and biophysically screened in vitro to identify shorter probe combinations with the most effective binding properties. In a mouse xenograft model, we evaluated the biodistribution of these probes, comparing them to the Z-HP15:[177Lu]Lu-HP16 combination. Tumor-to-kidney ratios at 4 and 144 h postinjection of the secondary probe showed no significant differences among the Z-HP9:[177Lu]Lu-HP16, Z-HP9:[177Lu]Lu-HP20, and the Z-HP15:[177Lu]Lu-HP16 pairs. Importantly, tumor uptake significantly exceeded, by several hundred-fold, that of most normal tissues, with kidney uptake being the critical organ for radiation therapy. This suggests that using a shorter 9-mer primary probe, Z-HP9, in combination with 9-mer HP16 or 8-mer HP20 secondary probes effectively targets tumors while minimizing the dose-limiting kidney uptake of radionuclide. In conclusion, the Z-HP9:HP16 and Z-HP9:HP20 probe combinations offer good prospects for both cost-effective production and efficient in vivo pretargeting of HER2-expressing tumors. 

NOVELTY - A pre-targeting system comprising an anti-cluster of differentiation (CD)38 single-domain antibody (sdAb) and a second agent capable of specifically binding to the anti-CD38 sdAb and comprising a second molecule is new, where the antibody comprises an amino acid sequence that comprises 3 complementary determining regions (CDR1-CDR3). The CDR1 is chosen from (a) an amino acid sequence of SEQ ID NO: 1, (b) polypeptides that have at least 80% amino acid sequence identity with SEQ ID NO: 1, and (c) polypeptides that have 3, 2 or 1 amino acid difference with SEQ ID NO: 1. The CDR2 is chosen from (a) an amino acid sequence of SEQ ID NO: 2, (b) polypeptides that have at least 80% amino acid sequence identity with SEQ ID NO: 2, (c) polypeptides that have 3, 2 or 1 amino acid difference with SEQ ID NO: 2.

USE - The pre-targeting system is useful in kit of parts or medicine or diagnostics for diagnosing, monitoring and treating neoplastic disease in subject, and evaluating or monitoring presence, location and/or amount of CD38-expressing cells in subject. The neoplastic disease is a solid tumor. The neoplastic disease is hepatocellular carcinoma, lung cancer, melanoma, breast cancer or glioma, preferably hematological malignancy. The neoplastic disease is multiple myeloma, non-Hodgkin lymphoma (NHL) or chronic lymphoid leukemia (CLL), preferably multiple myeloma (all claimed).

ADVANTAGE - The system exhibits excellent cytotoxic effect on CD38-expressing neoplastic cells.

DETAILED DESCRIPTION - A pre-targeting system comprising an anti-cluster of differentiation (CD)38 single-domain antibody (sdAb) and a second agent capable of specifically binding to the anti-CD38 sdAb and comprising a second molecule is new, where the antibody comprises an amino acid sequence that comprises 3 complementary determining regions (CDR1-CDR3). The CDR1 is chosen from (a) an amino acid sequence of SEQ ID NO: 1, (b) polypeptides that have at least 80% amino acid sequence identity with SEQ ID NO: 1, and (c) polypeptides that have 3, 2 or 1 amino acid difference with SEQ ID NO: 1. The CDR2 is chosen from (a) an amino acid sequence of SEQ ID NO: 2, (b) polypeptides that have at least 80% amino acid sequence identity with SEQ ID NO: 2, (c) polypeptides that have 3, 2 or 1 amino acid difference with SEQ ID NO: 2. The CDR3 is chosen from (a) a 18 amino acid sequence (SEQ ID NO: 3) fully defined in the specification, (b) polypeptides that have at least 80% amino acid sequence identity with SEQ ID NO: 3, and (c) polypeptides that have 3, 2 or 1 amino acid difference with SEQ ID NO: 3. Tyr-Thr-Asp-Ser-Asp-Tyr-Ile (SEQ ID NO: 1), and Thr-Ile-Tyr-Ile-Gly-Gly-Thr-Tyr-Ile-His (SEQ ID NO: 2).

INDEPENDENT CLAIMS are included for the following:

• kit of parts comprising the pre-targeting system;
• use of pre-targeting system or kit of parts in medicine or diagnostics for diagnosing, monitoring and treating a neoplastic disease in a subject; and
• imaging method for evaluating or monitoring presence, location and/or amount of CD38-expressing cells in a subject involves (i) detecting, in a subject to whom a detectable quantity of the pre-targeting system, and (ii) generating an image representative of the location and/or quantity or intensity of the signal, where the second agent comprises a signal-emitting molecule, has been administered, signal emitted by said signal-emitting molecule.