Conspectus
Magnetic resonance imaging (MRI)
is a clinical imaging modality
that provides high-resolution images of soft tissues, including cancerous
lesions. Stable gadolinium(III) chelates have been used as contrast
agents (CA) in MRI to enhance the contrast between the tissues of
interest and surrounding tissues for accurate diagnostic imaging.
Magnetic resonance molecular imaging (MRMI) of cancer requires targeted
CA to specifically elucidate cancer-associated molecular processes
and can provide high-resolution delineation and characterization of
cancer for precision medicine. The main challenge for MRMI is the
lack of sufficient sensitivity to detect the low concentration of
the cellular oncogenic markers. In addition, targeted CA must satisfy
regulatory safety requirements prior to clinical development. Up to
now, there is no FDA-approved targeted CA for MRMI of cancer.
In this Account, we discuss the latest developments in the design
and development of clinically translatable targeted CA for MRMI of
cancer, with an emphasis on our own research. The primary limitation
of MRMI can be overcome by designing small molecular targeted CA to
target abundant cancer-specific targets found in the tumor microenvironment
(TME). For example, aggressive tumors have a unique extracellular
matrix (ECM) composed of oncoproteins, which can be used as targetable
markers for MRMI. We have designed and prepared small peptide conjugates
of clinical contrast agents, including Gd-DTPA and Gd-DOTA, to target
fibrin-fibronectin clots in tumors. These small molecular CA have
been effective in enhancing MRMI detection of solid tumors and have
demonstrated the ability to detect submillimeter cancer micrometastases
in mouse tumor models, exceeding the detection limit of current clinical
imaging modalities. We have also identified extradomain B fibronectin
(EDB-FN), an oncofetal subtype of fibronectin, as a promising TME
target to leverage in the design and development of small peptide
targeted CA for clinical translation. The expression level of EDB-FN
is correlated with invasiveness of cancer cells and poor patient survival
of multiple cancer types. ZD2 peptide with a sequence of seven amino
acids (TVRTSAD) was identified to specifically bind to the EDB protein
fragment. Several ZD2 conjugates of macrocyclic GBCA, including Gd-DOTA
and Gd(HP-DO3A), have been synthesized and tested in mouse tumor models.
ZD2–N3-Gd(HP-DO3A) (MT218) with a high r1 relaxivity
was selected as the lead agent for clinical translation. The physicochemical
properties and preclinical assessments of MT218 are summarized in
this Account. MRMI of EDB-FN with MT218 can effectively detect invasive
tumors of multiple cancers with risk-stratification and monitor tumor
response to anticancer therapies in mouse models. Currently, MT218
is in clinical trials for precision cancer MRMI. Herein, we will show
that using targeted MRI contrast agents specific to abundant TME biomarkers
is a pragmatic solution for effective precision cancer imaging in
high spatial resolution. ...