Imaging is increasingly used to detect and monitor bacterial
infection.
Both anatomic (X-rays, computed tomography, ultrasound, and MRI) and
nuclear medicine ([111In]-WBC SPECT, [18F]FDG
PET) techniques are used in clinical practice but lack specificity
for the causative microorganisms themselves. To meet this challenge,
many groups have developed imaging methods that target pathogen-specific
metabolism, including PET tracers integrated into the bacterial cell
wall. We have previously reported the d-amino acid derived
PET radiotracers d-methyl-[11C]-methionine, d-[3-11C]-alanine, and d-[3-11C]-alanine-d-alanine, which showed robust bacterial accumulation in vitro and in vivo. Given the clinical
importance of radionuclide half-life, in the current study, we developed
[18F]3,3,3-trifluoro-d-alanine (d-[18F]-CF3-ala), a fluorine-18 labeled tracer. We
tested the hypothesis that d-[18F]-CF3-ala would be incorporated into bacterial peptidoglycan given its
structural similarity to d-alanine itself. NMR analysis showed
that the fluorine-19 parent amino acid d-[19F]-CF3-ala was stable in human and mouse serum. d-[19F]-CF3-ala was also a poor substrate for d-amino acid oxidase, the enzyme largely responsible for mammalian d-amino acid metabolism and a likely contributor to background
signals using d-amino acid derived PET tracers. In addition, d-[19F]-CF3-ala showed robust incorporation
into Escherichia coli peptidoglycan,
as detected by HPLC/mass spectrometry. Based on these promising results,
we developed a radiosynthesis of d-[18F]-CF3-ala via displacement of a bromo-precursor with [18F]fluoride followed by chiral stationary phase HPLC. Unexpectedly,
the accumulation of d-[18F]-CF3-ala
by bacteria in vitro was highest for Gram-negative
pathogens in particular E. coli. In
a murine model of acute bacterial infection, d-[18F]-CF3-ala could distinguish live from heat-killed E. coli, with low background signals. These results
indicate the viability of [18F]-modified d-amino
acids for infection imaging and indicate that improved specificity
for bacterial metabolism can improve tracer performance.