SUMMARY

The present invention pertains to a precursor compound and therefrom derived radiotracer for imaging expression of fibroblast activation protein (FAP). The inventive precursor compound has the structure Ch-Ll-B-L2-TV, wherein

LI is a bifunctional linker moiety;

L2 is a bifunctional linker moiety;

B is absent or a bifunctional linker moiety;

LI is configured to covalently bind to Ch and L2 or to Ch and B, if B is present;

B, if present, is configured to covalently bind to LI and to L2; and

L2 is configured to covalently bind to LI and TV or to TV and B, if B is present.

BACKGROUND

Nuclear Medicine Diagnosis of Tumours with ⁶⁸ Ga

Positron Emission Tomography (PET) combined with Computed Tomography (CT) using Gallium-68 (Ga-68 or ⁶⁸ Ga) is today a well-established nuclear medicine examination. The U.S. Food and Drug Administration as well as the European Medicinal Agency approved Ga-68 labelled l,4,7,10-tetraazacyclododecane-l,4,7,10-tetraacetic acid (DOTA)-octreotate (DOTATATE) and DOTA(0)-d-Phe(l)-Tyr(3)-octreotide, or DOTATOC for localization of somatostatin receptor positive neuroendocrine tumours (NETs) in adult and paediatric patients (in US) and for adult patients who are thought to have so-called well-differentiated gastroenteropancreatic neuroendocrine tumours (GEP-NETs) (in EU). Recently prostate specific membrane antigen inhibitor PSMA-11 was approved for imaging and staging of metastasized prostate carcinomas. The diagnostic value of PET/CT is mainly driven by sensitivity, specificity and accuracy. Sensitivity measures the proportion of positives that are correctly identified (true-positives divided by the sum of true-positives and false-negatives). Specificity measures the proportion of negatives that are correctly identified (true-negatives divided by the sum of true-negatives and false-positives). Diagnostic accuracy relates to the ability of a test to discriminate between the target condition and health. This discriminative potential can be quantified by the measures of sensitivity and specificity, target to background ratios, or the area under the receiver operating characteristic curve (ROC curve).

Fibroblast activation protein (FAP), a membrane-bound serine protease, is currently gaining increasing attention in nuclear medicine for targeting different cancer types with FAP-specific radiolabeled agents for both diagnostics and therapy. FAP is overexpressed by cancer associated fibroblasts (CAFs) which are abundant in more than 90% of common human epithelial tumors. CAFs are a myofibroblastic phenotype and situated in the tumor stroma. Stromal cells comprise up to 90 % of the total tumor mass. FAP may also be expressed by fibroblasts present in wound healing, chronic inflammation, liver cirrhosis, rheumatoid arthritis, pulmonary fibrosis, bone and soft tissue sarcomas. However, in healthy tissue is FAP expression is practically absent. Hence, FAP-targeting radiopharmaceuticals are well suited for molecular imaging via PET or SPECT as well as radioendotherapy of cancer tumors and metastases.

Quinoline-glycine-4,4-difluoro-2-cyanopyrrolidine Inhibitor of FAP

A potent FAP inhibitor (FAPi), commonly designated as UAMC1110, is based on a quinoline- glycine-4,4-difluoro-2-cyanopyrrolidine scaffold. UAMC1110 has low nanomolar FAP affinity and high selectivity with respect to enzymes of the dipeptidyl peptidase (DPP) and prolyl oligopeptidase (PREP) family. The high FAP-selectivity of UAMC1110 is particularly attractive for tumor-targeting, when considering the near-ubiquitous expression of DPP and PREP in the human body. As PREP displays the same endopeptidase activity as FAP and is abundant in healthy organs and tissues, high FAP specificity is essential for potent FAP ligands. UAMC1110 exhibits FAP affinity in the low nM range and PREP and DPP4 affinity in the pM range. Hence, UAMC1110 based FAPi-radiopharmaceuticals have recently been applied in nuclear medicine.

Schema 1: FAP inhibitor UAMC1110 Chelators in radiometal-containing radiopharmaceuticals

The following properties are relevant for a precursor and therefrom derived radiotracer:

- fast and effective complexation of a diagostic or therapeutic radioisotope to the labeling group;

- high affinity and selectivity for tumor cells and metastases relative to healthy tissue;

- in vivo stability, i.e. biochemical persistence in blood serum under physiological conditions;

- high uptake in tumors and metastases for precise diagnosis and effective therapy;

- rapid clearance from healthy tissues and blood to minimize systemic dose and toxicity.

According to current knowledge in the art:

- the chelator and radioisotope greatly influence affinity and pharmacokinetics of radiotracers;

- DOTA can severely affect the affinity of a targeting ligand;

- chelator, radioisotope and targeting ligand interact unpredictably in synergistic or antagonistic manner.

Fani et al. report that the chelator moiety and the radiometal of a radiotracer can strongly affect the affinity of a targeting ligand. Reubi et al. show that conjugation of a targeting ligand with DOTA can substantially reduce its affinity to the targeted cellular receptor. The data presented by Reubi et al. indicates that a combination of chelator, radiometal and targeting ligand can yield a synergistic or antagonistic effect which are rarely predictable. In general conjugation of a targeting ligand with a linker and a large chelator moiety is non-beneficial and severly mutes affinity to the targeted cellular receptor.

The chelator DOTA, for example, is not well suited for complexing the relatively small (radio) metal Gallium and necessitates elevated reaction temperature which is detrimental for many antibodies and heat-sensitive biomolecules. After complexation ^S8 Ga-DOTA chelates require time for cooling prior to intravenous injection, thereby imposing limitations for clinical use due to the short ⁶⁸ Ga half-life of 67.7 min.

"Hybrid" chelator scaffolds DATA and AAZTA

DATA (l,4-bis(carboxymethyl)-6-[methyl-carboxymethyl-amino]-l,4-d iazepane) and AAZTA (l,4-bis(carboxymethyl)-6-[bis(carboxymethyl)-amino]-l,4-dia zepane) exhibit cyclic, acyclic and hybrid properties and has been found to be provide favorable labeling characteristics for ⁵⁸ Ga. In particular, DATA enables fast and quantitative ⁶⁸ Ga-labelling in a wide pH range at ambient temperature. Furthermore, [ ⁶⁸ Ga]Ga-DATA chelates are immune against transchelation (DTPA and apo-transferrin) and trans-metalation (Fe ¹¹¹ ) and stable in physiological milieu. DETAILED DESCRIPTION

The invention has the object to improve nuclear theranostics of endothelial cancer tumors and metastases that exhibit elevated FAP expression.

This object is achieved by a precursor compound having structure Ch-Ll-B-L2-TV, wherein LI is a bifunctional linker moiety;

L2 is a bifunctional linker moiety;

B is absent or a bifunctional linker moiety;

LI is configured to covalently bind to Ch and L2 or to Ch and B, if B is present;

B, if present, is configured to covalently bind to LI and to L2; and L2 is configured to covalently bind to LI and TV or to TV and B, if B is present. Expedient embodiments of the inventive precursor compound are characterized by one of the following features or a combination of two or more of the following features insofar the combined features are not mutually exclusive or contradictory and according to which: wherein each P' is present for 1 < i < k and absent for i > k with k = 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10; each P ^s with s = 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10, if present, independently from one another is selected from the group comprising -CH2-, -CH2CH2O-, -N(H)- , -C(O)- and -C(CH ₃ )-;

L2 has the structure wherein each Q is present for 1 < j < h and absent for j > h with h = 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10; each Q ^s with s = 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10, if present, independently from one another is selected from the group comprising -CH2-, -CH2CH2O-, -N(H)- , -C(O)- and -C(CH ₃ )-;

B is absent; the precursor compound has the structure the precursor compound has the structure the precursor compound has the structure the precursor compound has the structure the precursor compound has the structure

The invention has the further object to provide a radiotracer that affords improved nuclear theranostics of endothelial cancer tumors and metastases with elevated FAP expression.

This object is achieved through a radiotracer comprised of the above described precursor compound and therewith complexed radioisotope ⁶⁸ Ga.

Further expedient embodiments of the invention pertain to:

- a radiopharmaceutical kit comprising one of the above described precursor compounds or a salt thereof;

- a radiopharmaceutical kit comprising one of the above described precursor compounds or a salt thereof and a solvent selected from the group comprising water, 0.45% aqueous NaCI solution, 0.9% aqueous NaCI solution, Ringer solution (Ringer lactate), 5% aqueous dextrose solution and aqueous alcohol solution;

- a radiopharmaceutical kit comprising

- a vial containing one of the above described precursor compounds or a salt thereof;

- a radiopharmaceutical kit comprising

- a vial containing one of the above described precursor compounds or a salt thereof and a lyophilized buffering agent selected from the group comprising sodium acetate, gentisic acid, ascorbic acid, succinic acid, HEPES, sodium carbonate, sodium bicarbonate and salts thereof;

- a radiopharmaceutical kit comprising

- a first vial containing one of the above described precursor compounds or a salt thereof, and

- a second vial containing

- a solvent selected from the group comprising water, 0.45% aqueous NaCI solution, 0.9% aqueous NaCI solution, Ringer solution (Ringer lactate), 5% aqueous dextrose solution and aqueous alcohol solution, or

- a buffer solution configured to modulate the pH between 3 to 7.4. In this invention following synonymous compound designations are employed:

(S)-2,2'-(6-((carboxymethyl)(methyl)amino)-6-(5-((4-((4-( (2-(2-cyano-4,4-difluoropyrrolidin-l- yl)-2- oxoethyl)carbamoyl)quinolin-6-yl)oxy)butyl)amino)-5-oxopenty l)-l,4-diazepane-l,4- diyl)diacetic acid

(S)-2,2'-(6-((carboxymethyl)(methyl)amino)-6-(5-(4-(2-((4 -((4-((2-(2-cyano-4,4- difluoropyrrolidin-l-yl)- 2-oxoethyl)carbamoyl)quinolin-6-yl)oxy)butyl)amino)-2- oxoethyl)piperazin-l-yl)-5-oxopentyl)-l,4- diazepane-l,4-diyl)diacetic acid

(S)-2,2'-(6-((carboxymethyl)(methyl)amino)-6-(5-(4-((2-(( 4-((4-((2-(2-cyano-4,4- difluoropyrrolidin-l-yl)-2-oxoethyl)carbamoyl)quinolin-6-yl) oxy)butyl)amino)-2- oxoethyl)(methyl)amino)piperidin-l-yl)-5-oxopentyl)-l,4-diaz epane-l,4-diyl)diacetic acid

2,2'-(6-((carboxymethyl)(methyl)amino)-6-(5-(((S)-l-(2-(( 4-((4-((2-((S)-2-cyano-4,4- difluoropyrrolidin- l-yl)-2-oxoethyl)carbamoyl)quinolin-6-yl)oxy)butyl)amino)-2- oxoethyl)pyrrolidin-3-yl)amino)-5- oxopentyl)-l,4-diazepane-l,4-diyl)diacetic acid

2,2'-(6-((carboxymethyl)(methyl)amino)-6-(5-((S)-3-((2-(( 4-((4-((2-((S)-2-cyano-4,4- difluoropyrrolidin- l-yl)-2-oxoethyl)carbamoyl)quinolin-6-yl)oxy)butyl)amino)-2- oxoethyl)(methyl)amino)pyrrolidin-l-yl)- 5-oxopentyl)-l,4-diazepane-l,4-diyl)diacetic acid

2, 2'-(6-((carboxymethyl)(methyl)amino)-6-(5-((S)-3-((2-((4-((4 -((2-((S)-2-cya no-4,4- difluoropyrrolidin- l-yl)-2-oxoethyl)carbamoyl)quinolin-6-yl)oxy)butyl)amino)-2- oxoethyl)(methyl)amino)pyrrolidin-l-yl)- 5-oxopentyl)-l,4-diazepane-l,4-diyl)diacetic acid

(S)-N-(2-(2-cyano-4,4-difluoropyrrolidin-l-yl)-2-oxoethyl )qiiinoline-4-carboxamide EXAMPLES

Example 1: DATA ^5m Prochelator Synthesis

Schema 2 illustrates the synthesis of the DATA ^Sm prochelator (cf. J. Seemann, B. Waldron, D. Parker, F. Roesch; DATATOC: a novel conjugate for kit-type ^S8 Ga labelling of TOC at ambient temperature; EJNMMI Radiopharmacy and Chemistry (2016) 1:4, DOI 10.1186/s41181-016- 0007-3).

5-(l,4-Dibenzyl-6-nitro-[l, 4]diazepan-6-yl)-pentanoic acid methyl ester (1)

2-Nitrocyclohexanone (0.608 g, 4.3 mmol) is added to Amberlyst A21 (1.216 g, 2 mass equivalents) in EtOH and stirred for 2 h at 60 °C under argon. N,N'-Dibenzyl-ethylenediamine (1.020 g, 4.3 mmol) and paraformaldehyde (0.446 g, 14.9 mmol) were added and the reaction stirred at 60 °C overnight. The mixture is filtered through Celite®, and solvent removed under reduced pressure. The resulting residue is re-dissolved in CHCI3 (40 mL) and washed successively with aqueous K2CO3 solution (2 x 30 mL, 0.1 M) and H2O (30 mL), dried over MgSC , filtered and solvent removed under reduced pressure. Purification by silica gel column chromatography (DCM) afforded the title compound as a yellow oil (1.607 g, 85 %). Rf = 0.80 (DCM).

5-(l,4-Dibenzyl-6-nitro-[l,4]diazepan-6-yl)-pentanoic acid methyl ester (2)

A catalytic amount of Pd(OH)2/C and acetic acid (50 pL, 0.87 mmol) is added to the protected triamine 1 (0.10 g, 0.29 mmol) in MeOH (20 mL), and the mixture agitated under an atmosphere of hydrogen for 3 h (1 atm H2). TLC (DCM) is used to confirm complete reduction of the nitro group and cleavage of the benzyl N-substituents. Pd(OH)2/C is removed using a Celite® filter. The solvent is removed under reduced pressure to afford a yellow oil (0.065 g, 97 %).

5-[l,4-Bis-tert-butoxycarbonylmethyl-6-(tert-butoxycarbon ylmethyl-amino)-[l,4]diazepan-6- yl]-pentanoic acid methyl ester (3) tert-Butyl-bromoacetate (0.567 g, 2.91 mmol) is added to 2 (0.208 g, 0.91 mmol) and K2CO3 (0.377 g, 2.73 mmol) in MeCN (25 mL), and the mixture stirred for 24 h at 368 K under argon atmosphere. The reaction is monitored by TLC (hexane/ethyl acetate; 1:1) for formation of the tetraalkylated derivative. The solvent is removed under reduced pressure, and the resulting oil re-dissolved in CHCI3 (25 mL) and washed successively with aqueous K2CO3 solution (2 x 25 mL, 0.1 M) and H2O (25 mL), dried over MgSC , filtered and the solvent removed under reduced pressure. Purification by silica gel column chromatography (hexane/ethyl acetate, 2:1 1:1) affords a yellow oil (0.229 g, 44 %). Rf = 0.35 (hexane/ethyl acetate; 2:1). 5-[l,4-Bis-tert-butoxycarbonylmethyl-6-(tert-butoxycarbonylm ethyl-methyl-amino)- [l,4]diazepan-6-yl]-pentanoic acid methyl ester (4) lodomethane (0.023 g, 0.16 mmol) is added to 3 (0.104 g, 0.18 mmol) and K2CO3 (0.025 g, 0.18 mmol) in DCM/MeCN (3:1) cooled in an ice-bath. The reaction mixture is allowed to warm to room temperature and left overnight. The solvent is removed under reduced pressure and the resulting oil re-dissolved in CHCI3 (20 mL), filtered and washed successively with aqueous K2CO3 solution (2 x 20 mL, 0.1 M) and H2O (20 mL), dried over MgSO4, filtered and solvent removed under reduced pressure. Purification by silica gel column chromatography (hexane/ethyl acetate, 3:1 -> 2:1) afforded a yellow oil (0.043 g, 46 %). Rf = 0.38 (hexane/ethyl acetate; 2:1).

5-[l,4-Bis-tert-butoxycarbonylmethyl-6-(tert-butoxycarbon ylmethyl-methyl-amino)- [l,4]diazepan-6-yl]-pentanoic acid (5)

LiOH (0.009 g, 0.039 mmol) dissolved in H2O (0.5 mL) is added to 4 (0.010 g, 0.023 mmol) in THF (0.5 mL), and the mixture stirred at 298 K. The reaction is monitored using LC-ESI MS for ester cleavage. Once complete, the solvent is removed by lyophilisation. H2O (5 mL) is added and removed by lyophilisation and the procedure repeated two times. The resulting solid is washed with ice-cold DCM (0.5 mL), and dried in vacuo to yield a waxy yellow solid (0.009 g, 70 %).

Schema 2: Synthesis of 3 ^l Bu-protected DATA ^5m prochelator (i) Amberlyst-21, EtOH; (ii) CH2O, EtOH; (iii) CH3COOH, Pd(OH) ₂ /C, H ₂ , EtOH; (iv) BrCH ₂ COO ^l Bu, K ₂ CO ₃ , MeCN; (v) CH ₃ I, K ₂ CO ₃ , DCM : MeCN; (vi) LiOH, THF : H ₂ O

Example 2: Synthesis of FAP targeting ligands

Schemata 3-5 illustrate the synthesis of FAP targeting ligands (cf. K. Jansen, L. Heirbaut, R. Verkerk, J.D. Cheng, J. Joossens, P. Cos, L. Maes, A.-M. Lambeir, I. De Meester, K. Augustyns, P. Van der Veken; Extended Structure-Activity Relationship and Pharmacokinetic Investigation of (4-Quinolinoyl)glycyl-2-cyanopyrrolidine Inhibitors of Fibroblast Activation Protein (FAP); J. Med. Chem. 2014 Apr 10; 57(7): 3053-74, DOI 10.1021/jm500031w).

Schema 3: Synthesis of (S)-4,4-difluoro-l-(aminoacetyl)pyrrolidone-2-carbonitrile

(a) TEMPO (0.02 eq), l,3,5-Trichloro-l,3,5-triazinane-2,4,6-trione, DCM, 1 h, 0°C, 74%;

(b) DAST, DCM, 16 h, 61%; (c) KOH, MeOH, 16 h, 86%; (d) DCC, HONSu, NH ₃ , DCM, 2 h, 72%; (e) TFA, DCM, 1 h, 90%; (f) HATU, Boc-Gly-OH, DIPEA, DCM, 3 h, 77%; (g) TFAA, pyridine, THF, -15°C, 70%; (h) TsOH, MeCN, 24 h, 90%.

Schema 4: Synthesis of 6-methoxyquinoline-4-carboxylic acid (a) PBr ₃ , DMF, 3 h, 63%;

(b) Zn(CN) ₂ , Pd/C, Zn ⁺⁺ (COO-) ₂ , dppf, 110°C, 3 h, 72%; (c) NaOH, H ₂ O/EtOH, reflux, 94%.

Schema 5: Conjugation of (S)-4,4-difluoro-l-(aminoacetyl)pyrrolidone-2-carbonitrile with 6-methoxyquinoline-4-carboxylic acid. Example 3: Affinity to FAP and PREP

The inventive precursor compounds and radiotracers exhibit high target affinity to FAP and excellent selectivity, i.e. low binding to PREP. Hence, they afford high image contrast for the diagnosis of endothelial tumors and metastases with Gallium-68 PET/CT.

Beneath Table 1 presents measured affinities to FAP and PREP for the inventive precursor compounds 1-4 and reference compound 5 as well as the original FAP inhibitor UAMC1110 as the current gold standard.

Table 1: Affinities to FAP and PREP

* S = PREP ICso / FAP IC50

** S _F = S relative to UAMC1110

Inventive precursor compounds (A), (B), (D) and (E) show higher affinity to FAP than reference compound (F) and the UAMC1110 gold standard (G). Compound (A), (D) and (E) exhibit reduced binding to off-target PREP compared to reference (F) and (G). Compound (B) has PREP affinitiy comparable to (F) and (G). All of compounds (A), (B), (D), (E) have a distinctly higher selectivity for FAP than PREP compared to reference (F) and gold standard (G). The selectivity of compound (B) is similar to that of (G). The selectivity of compound (E) is twice that of (G). The selectivity of compound (D) is three times higher than that of (G). The selectivity of compound (A) is six times that of (G). The DATA ^5m -conjugated reference compound (F) has lower affinity to FAP and lesser selectivity than (G) as expected due to chemical modification.

The inventive radiotracers can be conveniently provided as ready to use kit. Such kit contains one the above described freeze-dried precursor compound or a salt thereof, a buffer for pH adjustment, antioxidants as radical scavengers to prevent radiolysis and lyophilization bulking agents. The respective radiotracer is prepared by adding a hydrochloric acid solution of [ ⁶⁸ Ga]GaCl3 pursuant to European Pharmacopoeia monograph "Gallium (68Ga) chloride solution".

Example 4: PET MIP with [ ⁶⁸ Ga1Ga-DATA ^5m .Pip.FAPi

Fig. 1 shows an image acquired from a 52 year old male patient suffering from radioiodine refractory differentiated thyroid cancer via PET MIP using the inventive radiotracer [ ⁶⁸ Ga]Ga-DATA ^5m .Pip.FAPi. Multiple pancreas (1), lung (2) and lymph node (3) metastases are detected. Example 5: PET MIP with [ ⁶⁸ Ga1Ga-DATA ^5m .NH.FAPi

Fig. 2 shows an image acquired from a 40 year old male patient afflicted with radioiodine refractory differentiated thyroid cancer via PET MIP using the inventive radiotracer [ ⁶⁸ Ga]Ga-DATA ^5m .NH.FAPi. Multiple liver (1), lung (2) and lymph node (3) lesions are detected.

Example 6: Coronal PET/CT Imaging

Fig. 3 depicts a coronal PET/CT patient image acquired from a male patient suffering from metastasized gastroesophageal cancer using the inventive radiotracer [ ⁶⁸ Ga]Ga- DATA ^5m .NH-Pyr.FAPi. Multiple skeletal metastases are detected

The annotations in Fig. 3 designate

Li: Liver

Ki: Kidney

Bl: Bladder

LI: tumor bone lesion, pelvis

L2: tumor bone lesion, pelvis

L3: tumor bone lesion, rib

L4: tumor lesion

L5: tumor lesion

L6: tumor bone lesion, vertebra

L7: tumor bone lesion, shoulder

L8: multiple tumor bone lesion, pelvis

L9: tumor lesion, pelvis

LIO: multiple tumor bone lesions, vertebra

Lil: multiple tumor bone lesion, pelvis

L12: tumor bone lesion, rib