Somatostatin receptor antagonists (or somatostatin inhibitors) are a class of chemical compounds that work by imitating the structure of the neuropeptide somatostatin, which is an endogenous hormone found in the human body. The somatostatin receptors are G protein-coupled receptors. Somatostatin receptor subtypes in humans include sstr1, 2A, 2 B, 3, 4, and 5. While normally expressed in the gastrointestinal (GI) tract, pancreas, hypothalamus, and central nervous system (CNS), they are expressed in different types of tumours. The predominant subtype in cancer cells is the ssrt2 subtype, which is expressed in neuroblastomas, meningiomas, medulloblastomas, breast carcinomas, lymphomas, renal cell carcinomas, paragangliomas, small cell lung carcinomas, and hepatocellular carcinomas. As a radiopharmaceutical compound that is selective for somatostatin receptors, there is research being done for these radiolabeled compounds to act as diagnostic tests in PET scans for neuroendocrine tumors and other tumors not previously targeted with radiolabeled somatostatin receptor agonists, and to act as radiopharmaceutical therapeutic compound, more specifically to conduct peptide radionuclide receptor therapy. Some non-radiopharmaceutical compounds that are developed as competitive inhibitors of somatostatin, such as the hormone antagonist cyclosomatostatin.
Somatostatin
Somatostatin is a G protein-coupled receptor ligand. When the receptors are activated, it causes the cells where the receptors are expressed to decrease hormone secretion. Mainly, as a neuroendocrine inhibitor, it exerts its effects on the gastrointestinal tract, pancreas, hypothalamus, and central nervous system, causing hormone secretions coupled to this pathway to be reduced. It can affect neurotransmission and memory formation within the central nervous system. Within human and animal models, it demonstrated its effects of preventing angiogenesis and reducing healthy and cancer cell proliferation. Within tumors, somatostatin receptors, mostly of the ssrt2 subtype, are expressed in most neuroendocrine tumors, breast tumors, some brain tumors, renal tumors, lymphomas, and prostate tumors.
Somatostatin receptor antagonists in radiolabelling These compounds work by binding to somatostatin receptors, which are more common in specific types of tumours. It does not activate the receptor. Due to the radionuclide, it will appear on PET scans. The radiolabeled somatostatin receptor antagonists share the following structure. The antagonist has a peptide moiety, and is responsible for receptor recognition and antagonist activities. Nomenclature is based on Radionuclide-Chelator-Receptor Antagonist.
The structure of somatostatin receptor antagonists is similar to that of the agonists. Some agonists were already approved by the FDA for clinical use, such as In-DTPA-octreotide and Ga-DOTATATE. Development started after the discovery of modifications that can be done to the octreotide group, an ssrt selective subtype agonist, to cause its agonistic effects to be lost and gain antagonistic effects. Different subtype receptor antagonists were later developed. Research has been done mostly on the sstr2 receptor antagonist, as the sstr2 receptor is expressed on most tumors. Somatostatin receptor antagonists are divided by generation based on the type of the subtype receptor antagonist. The first generation consists of sst2-ANT and BASS, which are sstr2 selective; and sst3-ODAN-8, which is selective for sstr3. After initial results of their increased sensitivity to neurocrine tumors appeared, ssrt2 selective antagonists that had even higher affinity were developed. These were LM3, JR10, and JR11, which make up the second generation. JR11 was shown to be the most effective among these 3 antagonists, and compounds that entered further clinical development to act as a PET imaging agent or therapeutic agent carried this subtype antagonist. The presence of a chelator coupled to the subtype antagonist was shown to affect the biological properties., by increasing the binding stability of the radionuclide to the rest of the compound, and increasing the binding affinity to the receptor by allowing conjugation of the radionuclide to the receptor. Compounds were developed with 3 macrocyclic chelators: DOTA, NODAGA, and CB-TE2A. DOTA had already been used as a chelator in the radiolabeled somatostatin agonists, as well as NODAGA and CB-TE2A. Ga-NODAGA-based compounds were shown to have a higher binding affinity than its DOTA analogues. However, these somatostatin receptor antagonists showed a higher tumor uptake despite its lower affinity for ssrt receptors, due to being able to bind a receptor despite its activation status. Compounds containing one of the radionuclides of indium-111, lutetium-177, copper-64, yttrium-80 and gallium-68 have been made. A study indicated the gallium compound had the lowest affinity to the sstr2 receptor.
List of radiolabeled somatostatin receptor antagonists The following listed compounds are those that have entered some phase of a pre-clinical study.
Structure of selected antagonist peptides The structure of the antagonist peptides shown in the above table are shown below.
Further clinical studies of radiolabeled somatostatin receptor antagonists Ga-NODAGA-JR11 had entered further clinical studies as an imaging agent, while Lu-DOTA-JR11 had similar research done as a therapeutic agent, as JR11 has a high binding affinity for ssrt2 subtype receptors which are highly expressed on the surface of tumor cells. Gallium-containing agonists had already been established as an imaging agent. Lutetium-containing agonists were used as a therapeutic agent in peptide receptor radionuclide therapy, due to the lower energy electrons emitted, and γ-emission causing easier dose adjustment to patient characteristics to avoid renal damage. The NODAGA chelator was used over DOTA in Gallium antagonists due to higher binding affinity, while no Lu-NODAGA compounds were developed due to established usage of Lu-DOTA derivative agonist drugs, and poor uptake compared to DOTA, which is reverse that of the gallium-containing antagonists.
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