Somatostatin receptor antagonists (or somatostatin inhibitors) are a class of chemical compounds that work by imitating the structure of the neuropeptide somatostatin. The somatostatin receptors are G protein-coupled receptors. Somatostatin receptor subtypes in humans are 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 sstr2 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 to 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. There are also 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 gastrointestinal (GI) tract, pancreas, hypothalamus, and central nervous system (CNS), 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 cell tumors, lymphomas and prostate tumors.
Radiolabel The radiolabeled somatostatin receptor antagonists share the following structure:
The antagonist has a peptide moiety. The nomenclature of the somatostatin receptor antagonists is also based on this order. The structure of somatostatin receptor antagonists are 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, a 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 mostly been done 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 have an effect on the biologic properties. 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.
Compounds list The following listed compounds are those that have entered some phase of pre-clinical study.
Further clinical studies Ga-NODAGA-JR11 had entered further clinical studies as an imaging agent, while and 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.
Safety In general, somatostatin receptor antagonists were noted to be well tolerated. However, due to its mechanism of action, it may decrease the effectiveness of SSA therapy (Somatostatin Analogue Therapy), however other studies indicate SSA may not need to be stopped if somatostatin antagonists are used to label tumors instead of agonists. As somatostatin can cause inhibition of hormone production that uses it as a mediating hormone, it has an antiproliferative effect on cell tumors, especially in neuroendocrine tumors. Somatostatin analogue therapy uses longer-acting agonists than the endogenous somatostatin to extend the antiproliferative effects. Somatostatin receptor antagonists can bind to the receptors without activating them , antagonizing the therapeutic inhibitory effects of SSA therapy. Slow intravenous injection might be used until further safety data becomes available.
… excerpt ends here. Continue reading the full article.
