Renal toxicity of radiolabeled peptides and antibody fragments: mechanisms, impact on radionuclide therapy, and strategies for prevention.
Peptide-receptor radionuclide therapy (PRRT) with radiolabeled somatostatin analogs such as octreotide is an effective therapy against neuroendocrine tumors. Other radiolabeled peptides and antibody fragments are under investigation. Most of these compounds are cleared through the kidneys and reabsorbed and partially retained in the proximal tubules, causing dose-limiting nephrotoxicity. An overview of renal handling of radiolabeled peptides and resulting nephrotoxicity is presented, and strategies to reduce nephrotoxicity are discussed. Modification of size, charge, or structure of radiolabeled peptides can alter glomerular filtration and tubular reabsorption. Coinfusion of competitive inhibitors of reabsorption also interferes with the interaction of peptides with renal endocytic receptors; coinfusion of basic amino acids is currently used for kidney protection in clinical PRRT. Furthermore, nephrotoxicity may be reduced by dose fractionation, use of radioprotectors, or use of mitigating agents. Decreasing the risk of nephrotoxicity allows for administration of higher radiation doses, increasing the effectiveness of PRRT.
Vegt
Erik
E
Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. ErikVegt@gmail.com
de Jong
Marion
M
Wetzels
Jack F M
JF
Masereeuw
Rosalinde
R
Melis
Marleen
M
Oyen
Wim J G
WJ
Gotthardt
Martin
M
Boerman
Otto C
OC
D000818:Animals; D004307:Dose-Response Relationship, Radiation; D006801:Humans; D007128:Immunoglobulin Fragments / Q000009:adverse effects*; D007668:Kidney / Q000378:metabolism; D007674:Kidney Diseases / Q000209:etiology* / Q000517:prevention & control*; D010455:Peptides / Q000009:adverse effects* / Q000493:pharmacokinetics; D019275:Radiopharmaceuticals / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use*
D007128:Immunoglobulin Fragments; D010455:Peptides; D019275:Radiopharmaceuticals