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Noninvasive brain cancer imaging with a bispecific antibody fragment, generated via click chemistry

Significance Given the success of combination therapies for the treatment of cancer, the use of bispecific antibodies targeting multiple cancerous molecular pathways is an attractive strategy to enhance the efficacy of current therapeutic paradigms. However, parallel development of companion diagnostic tools is essential for patient identification, stratification, and the early assessment of treatment efficacies. Herein, we describe the generation of a bispecific construct for noninvasive PET imaging of glioblastoma via bioorthogonal click chemistry. The excellent tumor-homing properties displayed by our bispecific probe, which features two antibody fragments simultaneously targeting epidermal growth factor receptor and CD105, demonstrated that our approach is a simple and effective method to generate multispecific targeting agents for noninvasive molecular imaging. Early diagnosis remains a task of upmost importance for reducing cancer morbidity and mortality. Successful development of highly specific companion diagnostics targeting aberrant molecular pathways of cancer is needed for sensitive detection, accurate diagnosis, and opportune therapeutic intervention. Herein, we generated a bispecific immunoconjugate [denoted as Bs-F(ab)2] by linking two antibody Fab fragments, an anti-epidermal growth factor receptor (EGFR) Fab and an anti-CD105 Fab, via bioorthogonal “click” ligation of trans-cyclooctene and tetrazine. PET imaging of mice bearing U87MG (EGFR/CD105+/+) tumors with 64Cu-labeled Bs-F(ab)2 revealed a significantly enhanced tumor uptake [42.9 ± 9.5 percentage injected dose per gram (%ID/g); n = 4] and tumor-to-background ratio (tumor/muscle ratio of 120.2 ± 44.4 at 36 h postinjection; n = 4) compared with each monospecific Fab tracer. Thus, we demonstrated that dual targeting of EGFR and CD105 provides a synergistic improvement on both affinity and specificity of 64Cu-NOTA-Bs-F(ab)2. 64Cu-NOTA-Bs-F(ab)2 was able to visualize small U87MG tumor nodules (<5 mm in diameter), owing to high tumor uptake (31.4 ± 10.8%ID/g at 36 h postinjection) and a tumor/muscle ratio of 76.4 ± 52.3, which provided excellent sensitivity for early detection. Finally, we successfully confirmed the feasibility of a ZW800-1–labeled Bs-F(ab)2 for near-infrared fluorescence imaging and image-guided surgical resection of U87MG tumors. More importantly, our rationale can be used in the construction of other disease-targeting bispecific antibody fragments for early detection and diagnosis of small malignant lesions.