Renal Toxicity of Radiolabeled Peptides and Antibody Fragments: Mechanisms, Impact on Radionuclide Therapy, and Strategies for Prevention

Journal of Nuclear Medicine

Wim J.G. Oyen¹  Martin Gotthardt¹  Erik Vegt¹  Jack F.M. Wetzels¹  Marleen Melis¹  Rosalinde Masereeuw¹  Otto C. Boerman¹  Marion de Jong¹ 

关键词: kidney;    peptide;    antibody fragment;    radionuclide therapy;    PRRT;   

DOI  :  10.2967/jnumed.110.075101

学科分类：医学（综合）

来源: Society of Nuclear Medicine

【 摘 要 】

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.

【 授权许可】

Unknown