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Abstract
Metformin is the most widely prescribed drug for type 2 diabetes. Chemically, metformin
is a hydrophilic base that functions as an organic cation, suggesting that it may
have the capacity to inhibit the tubular reabsorption of peptide radiotracers. The
purpose of this study was to investigate whether metformin could reduce renal uptake
of peptidyl radiotracers and serve as a radioprotective agent for peptide receptor
radionuclide therapy (PRRT). We used two radiolabeled peptides: a 68 Ga-labeled cyclic
(TNYL-RAW) peptide ( 68 Ga-NOTA-c(TNYL-RAW) (NOTA: 1,4,7 triazacyclononane-1,4,7-trisacetic
acid) targeting EphB4 receptors and an 111 In- or 64 Cu-labeled octreotide ( 111
In/ 64 Cu-DOTA-octreotide) (DOTA: 1,4,7,10 triazacyclododecane-1,4,7,10-tetraacetic
acid) targeting somatostatin receptors. Each radiotracer was injected intravenously
into normal Swiss mice or tumor-bearing nude mice in the presence or absence of metformin
administered intravenously or orally. Micro–positron emission tomography or micro–single-photon
emission computed tomography images were acquired at different times after radiotracer
injection, and biodistribution studies were performed at the end of the imaging session.
To assess the radioprotective effect of metformin on the kidneys, normal Swiss mice
received two doses of 111 In-DOTA-octreotide in the presence or absence of metformin,
and renal function was analyzed via blood chemistry and histology. Intravenous injection
of metformin with 68 Ga-NOTA-c(TNYL-RAW) or 111 In-DOTA-octreotide reduced the renal
uptake of the radiotracer by 60% and 35%, respectively, compared to uptake without
metformin. These reductions were accompanied by greater uptake in the tumors for both
radiolabeled peptides. Moreover, the renal uptake of 111 In-DOTA-octreotide was significantly
reduced when metformin was administered via oral gavage. Significantly more radioactivity
was recovered in the urine collected over a period of 24 h after intravenous injection
of 64 Cu-DOTA-octreotide in mice that received oral metformin than in mice that received
vehicle. Finally, co-administration of 111 In-DOTA-octreotide with metformin mitigated
radio-nephrotoxicity. Metformin inhibits kidney uptake of peptidyl radiotracers, protecting
the kidney from nephrotoxicity. Further studies are needed to elucidate the mechanisms
of these finding and to optimize mitigation of radiation-induced damage to kidney
in PRRT.