Synthesis and Evaluation of [F]AlF-NOTA-iPD-L1 as a Potential Theranostic Pair for [Lu]Lu-DOTA-iPD-L1.

: Programmed cell death ligand-1 (PD-L1), which is overexpressed in certain tumors, inhibits the body's natural immune response by providing an "off" signal that enables cancer cells to evade the immune system. It has been demonstrated that [Lu]Lu-DOTA-iPD-L1 (PD-L1 inhibitor cyclic peptide) promotes immune responses. This study aimed to synthesize and evaluate [F]AlF-NOTA-iPD-L1 as a novel radiotracer for PD-L1 positron emission tomography (PET) imaging and as a potential theranostic pair for [Lu]Lu-DOTA-iPD-L1. : The NOTA-iPD-L1 peptide conjugate was synthesized and characterized by U.V.-vis, I.R.-FT, and UPLC-mass spectroscopies. Radiolabeling was performed using [F]AlF as the precursor, and the radiochemical purity (HPLC), partition coefficient, and serum stability were assessed. Cellular uptake and internalization (in 4T1 triple-negative breast cancer cells), binding competition, immunofluorescence, and Western blot assays were applied for the radiotracer in vitro characterization. Biodistribution in mice bearing 4T1 tumors was performed, and molecular imaging (Cerenkov images) of [F]AlF-NOTA-iPD-L1 and [Lu]Lu-DOTA-iPD-L1 in the same mouse was obtained. : [F]AlF-NOTA-iPD-L1 was prepared with a radiochemical purity greater than 97%, and it demonstrated high in vitro and in vivo stability, as well as specific recognition by the PD-L1 protein (IC = 9.27 ± 2.69 nM). Biodistribution studies indicated a tumor uptake of 6.4% ± 0.9% ID/g at 1-hour post-administration, and Cerenkov images showed a high tumor uptake of both [F]AlF-NOTA-iPD-L1 and Lu-iPD-L1 in the same mouse. : These results warrant further studies to evaluate the clinical usefulness of [F]AlF-NOTA-iPD-L1/[Lu]Lu-DOTA-iPD-L1 as a radiotheranostic pair in combination with anti-PD-L1/PD1 immunotherapy.