- Original research
- Open Access
The ultimate radiochemical nightmare: upon radio-iodination of Botulinum neurotoxin A, the introduced iodine atom itself seems to be fatal for the bioactivity of this macromolecule
© van Uhm et al.; licensee Springer. 2015
Received: 19 November 2014
Accepted: 22 January 2015
Published: 19 February 2015
The Erratum to this article has been published in EJNMMI Research 2016 6:8
Botulinum neurotoxin A (BoNT-A) is a highly neurotoxic drug and frequently used in patients. Knowledge on the optimal way of administration of BoNT-A and its subsequent distribution is still rather limited. An accurate method for monitoring these processes might be the use of radiolabelled BoNT-A. In this paper, we report our feasibility study on labelling BoNT-A with high-dose iodine-125 (125I) via IODOGEN-coated BoNT-A method.
Using cetuximab as model substrate for BoNT-A, a miniaturization of the IODOGEN-coated mAb method was developed with special attention to the minimum required amount of the oxidant IODOGEN, while the amount of substrate, reaction volume and reaction time were downsized. Labelling efficiency and radiochemical purity were determined by TLC, integrity by SDS-PAGE and HPLC and immunoreactivity by cell-binding assay. BoNT-A (50 μg) was labelled with 125I by coating with 2.5 μg IODOGEN, in a total reaction volume of 250 μL and a reaction time of 90 s. 125I-BoNT-A was purified by size exclusion chromatography (PD10 column) using ascorbic acid solution (5 mg/ml, pH = 5) as eluent. Quality analysis of 125I-BoNT-A was performed by an in vitro bladder strip model, an electrochemiluminescence assay and an Endopep assay.
Cetuximab (50 μg) labelling with 125I (15 to 150 MBq) resulted in a labelling efficiency of 70% to 80%, a radiochemical purity of >99%, an immunoreactivity of >95% and a retained integrity on SDS; HPLC analysis revealed partly affected integrity when 110 to 150 MBq 125I was used, i.e. when the averaged I/mAb molar ratio exceeded 3. Addition of HEPES (20 mM) and lactose (1.25%) (lyophilized BoNT-A contains HEPES and lactose) decreased the labelling efficiency to 44% to 54%. BoNT-A (50 μg) labelling with 125I (97.2 to 98.3 MBq) resulted in labelling efficiency of 51% to 52% with a radiochemical purity >98.5%, a specific activity of 150.5 to 152.9 MBq/nmol and an I/BoNT-A molar ratio of 1.86 to 1.90. The in vitro bladder strip model showed no bioactivity of 125I-BoNT-A when compared to unlabelled BoNT-A. The electrochemiluminescence and Endopep assay demonstrated around 10% and 15% bioactivity of 125I-BoNT-A compared to unlabelled BoNT-A, respectively. The remaining bioactivity correlates within the Poisson distribution with the amount of BoNT-A molecules that does not bear an iodine atom.
BoNT-A was successfully radio-iodinated with an activity high enough to enable in vivo measurement of nanograms of BoNT-A, which could be used in studying optimization of administration techniques of BoNT-A. The bioactivity of a BoNT-A molecule is, however, lost upon the introduction of an iodine atom into the tyrosine moiety of this sensitive molecule.
Botulinum neurotoxin A (BoNT-A) was introduced for the treatment of overactive bladder (OAB) by Schurch et al. at the beginning of this century . Since then, multiple clinical trials have proven BoNT-A to be an effective therapy for refractory OAB . These clinical trials also demonstrated differences in efficacy and duration of the response. The most effective dose, volume of dilution, number and sites of injection required for effective treatment are not well known . Notwithstanding evolving knowledge about the mechanism of action of BoNT-A on neurotransmitter release and receptor activation, the distribution of BoNT-A after intravesical injection remains largely unknown [4,5]. If the distribution in the bladder wall after administration of BoNT-A could be monitored, the differences in clinical effect among patients might be better understood. Besides, monitoring would enable investigation of the most optimal technique of administrating BoNT-A.
The so-called IODOGEN-coated mAb method , originally developed for high-dose radio-iodination in a large reaction volume, has been shown to give results superior to the chloramine-T method and IODOGEN-coated vial method [9,10]. In this paper we report the development of a new radio-iodination method for obtaining optimal quality substrates in the 50-μg range, using cetuximab as model substrate. Next, our results with this miniaturized form of the IODOGEN-coated mAb method on the high-dose labelling of BoNT-A and its quality control are described.
The mAb cetuximab (Erbitux; 5 mg/mL) was purchased from Merck (Darmstadt, Germany) and was buffer exchanged on a PD10 column (GE Healthcare Life Sciences, Eindhoven, The Netherlands) to a solution of 0.9% NaCl before radiolabelling. 125I (12.95 GBq/mL in 0.1 M NaOH, pH 12 to 14, no-carrier added, specific activity 643.8 GBq/mg) was purchased from Perkin Elmer (Groningen, The Netherlands). 1,3,4,6-tetrachloro-3α, 6α-diphenyl-glycouril (IODOGEN, MW 432.1) was supplied by Pierce (Oud Beijerland, The Netherlands). Pure BoNT-A (vials of 100 μg, 150 kD) from Clostridium botulinum, lyophilized powder containing 20 mM HEPES and 1.25% lactose when reconstituted with 100 μL buffer, was supplied by Sigma-Aldrich (Zwijndrecht, The Netherlands). The reference BoNT-A was obtained from Metabiologics (Madison, WI, USA). The human squamous cell carcinoma cell line A431 was obtained from the American Type Culture Collection (ATCC number CRL-15555).
Development of the labelling method
To avoid working routinely with 50 μg portions of extremely neurotoxic and expensive BoNT-A (LD50 in humans is about 75 ng ), developing and establishing the optimal method of labelling BoNT-A with 125I was done with cetuximab.
The coating approach was evaluated by several sets of labelling experiments within the following general frame: 1) every reaction was performed in a sterilized glass vial of 20 mL, which was wobbling continuously during the reaction; 2) the total reaction volume was 250 μL and consecutively consisted of X μL 125I in 0.1 M NaOH, 50 μL 0.5 M phosphate buffer (pH 7.4), 25 μL mAb solution (50 μg mAb, 2 mg/mL), 140-X μL 0.1 M phosphate buffer (pH 6.8) and 35 μL of IODOGEN/acetonitrile solution (1 mg/mL stock IODOGEN/acetonitrile solution was diluted to the desired amount of IODOGEN); 3) the reaction was started by IODOGEN/acetonitrile solution and abrogated with 100 μL ascorbic acid (25 mg/mL, pH 5); 4) labelling yields of all experiments were assessed with instant thin-layer chromatography (ITLC).
Technical protocol 125 I labelling of BoNT-A according to IODOGEN-coated method
X μL 125I is added to wobbling reaction vial
250 μL phosphate buffer (0.5 M, pH 7.4) is added
50 μL BoNT-A/ phosphate buffer (=50 μg BoNT-A) is addeda
115-X μL phosphate buffer (0.1 M, pH 6.8) is added to adjust the reaction volume to 215 μL
17.5 μL freshly prepared IODOGEN/acetonitrile solution (2.5 μg/35 μL) is added into the reaction mixture (start of reaction, t = 0)
At t = 45 s, another 17.5 μL IODOGEN/acetonitrile solution (2.5 μg/35 μL) is added
At t = 90 s, 100 μL ascorbic acid solution (25 mg/mL, pH 5.0) is added to stop the reaction and to reduce any formed S-Cl bonds
At t = 4.30 min, 10 μL BSA (50 mg/mL) is addedb
At t = 5.30 min, samples are taken for ITLC for determination of the labelling efficiency
At t = 10 min, 360 μL reaction mixture is transferred to a syringe connected to a filterc
The reaction vial is rinsed by 640 μL phosphate buffer (0.1M, pH 6.8) and also transferred to the syringe connected to the filterc
The combined solution in the syringe is filtered and purified on a PD10 column with ascorbic acid solution (5 mg/mL, pH 5.0) as eluent, collected fractions were 0.5 mL
Fractions with highest amount of 125I-BoNT-A and the highest radiochemical purity are pooled
Samples of the pooled 125I-BoNT-A (fractions 6, 7, 8) are taken for ITLC
Final product is diluted by BSA (1 mg/mL) till a concentration of 1 μg/100 μL and stored at 20°C
Quality analysis of mAb labelling
Conjugates were analysed by ITLC for labelling efficiency and radiochemical purity, by HPLC and SDS-PAGE followed by phosphor imager analysis for integrity and by a cell-binding assay for immunoreactivity. ITLC analysis of radiolabelled cetuximab was performed on silica gel-impregnated glass fibre sheets (PI Medical Diagnostic Equipment BV, Tijnje, The Netherlands), with citrate buffer (20 mM, pH 5.0) as the mobile phase. HPLC of the conjugates was performed on a JASCO Benelux BV HPLC (De Meern, The Netherlands) with a diode array detector system and an inline radiodetector (Raytest Isotopenmessgeräte GmbH, Straubenhardt, Germany) using a Superdex 200 10/300 GL size exclusion column (GE Healthcare Life Sciences, Eindhoven, The Netherlands). The eluent consisted of 0.05 M sodium phosphate/0.15 M sodium chloride plus 0.05% sodium azide (pH 6.8), and the flow was set at a rate of 0.5 mL/min. HPLC measurements were performed at A = 280 nm to measure mAb absorption. Gel electrophoresis was performed on a Pharmacia Phastgel System using 7.5% SDS-PAGE gel electrophoresis gels (Amersham Biosciences, Roosendaal, The Netherlands) under non-reducing conditions and analyzed on a phosphor imager (Molecular Dynamics, Zoetermeer, The Netherlands) and quantified with ImageQuant software. In vitro binding characteristics of radiolabelled cetuximab were determined in an immunoreactivity assay essentially as described before , using A431 cells fixed with 2% paraformaldehyde. Binding data were graphically analysed in a modified Lineweaver-Burk (double-reciprocal) plot, and the immunoreactive fraction was determined by linear extrapolation to conditions representing infinite antigen excess.
Quality analysis of BoNT-A labelling
The bioactivity of 125I-BoNT-A was measured by an in vitro bladder strip model, an electrochemiluminescence (ECL) assay to measure the antibody-antigen detection on the heavy chain and an Endopep assay to measure the cleavage activity of the light chain.
The animal experiments were performed according to the Dutch National Institutes of Health principles of laboratory animal care and Dutch national (‘Wet op de dierproeven,’ Stb 1985, 336). The bladders of female Wistar rats (n = 2, 250 to 300 g, Harlan®, Horst, The Netherlands) were used for the in vitro bladder strip experiments previously described . In short: two bladder strips of one rat bladder were mounted in two parallel organ baths. One strip was incubated in 125I-BoNT-A (0.3 mM) and one in unlabelled BoNT-A (0.3 mM). The contraction force of bladder strips due to electric field stimulation (EFS) was measured before and after incubation. The second quality analysis of 125I-BoNT-A was by ECL assay . The ECL assay is based on antibody docking of the heavy chain of BoNT-A, which is in this case the antigen. ECL 96-well plates were coated with BoNT-A capture antibodies. The unlabelled BoNT-A, reference BoNT-A (TNO, Rijswijk, The Netherlands) and 125I-BoNT-A were diluted in concentrations of 20, 5, 1.25, 0.31, 0.078, 0.02 and 0.005 ng/mL. These various concentrations were pipetted in the wells, and the plate was stirred and washed. The wells were filled with MSD-labelled detection antibody, stirred and washed. Finally, the wells were filled with READ buffer and the signals could be read with the ECL instrument (PR-100, Meso Scale Discovery, Gaithersburg, MD, USA).
The third quality analysis of 125I-BoNT-A was by Endopep assay . This assay is based on the cleavage activity of the light chain. Unlabelled BoNT-A, reference BoNT-A and 125I-BoNT-A were diluted in concentrations of 0.5, 0.2, 0.1, and 0.02 ng/μL. These samples were mixed with 20 μL Endopep reaction buffer (20 mM HEPES pH 7.3, 200 μM ZnCl2, 1 mg/mL BSA and 10 mM DTT). Substrate peptide (KGSNRTRIDQGNQRATR-NLeu-LGGK); 10 μL, 100 μM) was added, and the mixture was incubated at 36°C overnight. The activity of the light chain of BoNT-A was measured in a capillary electrophoresis instrument with laser-induced fluorescence (LIF) detection (Beckman Instruments, Fullerton, CA, USA). The excitation wavelength was 488 nm, and the emission wavelength was 520 nm. The total length of the fused silica capillary (i.e. 75 μm, PolyMicro, Phoenix, AZ, USA) was 67 cm; effective length to the detector was 60 cm. The separation voltage was 15 kV. Samples were introduced by pressure injection for 5 s at 0.5 psi. The running buffer consisted of 60 mM sodium hydroxide and 18 mM phosphoric acid, pH 12.
Radiolabelling of mAb and BoNT-A
Results of iodination of cetuximab with increasing amount of 125 I
125 I (MBq)
Labelling efficiency (%)
Radiochemical purity (%)
125 I/mAb molar ratio a
Results of iodination of cetuximab with addition of HEPES and/or lactose and iodination of BoNT-A
Product (50 μg)
125 I (MBq)
Labelling efficiency (%)
125 I/product molar ratio
1.25 + 1.25
1.25 + 1.25
1.25 + 1.25
1.25 + 1.25
1.25 + 1.25
In this article, a novel method is described for high-dose 125I labelling of macromolecules on microgram scale. A special feature of this miniaturized form of the IODOGEN-coated mAb method is the low amount (5.7 nmol) of the oxidizing agent IODOGEN required to arrive at efficient labelling yields. For cetuximab labelling, yields of 70% to 80% were obtained; in the presence of HEPES and lactose, the yields were 43% to 52%. Conjugates with high specific activity and with full retention of immunoreactivity and integrity were produced, provided the averaged I/mAb molar ratio was kept below 3. The labelling of BoNT-A to a level of specific activity necessary for sensitive detection by PET, i.e. 1 kBq/ng BoNT-A, was accomplished by this IODOGEN-coated BoNT-A method in a yield of 51% to 53%. The bioactivity of 125I-BoNT-A, however, was found to be seriously impaired when compared to unlabelled BoNT-A in three different assays. In an in vitro rat bladder strip model, contraction inhibition was not observed in case of 125I-BoNT-A. A reason could be a lower total amount of 125I-BoNT-A or a change of bioactivity of 125I-BoNT-A. To rule out the possibility of a concentration mishap, a batch of dry powder BoNT-A (100 μg) was dissolved in 100 μL phosphate buffer, in a weighing controlled way. Again controlled by weighing, 50 μL of this solution was used for a labelling reaction whereas the remaining 50 μL was diluted to a concentration of 1 μg/100 μL unlabelled BoNT-A and compared with a reference sample of BoNT-A (TNO) by determining the heavy and light chain bioactivity by antibody-antigen detection with ECL - and Endopep assay. Both assays gave for the unlabelled BoNT-A similar results as the reference BoNT-A, indicating that no dissolution mishap had occurred and that the amount of BoNT-A at the start of the labelling reaction was indeed the anticipated 50 μg. At the same time, the results of the ECL assay and the Endopep assay therefore implied 125I-BoNT-A had lost a great deal of its bioactivity.
In the 50 μg BoNT-A situation, the IODOGEN/BoNT-A molar ratio was 17; and under these conditions, no detectable harm to cetuximab was observed with respect to immunoreactivity or integrity. This and the fact that in 1983 Williams et al.  found remaining bioactivity even at chloramine-T/BoNT-A molar ratios of 200 to 300 make that damage from chemical oxidation cannot be the main reason for the huge loss of bioactivity. Also, the most effective chemoprotection against radiation damage (no Cl− containing PBS but phosphate buffer , addition of ascorbic acid and BSA ) before, during and after PD10 column purification of the 125I-BoNT-A was implemented, ruling out radiation damage, if any, as possible reason.
Hence, we arrive at the conclusion that the main loss of bioactivity does not originate from oxidative or radiation damage but from the introduction of the iodine atom itself, i.e. from the introduction of an apolar heavy atom combined with the effect of the decrease of the pKa of the iodinated phenol moiety from 10.0 to 8.9. A strong extra argument in favour of this conclusion can be derived from the fact that the averaged I/BoNT-A molar ratio of our 125I-BoNT-A with specific activity of 150.5 to 152.9 MBq/nmol is 1.86 to 1.90 (Table 3). This means that within the Poisson distribution, around 15% of the BoNT-A molecules do not bear an iodine atom, a percentage that fairly correlates with the remaining bioactivity in the ECL and Endopep assay. Also, the most optimal findings of Williams et al. , obtained with a chloramine-T/BoNT-A molar ratio of 23 to 35, fit with this concept. Their 125I-BoNT-A products with a specific activity of 700 to 712 and 1,532 to 1,750 Ci/mmol correlate with an averaged I/BoNT-A molar ratio of 0.32 and 0.75, respectively, or within the Poisson distribution with a zero iodination fraction of around 73% and 47%. This corresponds remarkably well with the reported remaining bioactivity of around 85% and 60%, respectively, bearing in mind that in those days the starting product contained a certain amount of contaminating protein which was bio-inactive at forehand.
Labelling with 124I requires the addition of 200 pmol iodine carrier to get efficient yields . Our established specific activity results with 125I-BoNT-A imply that this carrier aspect will not lead to a labelling problem. 124I-BoNT-A might therefore contribute to setting up a protocol for optimal dose injection and quantification in the bladder wall in a selected panel of patients. It is very uncertain, however, whether 124I-BoNT-A is representative for the distribution of BoNT-A through the bladder wall after intravesical injection. The heavy chain is important for docking and endocytosis of BoNT-A in the nerve end terminal, while the light chain cleaves SNAP-25 protein in the nerve end terminal, SNAP-25 being essential in the fusion of acetylcholine vesicles with the nerve end terminal membrane . When an iodine atom on essential tyrosine moieties blocks these subtle processes, it means that the PET signal of the 124I-BoNT-A molecule does not reflect the behaviour of an unlabelled BoNT-A molecule at cellular level.
On the basis of earlier studies with mAbs, we could state (1) that one cannot unlimitedly change the positive surrounding of lysine groups (for mice, the limit was eight groups; for patients, four groups before seriously affecting pharmacokinetics) , and (2) that the introduction of a large hydrophobic group like IRDyeCW800 is limited to 1 . The findings in this study allow us to add a third statement, namely that the more specific the macromolecule the less alterations, even small ones, are permitted.
We have developed a mild reliable and efficient electrophilic radio-iodination procedure for GMP-compliant labelling of macromolecules on microgram scale. The integrity of a mAb molecule becomes impaired when on average the number of introduced iodine atoms is ≥3. For the very sensitive macromolecule BoNT-A, however, a single introduced iodine atom already destroys the bioactivity.
- Schurch B, Stohrer M, Kramer G, Schmid DM, Gaul G, Hauri D. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol. 2000;164:692–7.View ArticlePubMedGoogle Scholar
- Duthie JB, Vincent M, Herbison GP, Wilson DI, Wilson D. Botulinum toxin injections for adults with overactive bladder syndrome. Cochrane Database Syst Rev. 2011;12:CD005493.PubMedGoogle Scholar
- Mangera A, Apostolidis A, Andersson KE, Dasgupta P, Giannantoni A, Roehrborn C, et al. An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders. Eur Urol. 2014;65:981–90.View ArticlePubMedGoogle Scholar
- Apostolidis A, Dasgupta P, Fowler CJ. Proposed mechanism for the efficacy of injected botulinum toxin in the treatment of human detrusor overactivity. Eur Urol. 2006;49:644–50.View ArticlePubMedGoogle Scholar
- Coelho A, Cruz F, Cruz CD, Avelino A. Spread of onabotulinumtoxinA after bladder injection. Experimental study using the distribution of cleaved SNAP-25 as the marker of the toxin action. Eur Urol. 2012;61:1178–1184.6.View ArticlePubMedGoogle Scholar
- Gill DM. Bacterial toxins: a table of lethal amounts. Microbiol Rev. 1982;46:86–94.PubMed CentralPubMedGoogle Scholar
- Ravichandran E, Gong Y, Al Saleem FH, Ancharski DM, Joshi SG, Simpson LL. An initial assessment of the systemic pharmacokinetics of botulinum toxin. J Pharmacol Exp Ther. 2006;318:1343–51.View ArticlePubMedGoogle Scholar
- Williams RS, Tse CK, Dolly JO, Hambleton P, Melling J. Radioiodination of botulinum neurotoxin type A with retention of biological activity and its binding to brain synaptosomes. Eur J Biochem. 1983;131:437–45.View ArticlePubMedGoogle Scholar
- Visser GW, Klok RP, Gebbinck JW, Ter LT, van Dongen GA, Molthoff CF. Optimal quality (131)I-monoclonal antibodies on high-dose labeling in a large reaction volume and temporarily coating the antibody with IODO-GEN. J Nucl Med. 2001;42:509–19.PubMedGoogle Scholar
- Tran L, Baars JW, Maessen HJ, Hoefnagel CA, Beijnen JH, Huitema AD. A simple and safe method for 131I radiolabeling of rituximab for myeloablative high-dose radioimmunotherapy. Cancer Biother Radiopharm. 2009;24:103–10.View ArticlePubMedGoogle Scholar
- Lindmo T, Boven E, Cuttitta F, Fedorko J, Bunn Jr PA. Determination of the immunoreactive fraction of radiolabeled monoclonal antibodies by linear extrapolation to binding at infinite antigen excess. J Immunol Methods. 1984;72:77–89.View ArticlePubMedGoogle Scholar
- Van Uhm JIM, Beckers GM, van der Laarse WJ, Meuleman EJ, Geldof AA, Nieuwenhuijzen JA. Development of an in vitro model to measure bioactivity of botulinum neurotoxin A in rat bladder muscle strips. BMC Urol. 2014;14:37.PubMed CentralView ArticlePubMedGoogle Scholar
- Rivera VR, Gamez FJ, Keener WK, White JA, Poli MA. Rapid detection of Clostridium botulinum toxins A, B, E, and F in clinical samples, selected food matrices, and buffer using paramagnetic bead-based electrochemiluminescence detection. Anal Biochem. 2006;353:248–56.View ArticlePubMedGoogle Scholar
- Kalb SR, Moura H, Boyer AE, McWilliams LG, Pirkle JL, Barr JR. The use of Endopep-MS for the detection of botulinum toxins A, B, E, and F in serum and stool samples. Anal Biochem. 2006;351:84–92.View ArticlePubMedGoogle Scholar
- Perk LR, Vosjan MWD, Visser GWM, Budde M, Jurek P, Kiefer GE, et al. p-Isothiocyanatobenzyl-desferrioxamine: a new bifunctional chelate for facile radiolabeling of monoclonal antibodies with zirconium-89 for immuno-PET imaging. EJNMMI. 2010;37:250–9.Google Scholar
- Tijink BM, Perk LR, Budde M, Stigter-van Walsum M, Visser GWM, Kloet RW, et al. 124I-L19-SIP for immuno-PET imaging of tumor vasculature and guidance of 131I-L19-SIP radioimmunotherapy. EJNMMI. 2009;36:1235–44.Google Scholar
- Dolly JO, Aoki KR. The structure and mode of action of different botulinum toxins. Eur J Neurol. 2006;13 Suppl 4:1–9.View ArticlePubMedGoogle Scholar
- Van Gog FB, Visser GW, Stroomer JW, Roos JC, Snow GB, van Dongen GA. High dose rhenium-186-labeling of monoclonal antibodies for clinical application: pitfalls and solutions. Cancer. 1997;80(12 Suppl):2360–70.View ArticlePubMedGoogle Scholar
- Cohen R, Stammes MA, De Roos IHC, Stigter-Van Walsum M, Visser GWM, Van Dongen GAMS. Inert coupling of IRDye800CW to monoclonal antibodies for clinical optical imaging of tumor targets. EJNMMI Res. 2011;1:31.PubMed CentralView ArticlePubMedGoogle Scholar
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.