Succinylated Gelatin Improves the Theranostic Potential of Radiolabeled Exendin-4 in Insulinoma Patients

J Nucl Med. 2019 Jun;60(6):812-816. doi: 10.2967/jnumed.118.219980. Epub 2018 Nov 30.


Being highly expressed in insulinomas, the glucagonlike peptide-1 receptor (GLP-1R) is a potential target for diagnosis, localization, and treatment with the radiolabeled GLP-1R agonist exendin. Tracer accumulation in the kidneys, however, hampers accurate diagnostic visualization of pancreatic tissue and prohibits the therapeutic application of radiolabeled exendin for β-cell-derived tumors. Therefore, we evaluated the ability of succinylated gelatin (Gelofusine) to reduce the renal accumulation of radiolabeled exendin in humans, and we performed dosimetric calculations to estimate the maximum absorbed insulinoma dose that could be achieved if exendin were to be used for peptide receptor radionuclide therapy. Methods: Ten healthy volunteers received 50 MBq of 111In-exendin-4, in combination with Gelofusine or saline, in a crossover design. SPECT/CT images were obtained after 24 h. The procedure was repeated 3 wk later. Uptake of 111In-exendin was determined by drawing regions of interest around the kidneys and in the pancreas. Planar scintigraphic 111In-exendin images of 5 insulinoma patients were used for dosimetry studies estimating the maximum insulinoma absorbed dose that could be achieved without causing radiotoxicity to other organs. Results: Gelofusine reduced the renal accumulation of 111In-exendin-4 by 18.1%, whereas the pancreatic uptake remained unchanged. In 3 of 10 subjects, the kidney uptake was reduced to such an extent that the pancreatic tail could be better discriminated from the kidney signal. Dosimetric estimations suggested that the insulinoma absorbed dose ranges from 30.3 to 127.8 Gy. This dose could be further increased to maximally 156.1 Gy if Gelofusine was used. Conclusion: We have shown that Gelofusine can reduce the renal accumulation of 111In-exendin-4 in humans. This reduction not only allows more accurate qualitative and quantitative analyses of radiolabeled exendin uptake in the tail region of the pancreas but also potentiates the safe delivery of a higher radiation dose to GLP-1R-positive tumors for therapy.

Keywords: dosimetry; exendin-4; insulinoma; kidney uptake; radionuclide therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biological Transport / drug effects
  • Exenatide / metabolism
  • Exenatide / therapeutic use*
  • Female
  • Gelatin / pharmacology*
  • Humans
  • Image Processing, Computer-Assisted
  • Indium Radioisotopes / therapeutic use
  • Insulinoma / diagnostic imaging*
  • Insulinoma / metabolism
  • Insulinoma / radiotherapy*
  • Isotope Labeling
  • Kidney / drug effects
  • Kidney / metabolism
  • Male
  • Single Photon Emission Computed Tomography Computed Tomography
  • Succinates / pharmacology*


  • Indium Radioisotopes
  • Succinates
  • succinylated gelatin
  • Gelatin
  • Exenatide
  • Indium-111