Peptides are ideal for theranostic development as they afford rapid target accumulation, fast clearance from background tissue, and exhibit good tissue penetration. Previously, we developed a novel series of peptides that presented discreet folding propensity leading to an optimal candidate [
68
Ga]Ga-DOTA-
GA1
([D-Glu]
6
-Ala-Tyr-
N
MeGly-Trp-
N
MeNle-Asp-Nal-NH
2
) with 50 pM binding affinity against cholecystokinin-2 receptors (CCK
2
R). However, we were confronted with challenges of unfavorably high renal uptake.
Methods:
A structure activity relationship study was undertaken of the lead theranostic candidate. Prudent structural modifications were made to the peptide scaffold to evaluate the contributions of specific
N
-terminal residues to the overall biological activity. Optimal candidates were then evaluated in nude mice bearing transfected A431-CCK
2
tumors, and their biodistribution was quantitated
ex vivo
.
Results:
We identified and confirmed that D-Glu
3
to D-Ala
3
substitution produced 2 optimal candidates, [
68
Ga]Ga-DOTA-
GA12
and [
68
Ga]Ga-DOTA-
GA13
. These radiopeptides presented with high target/background ratios, enhanced tumor retention, excellent metabolic stability in plasma and mice organ homogenates, and a 4-fold reduction in renal uptake, significantly outperforming their non-alanine counterparts.
Conclusions:
Our study identified novel radiopharmaceutical candidates that target the CCK
2
R. Their high tumor uptake and reduced renal accumulation warrant clinical translation.