Selective imaging of solid tumours via the calcium-dependent high-affinity binding of a cyclic octapeptide to phosphorylated Annexin A2


The heterogeneity and continuous genetic adaptation of tumours complicate their detection and treatment via the targeting of genetic mutations. However, hallmarks of cancer such as aberrant protein phosphorylation and calcium-mediated cell signalling provide broadly conserved molecular targets. Here, we show that, for a range of solid tumours, a cyclic octapeptide labelled with a near-infrared dye selectively binds to phosphorylated Annexin A2 (pANXA2), with high affinity at high levels of calcium. Because of cancer-cell-induced pANXA2 expression in tumour-associated stromal cells, the octapeptide preferentially binds to the invasive edges of tumours and then traffics within macrophages to the tumour’s necrotic core. As proof-of-concept applications, we used the octapeptide to detect tumour xenografts and metastatic lesions, and to perform fluorescence-guided surgical tumour resection, in mice. Our findings suggest that high levels of pANXA2 in association with elevated calcium are present in the microenvironment of most solid cancers. The octapeptide might be broadly useful for selective tumour imaging and for delivering drugs to the edges and to the core of solid tumours.

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Fig. 1: LS301 structure and cellular uptake.
Fig. 2: Identification of pANXA2 as a molecular target of LS301.
Fig. 3: Intercellular spread of pANXA2 from cancer cells to fibroblasts.
Fig. 4: Expression of pANXA2 in solid-cancer tissues.
Fig. 5: Selective accumulation of LS301 in diverse tumour models.
Fig. 6: Intratumoral distribution of LS301 and colocalization of LS301 with pANXA2 and calcium.
Fig. 7: Intraoperative surgical guidance using the CVG system.

Data availability

All data generated and analysed during the study are available within the paper and its Supplementary Information, with the exception of the code of company-proprietary imaging software.


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This study was supported primarily by a research grant from the National Cancer Institute (no. R01 CA171651) and in part by grants from the National Institutes of Health (nos. U54 CA199092, R01 EB021048, P50 CA094056, P30 CA091842, F30 CA189435, R50CA211481, S10 OD016237, S10 RR031625 and S10 OD020129), the Department of Defense Breast Cancer Research Program (grant no. W81XWH-16-1-0286) and the Alvin J. Siteman Cancer Research Fund (grant no. 11-FY16-01). We thank the Alvin J. Siteman Cancer Center at Washington University School of Medicine, Barnes-Jewish Hospital in St Louis and the Institute of Clinical and Translational Sciences at Washington University in St Louis, for the use of the Tissue Procurement Core which provided tissues from patients with breast cancer. The Siteman Cancer Center is supported in part by an NCI Cancer Center Support grant P30 CA091842 and the Institute of Clinical and Translational Sciences is funded by the National Institutes of Health’s NCATS Clinical and Translational Science Award programme grant UL1 TR002345. We thank Gabriel Birrane for providing the purified ANXA2 and pANXA2 protein reagents used in the initial study.

Author information

S.A. conceived the study and designed LS301; D.S. and B.X. screened and biologically validated LS301; D.S., B.X., R.T. and S.A. designed the research; D.S., B.X., R.T., K.L., G.P.S., C.E., S.-W.D.T., A.Som, R.G., D.M., L.H.-G., W.A., Y.L., S.B., S.M., S.K., Z.N., K.G. and A.Seidel performed the research; S.L. developed the breast cancer PDX model; S.A. supervised the overall study; S.-W.D.T., D.S., B.X., R.T., and S.A. wrote the manuscript. All authors reviewed and edited the manuscript.

Correspondence to Samuel Achilefu.

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Competing interests

S.A. is a co-inventor on the US patent no. 8,053,415 issued to Washington University covering LS301. The patent may become the subject of a licensing agreement in the future. The remaining authors declare no competing interests.

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Supplementary information

Supplementary Information

Supplementary figures and tables.

Reporting Summary

Supplementary Dataset

Proteomic analysis of of the 37 kDa band associated with LS301.

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Shen, D., Xu, B., Liang, K. et al. Selective imaging of solid tumours via the calcium-dependent high-affinity binding of a cyclic octapeptide to phosphorylated Annexin A2. Nat Biomed Eng 4, 298–313 (2020).

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