New developments in the production of theranostic pairs of radionuclides

Preparation of [68Ga]GaCl3 Using a Cyclotron

Recent developments in 68Ga-radiopharmaceuticals, including a number of regulatory approvals for clinical use, has created a hitherto unprecedented demand for 68Ga. Reliable access to enough 68Ga to meet growing clinical demand using only 68Ge/68Ga generators has been problematic in recent years. To address this challenge, we have optimized the direct production of 68Ga on a cyclotron via the 68Zn(p,n)68Ga reaction using a liquid target. This protocol describes the cyclotron-based production of [68Ga]GaCl3 implemented at the University of Michigan using a liquid target on GE PETtrace instrumentation. The protocol provides 56 ± 4 mCi (n = 3) of [68Ga]GaCl3 that meets the necessary quality control criteria to use for the preparation of 68Ga-radiopharmaceuticals for human use.

Nuclear Cross-Section of Proton-Induced Reactions on Enriched 48Ti Targets for the Production of Theranostic 47Sc Radionuclide, 46cSc, 44mSc, 44gSc, 43Sc, and 48V

The cross-sections of the 48Ti(p,x)47Sc, 46cSc, 44mSc, 44gSc, 43Sc, and 48V nuclear reactions were measured from 18 to 70 MeV, with particular attention to 47Sc production. Enriched 48Ti powder was deposited on an aluminum backing and the obtained targets were characterized via elastic backscattering spectroscopy at the INFN-LNL. Targets were exposed to low-intensity proton irradiation using the stacked-foils technique at the ARRONAX facility. Activated samples were measured using γ-spectrometry; the results were compared with the data int he literature and the theoretical TALYS-based values. A regular trend in the new values obtained from the different irradiation runs was noted, as well as a good agreement with the literature data, for all the radionuclides of interest: 47Sc, 46cSc, 44mSc, 44gSc, 43Sc, and 48V. 47Sc production was also discussed, considering yield and radionuclidic purity, for different 47Sc production scenarios.

Measurement of the 171Tm beta spectrum

The beta spectrum of the main transition of the β- decay of 171Tm was measured using a double focalizing spectrometer. The instrument was lately improved in order to reduce its low energy threshold to 34 keV. We used the spectrometer to measure the beta spectrum end-point energy of the main transition of 171Tm decay using the Kurie plot formalism. We report a new value of 97.60(38) keV, which is in agreement with previous measurements. In addition, the spectrum shape was compared with the ξ-approximation calculation where the shape factor is equal to 1 and good agreement was found between the theory and the measurement at the 1% level.

Co-production of 155Tb and 152Tb irradiating 155Gd / 151Eu tandem target with a medium energy α-particle beam

INTRODUCTION

Four terbium isotopes 149,152,155,161Tb emitting various types of radiation can be used for both diagnostics and therapy. 152Tb emits positrons and is ideal for PET. 155Tb is considered a promising Auger emitter and a diagnostic pair for other terbium therapeutic isotopes. Several methods for the production of 155Tb using charged particle accelerators have been proposed, but they all have significant limitations. The restricted availability of this isotope hinders its medical applications. We have proposed a new method for production of 155Tb, irradiating enriched 155Gd by alpha particles. The possibility of simultaneous production of two isotopes of terbium, 152,155Tb, was also studied for more efficient cyclotron beam use.

METHODS

Irradiation of 155Gd enriched targets and 155Gd / 151Eu tandem target with alpha-particles with an energy of 54 MeV was carried out at the U-150 cyclotron at the NRC "Kurchatov Institute". The cross sections of nuclear reactions on enr-155Gd were measured by the stack foil technique, detecting the gamma-radiation of the activation products. The separation of rare earth elements was performed by extraction chromatography with the LN Resin. 155Tb was produced via 155Dy decay.

RESULTS

The cross sections for the 155,156Tb and 155,157Dy production were measured by the irradiation of a gadolinium target enriched with the 155Gd isotope with alpha-particles in an energy range of 54 → 33 MeV. The yield of 155Dy on a thick target at 54 MeV was 130 MBq/μAh, which makes it possible to obtain 1 GBq of 155Tb in 11 hour-irradiation with 20 μA beam current. The possibility of simultaneous production of 152,155Tb by irradiation of 155Gd and 151Eu tandem target with medium-energy alpha-particles is implemented. Optimal irradiation energy ranges of alpha -particles as 54 → 42 MeV for 155Tb and 42 → 34 MeV for 152Tb were suggested. Product activity and radionuclidic purity were calculated.

Study of terbium production from enriched Gd targets via the reaction 155Gd(d,2n)155Tb

The terbium (Tb) family has attracted much attention in recent years thanks to the diagnostic and therapeutic applications of the quadruplet 149Tb, 152Tb, 155Tb and 161Tb. However, the scarce availability of Tb radioisotopes is one of the main reasons hindering its clinical applications. To increase its availability, this work proposes to use enriched gadolinium (Gd) targets to produce some Tb radioisotopes (149Tb, 152Tb, and 155Tb) via deuteron-induced reactions in cyclotrons. The production of the Auger and gamma emitter 155Tb was chosen as a case study because the 155Gd enrichment (92.8%) is the highest available from all Gd stable isotopes. The involved reaction is 155Gd(d,2n)155Tb. Using enriched thin Gd-containing targets, cross-sections of the reactions 155Gd(d,x)153,154,155,156Tb have been measured at the GIP ARRONAX cyclotron facility with a beam energy ranging from 8 MeV to 30 MeV. This measurement allows for estimating the production yield and the purity of 155Tb, and for determining the irradiation parameters for large production batches. A thick enriched 155Gd2O3 target has been then irradiated with an incident energy of 15.1 MeV and a beam current of 368 nA for 1 h. The production yield of 155Tb is 10.2 MBq/μA/h at End Of Bombardment (EOB) and the purity is 89% after 14 days of decay. These experimental values are consistent with estimation based on measured cross-sections. A comparison of the deuteron-induced and proton-induced production routes is also presented in this paper.

Theranostic Nuclear Medicine with Gallium-68, Lutetium-177, Copper-64/67, Actinium-225, and Lead-212/203 Radionuclides

Molecular changes in malignant tissue can lead to an increase in the expression levels of various proteins or receptors that can be used to target the disease. In oncology, diagnostic imaging and radiotherapy of tumors is possible by attaching an appropriate radionuclide to molecules that selectively bind to these target proteins. The term "theranostics" describes the use of a diagnostic tool to predict the efficacy of a therapeutic option. Molecules radiolabeled with γ-emitting or β+-emitting radionuclides can be used for diagnostic imaging using single photon emission computed tomography or positron emission tomography. Radionuclide therapy of disease sites is possible with either α-, β-, or Auger-emitting radionuclides that induce irreversible damage to DNA. This Focus Review centers on the chemistry of theranostic approaches using metal radionuclides for imaging and therapy. The use of tracers that contain β+-emitting gallium-68 and β-emitting lutetium-177 will be discussed in the context of agents in clinical use for the diagnostic imaging and therapy of neuroendocrine tumors and prostate cancer. A particular emphasis is then placed on the chemistry involved in the development of theranostic approaches that use copper-64 for imaging and copper-67 for therapy with functionalized sarcophagine cage amine ligands. Targeted therapy with radionuclides that emit α particles has potential to be of particular use in late-stage disease where there are limited options, and the role of actinium-225 and lead-212 in this area is also discussed. Finally, we highlight the challenges that impede further adoption of radiotheranostic concepts while highlighting exciting opportunities and prospects.

Copper radionuclides for theranostic applications: towards standardisation of their nuclear data. A mini-review

Copper has several clinically relevant radioisotopes and versatile coordination chemistry, allowing attachment of its radionuclides to biological molecules. This characteristic makes it suitable for applications in molecular imaging or radionuclide targeted therapy. Of particular interest in nuclear medicine today is the theranostic approach. This brief review considers five radionuclides of copper. These are Cu-60, Cu-61, Cu-62, Cu-64, and Cu-67. The first four are positron emitters for imaging, and the last one Cu-67 is a β--emitting radionuclide suitable for targeted therapy. The emphasis here is on theory-aided evaluation of available experimental data with a view to establishing standardised cross-section database for production of the relevant radionuclide in high purity. Evaluated cross section data of the positron emitters have been already extensively reported; so here they are only briefly reviewed. More attention is given to the data of the 68Zn(p,2p)67Cu intermediate energy reaction which is rather commonly used for production of 67Cu.

Nuclear Medicine and Cancer Theragnostics: Basic Concepts

Cancer theragnostics is a novel approach that combines diagnostic imaging and radionuclide therapy. It is based on the use of a pair of radiopharmaceuticals, one optimized for positron emission tomography imaging through linkage to a proper radionuclide, and the other bearing an alpha- or beta-emitter isotope that can induce significant damage to cancer cells. In recent years, the use of theragnostics in nuclear medicine clinical practice has increased considerably, and thus investigation has focused on the identification of novel radionuclides that can bind to molecular targets that are typically dysregulated in different cancers. The major advantages of the theragnostic approach include the elimination of multi-step procedures, reduced adverse effects to normal tissues, early diagnosis, better predictive responses, and personalized patient care. This review aims to discuss emerging theragnostic molecules that have been investigated in a series of human malignancies, including gliomas, thyroid cancer, neuroendocrine tumors, cholangiocarcinoma, and prostate cancer, as well as potent and recently introduced molecular targets, like cell-surface receptors, kinases, and cell adhesion proteins. Furthermore, special reference has been made to copper radionuclides as theragnostic agents and their radiopharmaceutical applications since they present promising alternatives to the well-studied gallium-68 and lutetium-177.

Design and synthesis of a new bifunctional chelating agent: Application for Al 18F/177Lu complexation

Theranostic and personalized medicine are blooming strategies to improve oncologic patients' health care and facilitate early treatment. While 18F-radiochemistry for theranostic application is attractive due to its imaging properties, combining diagnosis by positron emission tomography (PET) via aluminum-fluoride-18 and β- therapy with lutetium-177 is relevant. Nevertheless, it requires the use of two different chelating agents, which are NOTA and DOTA for aluminum-fluoride-18 and lutetium-177 radiolabeling, respectively. To overcome this issue, we propose herein the synthesis of a new hybrid chelating agent named NO2A-AHM, which can be labeled with different types of emitters (β+, β- and γ) using the mismatched Al18F/177Lu pair. NO2A-AHM, is based on a hydrazine moiety functionalized by a NOTA cycle, a chelating arm, and a linker with a maleimide function. This design is chosen to increase the flexibility and allow the formation of 5 up to 7 coordination bonds with metal ions. Moreover, this agent can be coupled to targeting moieties containing a thiol function, such as peptides, to increase selectivity towards specific cancer cells. Experimental complexation and computational chemistry studies are performed to confirm the capacity of our chelating agent to label both aluminum-fluoride and lutetium using molecular modeling approaches at Density Functional Theory (DFT) level. The proof of concept of the ability of NO2A-AHM to complex both aluminum-fluoride-18, for PET imaging applications, and lutetium-177 for radiotherapy has shown encouraging results which is prominent for the development of a fully consistent theranostic approach.

Recent Advances in 64Cu/67Cu-Based Radiopharmaceuticals

Copper-64 (T_1/2 = 12.7 h) is a positron and beta-emitting isotope, with decay characteristics suitable for both positron emission tomography (PET) imaging and radiotherapy of cancer. Copper-67 (T_1/2 = 61.8 h) is a beta and gamma emitter, appropriate for radiotherapy β-energy and with a half-life suitable for single-photon emission computed tomography (SPECT) imaging. The chemical identities of ⁶⁴Cu and ⁶⁷Cu isotopes allow for convenient use of the same chelating molecules for sequential PET imaging and radiotherapy. A recent breakthrough in ⁶⁷Cu production opened previously unavailable opportunities for a reliable source of ⁶⁷Cu with high specific activity and purity. These new opportunities have reignited interest in the use of copper-containing radiopharmaceuticals for the therapy, diagnosis, and theranostics of various diseases. Herein, we summarize recent (2018-2023) advances in the use of copper-based radiopharmaceuticals for PET, SPECT imaging, radiotherapy, and radioimmunotherapy.

Production of Co-58m in a siphon-style liquid target on a medical cyclotron

We present the production of ^58mCo on a small, 13 MeV medical cyclotron utilizing a siphon style liquid target system. Different concentrated iron(III)-nitrate solutions of natural isotopic distribution were irradiated at varying initial pressures and subsequently separated by solid phase extraction chromatography. The radio cobalt (^58m/gCo and ⁵⁶Co) was successfully produced with saturation activities of (0.35 ± 0.03) MBq μA^-1 for ^58mCo with a separation recovery of (75 ± 2) % of cobalt after one separation step utilizing LN-resin.

An Overview of In Vitro Assays of 64Cu-, 68Ga-, 125I-, and 99mTc-Labelled Radiopharmaceuticals Using Radiometric Counters in the Era of Radiotheranostics

Radionuclides are unstable isotopes that mainly emit alpha (α), beta (β) or gamma (γ) radiation through radiation decay. Therefore, they are used in the biomedical field to label biomolecules or drugs for diagnostic imaging applications, such as positron emission tomography (PET) and/or single-photon emission computed tomography (SPECT). A growing field of research is the development of new radiopharmaceuticals for use in cancer treatments. Preclinical studies are the gold standard for translational research. Specifically, in vitro radiopharmaceutical studies are based on the use of radiopharmaceuticals directly on cells. To date, radiometric β- and γ-counters are the only tools able to assess a preclinical in vitro assay with the aim of estimating uptake, retention, and release parameters, including time- and dose-dependent cytotoxicity and kinetic parameters. This review has been designed for researchers, such as biologists and biotechnologists, who would like to approach the radiobiology field and conduct in vitro assays for cellular radioactivity evaluations using radiometric counters. To demonstrate the importance of in vitro radiopharmaceutical assays using radiometric counters with a view to radiogenomics, many studies based on ⁶⁴Cu-, ⁶⁸Ga-, ¹²⁵I-, and ^99mTc-labeled radiopharmaceuticals have been revised and summarized in this manuscript.

Engineering a modular 44Ti/44Sc generator: eluate evaluation in preclinical models and estimation of human radiation dosimetry

BACKGROUND

⁴⁴Sc/⁴⁷Sc is an attractive theranostic pair for targeted in vivo positron emission tomographic (PET) imaging and beta-particle treatment of cancer. The ⁴⁴Ti/⁴⁴Sc generator allows daily onsite production of this diagnostic isotope, which may provide an attractive alternative for PET facilities that lack in-house irradiation capabilities. Early animal and patient studies have demonstrated the utility of ⁴⁴Sc. In our current study, we built and evaluated a novel clinical-scale ⁴⁴Ti/⁴⁴Sc generator, explored the pharmacokinetic profiles of ⁴⁴ScCl₃, [⁴⁴Sc]-citrate and [⁴⁴Sc]-NODAGA (1,4,7-triazacyclononane,1-glutaric acid-4,7-acetic acid) in naïve mice, and estimated the radiation burden of ⁴⁴ScCl₃ in humans.

METHODS

⁴⁴Ti/⁴⁴Sc (101.2 MBq) in 6 M HCl solution was utilized to assemble a modular ZR resin containing generator. After assembly, ⁴⁴Sc was eluted with 0.05 M HCl for further PET imaging and biodistribution studies in female Swiss Webster mice. Based on the biodistribution data, absorbed doses of ^44/47ScCl₃ in human adults were calculated for 18 organs and tissues using the IDAC-Dose software.

RESULTS

⁴⁴Ti in 6 M HCl was loaded onto the organic resin generator with a yield of 99.97%. After loading and initial stabilization, ⁴⁴ScCl₃ was eluted with 0.05 M HCl in typical yields of 82.9 ± 5.3% (N = 16), which was normalized to the estimated generator capacity. Estimated generator capacity was computed based on elution time interval and the total amount of ⁴⁴Ti loaded on the generator. Run in forward and reverse directions, the ⁴⁴Sc/⁴⁴Ti ratio from a primary column was significantly improved from 1038 ± 440 to 3557 ± 680 (Bq/Bq) when a secondary, replaceable, ZR resin cartridge was employed at the flow outlet. In vivo imaging and ex vivo distribution studies of the reversible modular generator for ⁴⁴ScCl₃, [⁴⁴Sc]-citrate and [⁴⁴Sc]-NODAGA show that free ⁴⁴Sc remained in the circulation significantly longer than the chelated ⁴⁴Sc. The dose estimation of ⁴⁴ScCl₃ reveals that the radiation burden is 0.146 mSv/MBq for a 70 kg adult male and 0.179 mSv/MBq for a 57 kg adult female. Liver, spleen and heart wall will receive the highest absorbed dose: 0.524, 0.502, and 0.303 mGy/MBq, respectively, for the adult male.

CONCLUSIONS

A clinical-scale ⁴⁴Ti/⁴⁴Sc generator system with a modular design was developed to supply ⁴⁴ScCl₃ in 0.05 M HCl, which is suitable for further radiolabeling and in vivo use. Our data demonstrated that free ⁴⁴ScCl₃ remained in the circulation for extended periods, which resulted in approximately 10 times greater radiation burden than stably chelated ⁴⁴Sc. Stable ⁴⁴Sc/⁴⁷Sc-complexation will be more favorable for in vivo use and for clinical utility.

Development of purification of no-carrier-added 47Sc of theranostic interest: selective separation study from the natTi(n,p) process

Scandium-47 is one of the most promising medical radioisotopes, and its production and trace separation make it an attractive candidate for theranostic application. In this study, the production of no-carrier-added (NCA) 47Sc through the natTi(n,p) reaction and subsequent purification using liquid–liquid extraction was done for the theranostic application. The comparative separation of NCA 47Sc after the dissolution of an activated Ti target using Di-2-Ethylhexyl Phosphoric Acid (HDEHP) in kerosene was evaluated. The extraction process was optimized in terms of the concentration of extractant, extraction time, pH, and reaction temperature to achieve the maximum possible separation. HDEHP is efficient and promising for rapid extraction and separation of NCA 47Sc from Ti ions at low acidity (pH 0.85) with high extraction percent (>99%), contaminated with 22.3% of Ti ions after 5 min of extraction time. Different stripping reagents were used to separate loaded 47Sc and Ti ions. Firstly, 5 M HCl was enough for stripping the loaded Ti ions. Then the loaded 47Sc was separated with a purity of 100% using 0.05 M NaOH. The obtained results find the HDEHP a promising extractant for efficient separation of 47Sc from irradiated Ti target for preparing the 47Sc radiopharmaceuticals for theranostics applications.

Nanomedicine embraces cancer radio-immunotherapy: mechanism, design, recent advances, and clinical translation

Cancer radio-immunotherapy, integrating external/internal radiation therapy with immuno-oncology treatments, emerges in the current management of cancer. A growing number of pre-clinical studies and clinical trials have recently validated the synergistic antitumor effect of radio-immunotherapy, far beyond the "abscopal effect", but it suffers from a low response rate and toxicity issues. To this end, nanomedicines with an optimized design have been introduced to improve cancer radio-immunotherapy. Specifically, these nanomedicines are elegantly prepared by incorporating tumor antigens, immuno- or radio-regulators, or biomarker-specific imaging agents into the corresponding optimized nanoformulations. Moreover, they contribute to inducing various biological effects, such as generating in situ vaccination, promoting immunogenic cell death, overcoming radiation resistance, reversing immunosuppression, as well as pre-stratifying patients and assessing therapeutic response or therapy-induced toxicity. Overall, this review aims to provide a comprehensive landscape of nanomedicine-assisted radio-immunotherapy. The underlying working principles and the corresponding design strategies for these nanomedicines are elaborated by following the concept of "from bench to clinic". Their state-of-the-art applications, concerns over their clinical translation, along with perspectives are covered.

Development of radiopharmaceuticals for targeted alpha therapy: Where do we stand?

Targeted alpha therapy is an oncological treatment, where cytotoxic doses of alpha radiation are locally delivered to tumor cells, while the surrounding healthy tissue is minimally affected. This therapeutic strategy relies on radiopharmaceuticals made of medically relevant radionuclides chelated by ligands, and conjugated to targeting vectors, which promote the drug accumulation in tumor sites. This review discusses the state-of-the-art in the development of radiopharmaceuticals for targeted alpha therapy, breaking down their key structural components, such as radioisotope, targeting vector, and delivery formulation, and analyzing their pros and cons. Moreover, we discuss current drawbacks that are holding back targeted alpha therapy in the clinic, and identify ongoing strategies in field to overcome those issues, including radioisotope encapsulation in nanoformulations to prevent the release of the daughters. Lastly, we critically discuss potential opportunities the field holds, which may contribute to targeted alpha therapy becoming a gold standard treatment in oncology in the future.

Cross sections and calculated yields of some radionuclides of yttrium, strontium and rubidium formed in proton-induced reactions on enriched strontium-86: possibility of production of 85gSr, 83Rb and 82mRb in no-carrier-added form

Cross sections of the 86Sr(p,3n)84mY, 86Sr(p,αn)82mRb, and 86Sr(p,x)85gSr reactions were measured from their respective thresholds up to 16.2 MeV and from 23.0 to 44.1 MeV at FZJ, and from 14.3 to 24.5 MeV at LBNL, using 96.4% enriched 86SrCO3 as target material. Thin targets prepared by sedimentation were irradiated with protons in a stacked-form, and the induced radioactivity was measured by high-resolution γ-ray spectrometry. Nuclear model calculations based on the code TALYS reproduced our experimental cross section data well. From the excitation functions, the integral yields of the above three radionuclides were calculated. The yield of 85gSr via the natSr(n,γ) process was also measured using the TRIGA Mark-II reactor at AERE, Savar. A comparison of the reactor and cyclotron production of carrier-added 85gSr is given. The production possibilities of the three investigated radionuclides in no-carrier-added forms at a 30 MeV cyclotron via new routes are discussed.

Study of activation cross sections of proton induced reactions on natBa and natCe near their threshold energy regions

Activation cross-sections of the nuclear reactions natBa(p,x)135,132gLa, 135mBa and natCe(p,x)142,139,138mPr, 141,139,137mCe have been measured experimentally at the MGC-20 cyclotron, Cairo, Egypt, from their respective threshold energies up to about 14.7 MeV. Stacked foil irradiation technique and high-resolution gamma-ray spectroscopy were used. A comparison between the experimental and theoretical data derived from the nuclear model codes EMPIRE and TALYS (in the form of the TENDL library) was performed. The agreement in the low-energy region is fairly good. Integral yields of the produced radioisotopes were estimated from the present cross-section data and the results are discussed in terms of their production possibilities.

Cutting edge rare earth radiometals: prospects for cancer theranostics

Background

With recent advances in novel approaches to cancer therapy and imaging, the application of theranostic techniques in personalised medicine has emerged as a very promising avenue of research inquiry in recent years. Interest has been directed towards the theranostic potential of Rare Earth radiometals due to their closely related chemical properties which allow for their facile and interchangeable incorporation into identical bifunctional chelators or targeting biomolecules for use in a diverse range of cancer imaging and therapeutic applications without additional modification, i.e. a “one-size-fits-all” approach. This review will focus on recent progress and innovations in the area of Rare Earth radionuclides for theranostic applications by providing a detailed snapshot of their current state of production by means of nuclear reactions, subsequent promising theranostic capabilities in the clinic, as well as a discussion of factors that have impacted upon their progress through the theranostic drug development pipeline.

Main body

In light of this interest, a great deal of research has also been focussed towards certain under-utilised Rare Earth radionuclides with diverse and favourable decay characteristics which span the broad spectrum of most cancer imaging and therapeutic applications, with potential nuclides suitable for α-therapy (¹⁴⁹Tb), β⁻-therapy (⁴⁷Sc, ¹⁶¹Tb, ¹⁶⁶Ho, ¹⁵³Sm, ¹⁶⁹Er, ¹⁴⁹Pm, ¹⁴³Pr, ¹⁷⁰Tm), Auger electron (AE) therapy (¹⁶¹Tb, ¹³⁵La, ¹⁶⁵Er), positron emission tomography (⁴³Sc, ⁴⁴Sc, ¹⁴⁹Tb, ¹⁵²Tb, ¹³²La, ¹³³La), and single photon emission computed tomography (⁴⁷Sc, ¹⁵⁵Tb, ¹⁵²Tb, ¹⁶¹Tb, ¹⁶⁶Ho, ¹⁵³Sm, ¹⁴⁹Pm, ¹⁷⁰Tm). For a number of the aforementioned radionuclides, their progression from ‘bench to bedside’ has been hamstrung by lack of availability due to production and purification methods requiring further optimisation.

Conclusions

In order to exploit the potential of these radionuclides, reliable and economical production and purification methods that provide the desired radionuclides in high yield and purity are required. With more reactors around the world being decommissioned in future, solutions to radionuclide production issues will likely be found in a greater focus on linear accelerator and cyclotron infrastructure and production methods, as well as mass separation methods. Recent progress towards the optimisation of these and other radionuclide production and purification methods has increased the feasibility of utilising Rare Earth radiometals in both preclinical and clinical settings, thereby placing them at the forefront of radiometals research for cancer theranostics.

Production Review of Accelerator-Based Medical Isotopes

The production of reactor-based medical isotopes is fragile, which has meant supply shortages from time to time. This paper reviews alternative production methods in the form of cyclotrons, linear accelerators and neutron generators. Finally, the status of the production of medical isotopes in China is described.

Design synthesis of Y-90 glass microspheres and study of their therapeutic effects on mouse liver cancer cell line Hep3B

In this article, a system for synthesizing Y-90 glass microspheres (Y-90-GM) was successfully designed in the Da Lat nuclear reactor (Vietnam), and the therapeutic effects of Y-90-GM on mice liver cancer cell line Hep3B were studied. The effects of synthesis factors, including heating time, heating temperature, gas flow rate, sample conduit length and diameter, were investigated to establish the optimal parameters. The size and shape of Y-90-GM were checked by field emission scanning electron microscope, and the radioactivity measurement was performed on a dosimeter. The results indicated that the optimal conditions for the synthesis of Y-90-GM were determined as the heating temperature of 1600 °C, heating time of 2 h, conduit length and diameter of 50 cm and 3.6 cm, and gas/oxygen flow rate of 15 mph. The Y-90-GM samples obtained at the optimal parameters have a size of 18-30 μm with a density of 3.53 g cm^-3 and a specific radioactivity of 630 mCi g^-1. The results of the therapeutic study on mice liver cancer cell line Hep3B showed that after two weeks of treatment with Y-90-GM (1mCi/mouse), the tumor volume was reduced by about 30.7% and after 3 consecutive treatment cycles, the liver cancer tumor was completely reduced. It was demonstrated that Y-90-GM is promising radiopharmaceuticals in the treatment of liver cancer by the radioembolization method.

Synthesis, solid-state, solution, and theoretical characterization of an "in-cage" scandium-NOTA complex

Developing chelators that strongly and selectively bind rare-earth elements (Sc, Y, La, and lanthanides) represents a longstanding fundamental challenge in inorganic chemistry. Solving these challenges is becoming more important because of increasing use of rare-earth elements in numerous technologies, ranging from paramagnets to luminescent materials. Within this context, we interrogated the complexation chemistry of the scandium(III) (Sc³⁺) trication with the hexadentate 1,4,7-triazacyclononane-1,4,7-triacetic acid (H₃NOTA) chelator. This H₃NOTA chelator is often regarded as an underperformer for complexing Sc³⁺. A common assumption is that metalation does not fully encapsulate Sc³⁺ within the NOTA^3- macrocycle, leaving Sc³⁺ on the periphery of the chelate and susceptible to demetalation. Herein, we developed a synthetic approach that contradicted those assumptions. We confirmed that our procedure forced Sc³⁺ into the NOTA^3- binding pocket by using single crystal X-ray diffraction to determine the Na[Sc(NOTA)(OOCCH₃)] structure. Density functional theory (DFT) and ⁴⁵Sc nuclear magnetic resonance (NMR) spectroscopy showed Sc³⁺ encapsulation was retained when the crystals were dissolved. Solution-phase and DFT studies revealed that [Sc(NOTA)(OOCCH₃)]^1- could accommodate an additional H₂O capping ligand. Thermodynamic properties associated with the Sc-OOCCH₃ and Sc-H₂O capping ligand interactions demonstrated that these capping ligands occupied critical roles in stabilizing the [Sc(NOTA)] chelation complex.

Efficiency of 124I radioisotope production from natural and enriched tellurium dioxide using 124Te(p,xn)124I reaction

Background

¹²⁴I Iodine (T\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$_{1/2}$$\end{document}1/2 = 4.18 d) is the only long-life positron emitter radioisotope of iodine that may be used for both imaging and therapy as well as for ¹³¹I dosimetry. Its physical characteristics permits taking advantages of the higher Positron Emission Tomography (PET) image quality, whereas the availability of new molecules to be targeted with ¹²⁴I makes it a novel innovative radiotracer probe for a specific molecular targeting.

Results

In this study Monte Carlo and SRIM/TRIM modelling was applied to predict the nuclear parameters of the ¹²⁴I production process in a small medical cyclotron IBA 18/9 Cyclone. The simulation production yields for ¹²⁴I and the polluting radioisotopes were  calculated for the natural and enriched ¹²⁴TeO₂  +  Al₂O₃  solid targets irradiated with 14.8 MeV protons. The proton beam was degraded energetically from 18 MeV with 0.2 mm Havar foil. The ¹²⁴Te(p,xn)¹²⁴I reactions were taken into account in the simulations. The optimal thickness of the target material was calculated using the SRIM/TRIM and Geant4 codes. The results of the simulations were compared with the experimental data obtained for the natural TeO₂ +Al₂O₃ target. The dry distillation technique of the 124-iodine was applied.

Conclusions

The experimental efficiency for the natural Te target was better than 41% with an average thick target (>0.8 mm) yield of 1.32 MBq/μAh. Joining the Monte Carlo and experimental approaches makes it possible to optimize the methodology for the ¹²⁴I production from the expensive Te enriched targets.

Status of the decay data for medical radionuclides: existing and potential diagnostic γ emitters, diagnostic β+ emitters and therapeutic radioisotopes

Recommended half-lives and specific well-defined emission energies and absolute emission probabilities are important input parameters that should be well-defined to assist in ensuring the diagnostic and therapeutic efficacy of individual radionuclides when applied in the field of nuclear medicine. Bearing in mind the nature of these requirements, approximately one hundred radionuclides have been considered and re-assessed as to whether their decay data are either adequately quantified, or require further in-depth measurements to improve their existing status and merit full re-evaluations of their decay schemes. The primary aim of such a review is to provide sufficient information on the existing and future requirements for such atomic and nuclear data.

Theragnostic 64Cu/67Cu Radioisotopes Production With RFT-30 Cyclotron

⁶⁴Cu and ⁶⁷Cu are theragnostic pair radionuclides with promising application in the nuclear medicine. ⁶⁴Cu is PET nuclide for the non-invasive diagnosis and ⁶⁷Cu is beta emitter for therapy of various cancers. This study discusses optimization efforts in the production of these radioactive coppers carried out with 30 MeV cyclotron. Optimized conditions include target preparation, chemical separation, and quality control. The production routes of ⁶⁴Cu and ⁶⁷Cu were studied based on the nuclear reactions of ⁶⁴Ni(p,n)⁶⁴Cu and ⁷⁰Zn(p,α)⁶⁷Cu. The produced ⁶⁴Cu and ⁶⁷Cu have >99.9% of the radionuclidic purity. The yield at the end of bombardment (EOB) of ⁶⁴Cu and ⁶⁷Cu is 28.5 MBq/μAh and ⁶⁷Cu is 0.58 MBq/μAh, respectively.

Nuclear data for light charged particle induced production of emerging medical radionuclides

Whatever the radionuclide to be used in nuclear medicine, it is essential to know the expected yield during the production process, but also of all the possible radionuclidic impurities coproduced, that can have an impact on the product final quality, as well as in the related waste management. The availability of the majority of emerging radioisotopes, including the theranostic ones or pairs, is mainly limited by the fact that, for most of them, the optimal production route still needs to be strengthened if not defined in some cases. The aim of this work is to present a review on the charged particle induced nuclear cross sections to produce some emerging radionuclides for medical applications to show that all types of projectiles should be considered in the quest of producing medical radionuclides. An accurate analysis of the production routes is presented for some radionuclides (67Cu, 47Sc, 89Zr, 103Pd, 186gRe, 97Ru, 211At) chosen as examples to highlight (i) how the quality of the final product strongly depends on the chosen target/projectile/energy parameters set, (ii) how deuteron production routes may sometimes be more effective than the proton ones or lead to a different impurity profile and (iii) how α-particle beams may allow to bypass the limitations occurring when using Z = 1 beams. An overview of possible advantages and drawbacks of the cited production routes and of potential cross sections that still need to be measured, is also reported.

Production of neutron deficient rare earth radionuclides by heavy ion activation

The attempts to produce neutron deficient radioisotopes of rare Earth elements by heavy ion activation are discussed in this review. The heavy ion induced reaction products have large atomic number difference with that of the target; therefore, radiochemical separation of no-carrier-added radio-lanthanides from the target matrix becomes easier. Heavy ion induced reactions also allow the production of rare Earth radionuclides from non-rare Earth target by tailor-made target-projectile combinations, and in those cases, radiochemical separations become even more easier. In general, the cross sections of heavy ion induced reactions are less than those of light charged particle induced reactions. However, some of the heavy ion induced reactions have comparable cross sections with those of light ion induced reactions. The range of heavy ions is also much smaller in the target matrix than that of lighter charged particles. These points hinder application of heavy ion induced reactions to produce radionuclides for nuclear medicine.

The role of chemistry in accelerator-based production and separation of radionuclides as basis for radiolabelled compounds for medical applications

Radiochemical separations used in large scale routine production of diagnostic and therapeutic radionuclides at a particle accelerator for patient care are briefly outlined. The role of chemistry at various stages of development of a production route of a novel radionuclide, namely nuclear data measurement, high-current targetry, chemical processing and quality control of the product, is discussed in detail. Special attention is paid to production of non-standard positron emitters (e.g. 44gSc, 64Cu, 68Ga, etc.) at a cyclotron and novel therapeutic radionuclides (e.g. 67Cu, 225Ac, etc.) at an accelerator. Some typical examples of radiochemical methods involved are presented.

Nuclear reaction data for medical and industrial applications: recent contributions by Egyptian cyclotron group

Measurement and evaluation of nuclear data of radioisotopes used as tracers are continuously underway in many laboratories to reach high accuracy for their use in production. We briefly mention some of the radionuclides useful for medical diagnostics and other industrial applications. The research group at the Egyptian cyclotron facility (EGCF) performed in collaboration with nuclear research centres and universities in many countries (Germany, Hungary, Finland, USA, Japan and Saudi Arabia) some measurements and evaluations of interesting nuclear reaction data. Nuclear reactions induced by p, d and α-particles on a wide variety of targets were extensively studied from threshold energy up to 50 MeV. Nuclear model code calculations, mainly using EMPIRE and TALYS, were performed for nuclear data validation. Proton and neutron activation of some industrially interesting samples were also studied as technological application of nuclear analytical techniques. Since the cyclotron facility is dedicated to development of the production routes of medical radioisotopes, this overview presents examples of optimization experiments to establish good production conditions.

An overview of nuclear data standardisation work for accelerator-based production of medical radionuclides in Pakistan

The standardisation of nuclear reaction cross section data is an integral part of optimisation of production routes of medical radionuclides. The production cross sections are available for the reactor and cyclotron produced radionuclides to be used for diagnostics or therapeutic procedures. The types of nuclear data needed, and the sources of their availability are summarized. The method of standardisation of charged-particle data is briefly described. A historical overview of research work in Pakistan in this direction is given. Examples of a few medically important radionuclides, such as 64Cu, 86Y, 89Zr, 103Pd, 186Re, etc., whose data were standardised and evaluated are highlighted. Calculated thick target yields from the recommended data are given. Some new directions in the nuclear data research are outlined.

Production and subsequent separation of 47Sc of nuclear medicine applications using neutron-induced reactions on different natural targets

47Sc can be produced from different three neutron induced nuclear reactions as 47Ti(n,p)47Sc, 50V(n,α)47Sc and 46Ca(n,γ)47Ca, 47Ca(β−)47Sc using the Egyptian Second Research Reactor. The measured neutron cross-sections (σ) are 62.12 ± 1.93, 4.51 ± 1.27 and 69.36 ± 2.01 mb from the natural targets of TiO2, V2O3 and CaO respectively. The carrier-free 47Sc from 47Ti(n,p), was purified using a composite of Alginate–Carboxymethyl cellulose/di-2-ethylhexyl phosphoric acid. The radiochemical separation of 47Sc with a recovery yield of 90 ± 1.2% was obtained. The eluted 47Sc passed quality control tests (chemical, radionuclide, and radiochemical purities) and was found to be suitable for nuclear medicine applications.

Positron Emission Intensity in the Decay of 86gY for Use in Dosimetry Studies

The β⁺-emitting radionuclide ^86gY (t_1/2 = 14.7 h) forms a matched-pair with the β⁻-emitting therapeutic radionuclide ⁹⁰Y (t_1/2 = 2.7 d) for theranostic application in medicine. This approach demands a precise knowledge of the positron emission probability of the PET nuclide which was until recently rather uncertain for ^86gY. In this work, an ^86gY source of high radionuclidic purity was prepared and a direct measurement of the positron emission intensity per 100 decay of the parent (hereafter “positron emission intensity”) was performed using high-resolution HPGe detector γ-ray spectroscopy. The electron capture intensity was also determined as an additional check by measuring the K_α and K_β X-rays of energies 14.1 and 15.8 keV, respectively, using a low energy HPGe detector. From those measurements, normalized values of 27.2 ± 2.0% for β⁺-emission and 72.8 ± 2.0% for EC were obtained. These results are in excellent agreement with values recently reported in the literature based on a detailed decay scheme study.

Expanding Theranostic Radiopharmaceuticals for Tumor Diagnosis and Therapy

Radioligand theranostics (RT) in oncology use cancer-type specific biomarkers and molecular imaging (MI), including positron emission tomography (PET), single-photon emission computed tomography (SPECT) and planar scintigraphy, for patient diagnosis, therapy, and personalized management. While the definition of theranostics was initially restricted to a single compound allowing visualization and therapy simultaneously, the concept has been widened with the development of theranostic pairs and the combination of nuclear medicine with different types of cancer therapies. Here, we review the clinical applications of different theranostic radiopharmaceuticals in managing different tumor types (differentiated thyroid, neuroendocrine prostate, and breast cancer) that support the combination of innovative oncological therapies such as gene and cell-based therapies with RT.

Theragnostic radionuclides: a clinical perspective

The concept of theragnostics goes back to the earliest days of nuclear medicine, with [¹²³I/¹³¹I]iodide in thyroid disease and [¹²³I/¹³¹I]MIBG in phaeochromocytoma being examples in long-term use. However, in recent years there has been a great expansion in the application of theragnostics, beginning with [⁶⁸Ga/¹⁷⁷Lu]-labelled somatostatin peptides for evaluation and treatment of neuroendocrine tumors. We are currently seeing the rapid development of [⁶⁸Ga/¹⁷⁷Lu]PSMA theragnostics in metastatic prostate cancer. While these applications are very promising, there are a number of practicalities which must be addressed in the development and introduction of novel theragnostics. The physical half-lives of the diagnostic and therapeutic radionuclides must be appropriate for imaging and delivery of targeted cell killing, respectively. The types of radioactive emissions are critical; beta particles can traverse several millimeters but also risk damaging non-target tissues, while alpha particles deliver their energy over a much shorter path length, a few cell diameters, and must be more directly targeted. It must be practical to produce the therapeutic radionuclide and the final radiopharmaceutical and deliver them to the final user within an appropriate time-frame determined by half-life and stability. The biodistribution of the agent must demonstrate adequate accumulation and retention in the target tissue with clearance from adjacent and/or radio-sensitive normal tissues. The commercial success of recently introduced theragnostics suggests a rosy future for personalized medicine.

High purity 47Sc production using high-energy photons and natural vanadium targets

Scandium-47 (⁴⁷Sc) is of high value for targeted radiotherapy and theranostics; we report a novel, cost-effective approach to produce high-purity ⁴⁷Sc via photonuclear reactions with natural vanadium. Irradiation at 20 MeV photon end-point energy produces >99.998% pure ⁴⁷Sc, while irradiation at 38 MeV produces 98.8 ± 1.6% pure ⁴⁷Sc. Experimental data suggest producing greater than 100 mCi (3700 MBq) of ⁴⁷Sc using this approach may be feasible. Future research into refinement and scale-up to support pre-clinical research is recommended.

Fusion-Based Neutron Generator Production of Tc-99m and Tc-101: A Prospective Avenue to Technetium Theranostics

Presented are the results of ^99mTc and ¹⁰¹Tc production via neutron irradiation of natural isotopic molybdenum (Mo) with epithermal/resonance neutrons. Neutrons were produced using a deuterium-deuterium (D-D) neutron generator with an output of 2 × 10¹⁰ n/s. The separation of Tc from an irradiated source of bulk, low-specific activity (LSA) Mo on activated carbon (AC) was demonstrated. The yields of ^99mTc and ¹⁰¹Tc, together with their potential use in medical single-photon emission computed tomography (SPECT) procedures, have been evaluated from the perspective of commercial production, with a patient dose consisting of 740 MBq (20 mCi) of ^99mTc. The number of neutron generators to meet the annual 40,000,000 world-wide procedures is estimated for each imaging modality: ^99mTc versus ¹⁰¹Tc, D-D versus deuterium-tritium (D-T) neutron generator system outputs, and whether or not natural molybdenum or enriched targets are used for production. The financial implications for neutron generator production of these isotopes is also presented. The use of ¹⁰¹Tc as a diagnostic, therapeutic, and/or theranostic isotope for use in medical applications is proposed and compared to known commercial nuclear diagnostic and therapeutic isotopes.

Emerging chelators for nuclear imaging

Chelators are necessary in nuclear medicine imaging to direct an inorganic radionuclide, a radiometal, to a desired target; unfortunately, there is no 'one-size-fits-all' chelator. As the toolbox of radiometals is expanding, new chelators are required to prevent off-target side effects. 1,4,7,10-Tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA) is the current gold standard chelator for several radiometals, but typically, chelation requires harsh conditions, making it unsuitable to label biological vectors. The ideal chelator would allow labelling under mild conditions (near-neutral pH and low temperatures [∼37 °C]) and be both thermodynamically and kinetically stable. Over the past 2-3 years, several exciting chelators have been developed that have superior properties to make them worth investigating for future clinical applications.

Separation of 71,72As from alpha particle induced gallium oxide target by solid cation and anion exchangers, DOWEX-50 and DOWEX-1

46.0 MeV alpha particle induced reaction on gallium oxide target results production of no-carrier-added (NCA) ^71,72As and ⁶⁷Ga tracer. ^71,72As were separated from the target matrix by solid liquid extraction (SLX) using two different exchangers, Dowex-1 and Dowex-50. At best condition of 0.2 g Dowex-1 + 6 M HCl and 0.2 g Dowex-50 + 10^-3 M HCl bulk gallium was completely extracted leaving behind NCA ^71,72As in the aqueous phase. Dowex-50 was found to be more suitable and offered high separation factor, 3.2 × 10⁵.

Theranostic Terbium Radioisotopes: Challenges in Production for Clinical Application

Currently, research on terbium has gained a momentum owing to its four short-lived radioisotopes, ¹⁴⁹Tb, ¹⁵²Tb, ¹⁵⁵Tb, and ¹⁶¹Tb, all of which can be considered in one or another field of nuclear medicine. The members of this emerging quadruplet family have appealing nuclear characteristics and have the potential to do justice to the proposed theory of theranostics nuclear medicine, which amalgamates therapeutic and diagnostic radioisotopes together. The main challenge for in vivo use of these radioisotopes is to produce them in sufficient quantity. This review discusses that, at present, neither light charged particle nor the heavy ion (HI) activation are suitable for large-scale production of neutron deficient terbium nuclides. Three technological factors like (i) enrichment of stable isotopes to a considerable level, (ii) non-availability of higher energies in commercial cyclotrons, and (iii) non-availability of the isotope separation technique coupled with commercial accelerators limit the large scale production of terbium radionuclides by light charged particle activation. If in future, the technology can overcome these hurdles, then the light charged particle activation of enriched targets would produce a high amount of useful terbium radionuclides. On the other hand, to date, the spallation reaction coupled with an online isotope separator has been found suitable for such a requirement, which has been adopted by the CERN MEDICIS programme. The therapeutic ¹⁶¹Tb radionuclide can be produced in a reactor by neutron bombardment on enriched ¹⁶⁰Gd target to produce ¹⁶¹Gd which subsequently decays to ¹⁶¹Tb. The radiochemical separation is mandatory even if the ISOL technique is used to obtain high radioisotopic purity of the desired radioisotope.