Robotic preparation of Sodium Acetate C 11 Injection for use in clinical PET

Radiosynthesis, Preclinical, and Clinical Positron Emission Tomography Studies of Carbon-11 Labeled Endogenous and Natural Exogenous Compounds

The presence of positron emission tomography (PET) centers at most major hospitals worldwide, along with the improvement of PET scanner sensitivity and the introduction of total body PET systems, has increased the interest in the PET tracer development using the short-lived radionuclides carbon-11. In the last few decades, methodological improvements and fully automated modules have allowed the development of carbon-11 tracers for clinical use. Radiolabeling natural compounds with carbon-11 by substituting one of the backbone carbons with the radionuclide has provided important information on the biochemistry of the authentic compounds and increased the understanding of their in vivo behavior in healthy and diseased states. The number of endogenous and natural compounds essential for human life is staggering, ranging from simple alcohols to vitamins and peptides. This review collates all the carbon-11 radiolabeled endogenous and natural exogenous compounds synthesised to date, including essential information on their radiochemistry methodologies and preclinical and clinical studies in healthy subjects.

Method to Development of PET Radiopharmaceutical for Cancer Imaging

The increasing number of different novel positron emission tomography (PET) radiopharmaceuticals poses challenges for their manufacturing procedures at different PET research facilities. Recent commercially available radiochemistry units with disposable cassettes are becoming common stations to produce radiopharmaceuticals with high specifications to understand the critical PET imaging outputs of the study. Therefore, several radiochemists across the PET research centers develop and optimize their own radiochemistry protocols to develop a novel or routine radiopharmaceutical at their lab. In this report, we describe the general procedure and steps followed to develop a (clinical-grade) radiopharmaceutical on a commercially available radiochemistry unit, TRASIS AIO. As an example, we use our routine protocol followed for the production of [¹¹C]acetate, a fatty acid metabolic PET imaging ligand for several cancer imaging studies.

An Exposition of 11C and 18F Radiotracers Synthesis for PET Imaging

The development of new radiolabeled Positron emission tomography tracers has been extensively utilized to access the increasing diversity in the research process and to facilitate the development in research methodology, clinical usage of drug discovery and patient care. Recent advances in radiochemistry, as well as the latest techniques in automated radio-synthesizer, have encouraged and challenged the radiochemists to produce the routinely developed radiotracers. Various radionuclides like 18F, 11C, 15O, 13N 99mTc, 131I, 124I and 64Cu are used for incorporating into different chemical scaffolds; among them, 18F and 11C tagged radiotracers are mostly explored such as 11C-Methionine, 11C-Choline, 18F-FDG, 18F-FLT, and 18F-FES. This review is focused on the development of radiochemistry routes to synthesize different radiotracers of 11C and 18F for clinical studies.

Acetuino-A Handy Open-Source Radiochemistry Module for the Preparation of [1-11C]Acetate

Radiosynthesis of [1-¹¹C]acetate is well described in literature, but all syntheses either require adaptations in complex commercial synthesizers or rely on closed-source hardware and software control. Arduino microcontrollers are ideal for the compact, flexible, and inexpensive control of low-complexity hardware, making them particularly suited for radiochemistry where operation in space-limited shielded hot cells is mandatory. We established a [1-¹¹C]acetate radiosynthesis module for combination with a [¹¹C]MeI module available in almost every lab working with ¹¹C. Its small footprint even enables back-to-back production in a hot cell already occupied by other modules. Using this setup, we achieved a reliable and flexible supply of this tracer, with radiochemical yields of 51.4 ± 28.2% and radiochemical purities (RCPs) of 94.4 ± 6.7% ( n = 9) in a synthesis time of 15 minutes. Positron emission tomography (PET) and biodistribution analysis demonstrated low background uptake in healthy mice, with highest uptake in liver and kidneys. Arduino microcontrollers have become valuable and versatile tools in our lab for the automatization of low-complexity procedures not requiring full-blown commercial radiochemistry synthesizers, as showcased here for the production of [1-¹¹C]acetate.

Development of 68Ga-SCN-DOTA-Capsaicin as an Imaging Agent Targeting Apoptosis and Cell Cycle Arrest in Breast Cancer

⁶⁸Ga-labeled capsaicin using a DOTA (1,4,7,10-tetraazocyclododecane-N,N',N″,N'″-tetraacetic acid) derivative [⁶⁸Ga-SCN-Benzyl(Bn)-DOTA-capsaicin] was studied for the diagnosis of breast cancers, such as MCF-7 and SK-BR-3. The standard compound, ⁶⁹Ga-SCN-Bn-DOTA-capsaicin, was also prepared and characterized by spectroscopic analysis. The binding affinity of ⁶⁸Ga-SCN-Bn-DOTA-capsaicin was evaluated by using breast cancer cell lines (MCF-7, SK-BR-3) and colon cancer cell (CT-26); the biodistribution was carried out by using MCF-7-bearing nude mice, after which the positron emission tomography (PET) images were obtained at different time intervals (15-120 minutes). ⁶⁸Ga-SCN-Bn-DOTA-capsaicin showed a cellular uptake of 0.93% Injected Dose (ID) after 30 minutes of incubation, whereas ⁶⁸Ga-SCN-Bn-DOTA showed a lower uptake of 0.25% ID. The tumor-to-blood ID/g% ratios increased and were found to be 0.49, 0.22, and 0.77 for 15, 30, and 60 minutes, respectively. The small-animal PET study showed that the uptake of ⁶⁸Ga-SCN-Bn-DOTA-capsaicin was higher in the tumor regions even at 30 minutes after injection. These results suggest that ⁶⁸Ga-SCN-Bn-DOTA-capsaicin is a potential targeting agent for PET imaging of MCF-7.

In-house development of an optimized synthetic module for routine [11C]acetate production

[11C]Acetate, a radiotracer for PET imaging, is a promising radiopharmaceutical for overcoming the limitation of 2-deoxy-2-[18F]fluoro-D-glucose in a number of cancers. Here, the optimized automatic synthesis of [11C]acetate using an in-house-developed module under different conditions has been reported for routine production. [11C]CO2 was produced in a 16.4 MeV PETtrace cyclotron, and methyl magnesium chloride was used for synthesis. For product purification, ion-exchange solid-phase extraction cartridges were used, connected in series. High-performance liquid chromatography and gas chromatography were used to measure radiochemical and chemical purity. The Limulus amebocyte lysate test and the fluid thioglycollate medium test were performed for quality control of [11C]acetate. The total reaction time of [11C]acetate was within 15 min, and the overall decay-corrected radiochemical yield was 84.33±8.85%. Radiochemical purity was greater than 98% when evaluated on an analytical high-performance liquid chromatography system. No endotoxins or anaerobic bacteria were seen on quality control checks. Optimized production of [11C]acetate was achieved by the in-house module. Radiochemical and biological properties of the [11C]acetate produced were appropriate for clinical PET study.

Easy upgrade of the TRACERLab FX C Pro for [¹¹C]carboxylation reactions: application to the routine production of [1-¹¹C]acetate

Carbon-11-labeled acetate ([1-(11)C]acetate) is a radiopharmaceutical of importance in clinical practice as well as in preclinical research in cardiology and oncology. Its preparation is based on the [(11)C]carboxylation reaction of a Grignard reagent with [(11)C]CO2. Most of the commercially available synthesizers are only dedicated to the preparation of [(11)C]methyl iodide (or [(11)C]methyl triflate) for the radiomethylation of an appropriate precursor but not for the direct use of cyclotron-produced [(11)C]CO2. Based on the classical [(11)C]carboxylation reaction and SPE purification, we propose in this technical note a detailed, simple, easy-to-handle and fully reversible modification of the TRACERLab FX C Pro to operate, on demand, [(11)C]carboxylation reactions, exemplified herein by the production of [1-(11)C]acetate, or [(11)C]radiomethylation reactions. This also opens new prospects to other type of radiochemical reactions involving [(11)C]CO2.

11C-Acetate PET/CT in localized prostate cancer: a study with MRI and histopathologic correlation

This work characterizes the uptake of (11)C-acetate in prostate cancer (PCa), benign prostate hyperplasia, and normal prostate tissue in comparison with multiparametric MRI, whole-mount histopathology, and clinical markers to evaluate the potential utility of (11)C-acetate for delineating intraprostatic tumors in a population of patients with localized PCa.

METHODS

Thirty-nine men with presumed localized PCa underwent dynamic-static abdominal-pelvic (11)C-acetate PET/CT for 30 min and 3-T multiparametric MRI before prostatectomy. PET/CT images were registered to MR images using pelvic bones for initial rotation-translation, followed by manual adjustments to account for prostate motion and deformation from the MRI endorectal coil. Whole-mount pathology specimens were sectioned using an MRI-based patient-specific mold resulting in improved registration between the MRI, PET, and pathology. (11)C-acetate PET standardized uptake values were compared with multiparametric MRI and pathology.

RESULTS

(11)C-acetate uptake was rapid but reversible, peaking at 3-5 min after injection and reaching a relative plateau at approximately 10 min. The average maximum standardized uptake value (10-12 min) of tumors was significantly higher than that of normal prostate tissue (4.4 ± 2.05 [range, 1.8-9.2] vs. 2.1 ± 0.94 [range, 0.7-3.4], respectively; P < 0.001); however, it was not significantly different from that of benign prostatic hyperplasia (4.8 ± 2.01 [range, 1.8-8.8]). A sector-based comparison with histopathology, including all tumors greater than 0.5 cm, revealed a sensitivity and specificity of 61.6% and 80.0%, respectively, for (11)C-acetate PET/CT and 82.3% and 95.1%, respectively, for MRI. The (11)C-acetate accuracy was comparable to that of MRI when only tumors greater than 0.9 cm were considered. In a small cohort (n = 9), (11)C-acetate uptake was independent of fatty acid synthase expression using immunohistochemistry.

CONCLUSION

(11)C-acetate PET/CT demonstrates higher uptake in tumor foci than in normal prostate tissue; however, (11)C-acetate uptake in tumors is similar to that in benign prostate hyperplasia nodules. Although (11)C-acetate PET/CT is not likely to have utility as an independent modality for evaluation of localized PCa, the high uptake in tumors may make it useful for monitoring focal therapy when tissue damage after therapy may limit anatomic imaging methods.

Synthesis of oncological [11C]radiopharmaceuticals for clinical PET

Positron emission tomography (PET) is a nuclear medicine modality which provides quantitative images of biological processes in vivo at the molecular level. Several PET radiopharmaceuticals labeled with short-lived isotopes such as (18)F and (11)C were developed in order to trace specific cellular and molecular pathways with the aim of enhancing clinical applications. Among these [(11)C]radiopharmaceuticals are N-[(11)C]methyl-choline ([(11)C]choline), l-(S-methyl-[(11)C])methionine ([(11)C]methionine) and 1-[(11)C]acetate ([(11)C]acetate), which have gained an important role in oncology where the application of 2-[(18)F]fluoro-2-deoxy-d-glucose ([(18)F]FDG) is suboptimal. Nevertheless, the production of these radiopharmaceuticals did not reach the same level of standardization as for [(18)F]FDG synthesis. This review describes the most recent developments in the synthesis of the above-mentioned [(11)C]radiopharmaceuticals aiming to increase the availability and hence the use of [(11)C]choline, [(11)C]methionine and [(11)C]acetate in clinical practice.

Automated production of [11C]acetate and [11C]palmitate using a modified GE Tracerlab FX(C-Pro)

As researchers explore new applications for positron emission tomography radiopharmaceuticals, the demand for effective and readily available radiopharmaceuticals continues to increase. The syntheses of two such radiopharmaceuticals, [(11)C]acetate and [(11)C]palmitate, can be automated on the GE Tracerlab FX(C-Pro) by utilizing Grignard reactions. Radiochemical purities of the [(11)C]acetate and the [(11)C]palmitate products were high (>98% and >99.9%, respectively) with average non-corrected yields of 18% (n = 3) and 10% (n = 5), respectively. These data comprise the validation trials for site qualification of clinical production of both radiopharmaceuticals.

1-11C-acetate as a PET radiopharmaceutical for imaging fatty acid synthase expression in prostate cancer

Although it is accepted that the metabolic fate of 1-(11)C-acetate is different in tumors than in myocardial tissue because of different clearance patterns, the exact pathway has not been fully elucidated. For decades, fatty acid synthesis has been quantified in vitro by the incubation of cells with (14)C-acetate. Fatty acid synthase (FAS) has been found to be overexpressed in prostate carcinomas, as well as other cancers, and it is possible that imaging with 1-(11)C-acetate could be a marker for its expression.

METHODS

In vitro and in vivo uptake experiments in prostate tumor models with 1-(11)C-acetate were performed both with and without blocking of fatty acid synthesis with either C75, an inhibitor of FAS, or 5-(tetradecyloxy)-2-furoic acid (TOFA), an inhibitor of acetyl-CoA carboxylase (ACC). FAS levels were measured by Western blot and immunohistochemical techniques for comparison.

RESULTS

In vitro studies in 3 different prostate tumor models (PC-3, LNCaP, and 22Rv1) demonstrated blocking of 1-(11)C-acetate accumulation after treatment with both C75 and TOFA. This was further shown in vivo in PC-3 and LNCaP tumor-bearing mice after a single treatment with C75. A positive correlation between 1-(11)C-acetate uptake into the solid tumors and FAS expression levels was found.

CONCLUSION

Extensive involvement of the fatty acid synthesis pathway in 1-(11)C-acetate uptake in prostate tumors was confirmed, leading to a possible marker for FAS expression in vivo by noninvasive PET.

Captive solvent [11C]acetate synthesis in GMP conditions

Reliable procedure for the production of 1-[(11)C]acetate in GMP conditions was developed based on a combination of the captive-solvent Grignard reaction conducted in the sterile catheter followed by the convenient solid-phase extraction purification on a series of ion-exchange cartridges. The described procedure proved to be reliable in more than 30 patient productions. The process provides stable radiochemical yields (65% EOB) of sodium acetate (1-[(11)C]) of the Ph.Eur. quality (radiochemical purity better than 95%) in a short time (5 min).

Renal Oncocytoma on 1-11C acetate Positron Emission Tomography: Case Report and Literature Review

Renal oncocytomas are uncommon tumors of the renal collecting duct. Although generally benign, these tumors pose a diagnostic and therapeutic dilemma in that they can not be differentiated noninvasively from renal cell carcinomas. We report a 67-year-old man who underwent a clinical 1-11C acetate positron emission tomography (PET) scan for evaluation of possible metastatic prostate carcinoma. The study demonstrated a nodule at the inferior pole of the right kidney with more uptake than the remainder of the kidney. Correlation was made with MRI, which demonstrated that the nodule was solid, and enhanced after contrast agent administration. Upon resection, this nodule was determined to be an oncocytoma. To our knowledge, this marks the first report of the 1-11C acetate PET scan appearance of a renal oncocytoma Possible mechanisms for increased uptake include dysfunctional, but up-regulated oxidative phosphorylation or uptake through lipid biosynthesis pathways.

Distribution kinetics of 18F-DOPA in weaver mutant mice

Distribution kinetics of 18F-fluoro-dihydroxy phenylalanine (18F-DOPA) were studied with high-resolution micro-positron emission tomography (microPET) imaging and conventional methods in control wild-type mice, heterozygous weaver mutant mice, and homozygous weaver mutant mice. 18F-DOPA uptake was significantly increased in the CNS within 60 min in all the genotypes examined. Homozygous weaver mutant mice exhibited significantly reduced 18F-DOPA uptake in the region of interest (striatum) as compared to heterozygous weaver mutant mice and control wild-type mice. 18F-DOPA was de-localized in the kidneys of homozygous weaver mutant mice. The radioactivity was localized primarily in the liver and kidneys within 2 h and in the urinary bladder within 4 h. After 8 h, it could be detected neither by conventional nor by microPET imaging. Distribution kinetics of 18F-DOPA with microPET imaging correlated and confirmed the conventional observations. These data are interpreted to suggest that microPET imaging may provide an efficient, noninvasive, cost-effective procedure to study distribution kinetics of PET radiopharmaceuticals in rare genetically altered animals. Furthermore, this unique and noninvasive approach may expedite quality control and drug development for human applications.

New aspects on the preparation of [11C]acetate--a simple and fast approach via distillation

[11C]Acetate, initially developed for nuclear cardiology has gained increased interest also for oncological problems. A conjoint problem of all preparation methods is the high sensitivity of the Grignard-precursor to moisture, demanding long cleaning and drying procedures of apparatus and reaction vials. Our rationale was to simplify and accelerate the preparation of [11C]acetate by the development of an inert, sterile and disposable system. The present publication deals with the remote-controlled preparation of [11C]acetate via distillation into a buffer ready to use.

Positron emission tomography radiochemistry

Factors that place constraints on radio-chemists who are seeking to design and develop radiopharmaceuticals for PET imaging studies include the short half-lives of 11C and 18F, minimum radiochemical yield and specific activity requirements, and high radiation fields that are associated with multi-Curie quantities of PET radionuclides. Nevertheless, during the past 20 years, considerable progress has been made in the development and application of a variety of PET radiotracers for a range of imaging studies in human subjects. We have highlighted a few areas of radiochemistry that focused on PET radiotracers that are described in this issue. Although the number of PET radiotracers synthesized is in the hundreds [6], much work remains to develop specific and useful PET radiotracers for a host of new and exciting noninvasive imaging applications.