An efficient and aseptic preparation of “sodium fluoride (18F) injection” in a GMP compliant facility

Inhibition of viability of microorganisms in [18F]-labeled radiopharmaceuticals

INTRODUCTION

Good manufacturing practice (GMP)-compliant production of radiopharmaceuticals for parenteral application requires great efforts in maintenance of clean room infrastructure and equipment in order to reliably guarantee the constant hygienic quality of the product (sterility). Terminal sterilization of the product is not always possible due to short half-life or due to thermal instability of the compound. The typical method for sterilization in these cases is sterile filtration prior to dispensing (distribution of product solution from bulk to patient vials). Therefore, aseptic processing techniques have to be in place in order to ensure sterility. Still, there remains some risk of microbial contamination of the product, and hence a risk for the patient to suffer from infection. Due to the short half-life of the labeling radionuclides, this aspect is aggravated by only retrospectively possible testing for sterility. This work investigated the potential of [¹⁸F]-radiation to intrinsically inactivate microorganisms (MO) that might have slipped through the aseptic process.

METHODS

Defined numbers of viable cells of different bacterial strains and molds were incubated with defined amounts of [¹⁸F]-activity. After decay of radiation the number of surviving viable cells was determined, D₁₀-values were calculated and evaluated.

RESULTS

The MOs tested exhibit a broad range of [¹⁸F]-radiation susceptibility, D₁₀-values range from a sensitive 114MBq/mL (46Gy) to a durable 2,048MBq/mL (790Gy).

CONCLUSION

The intrinsic [¹⁸F]-radiation in radiopharmaceuticals is no safe measure to generally ensure sterility of the product solution in terms of "autosterilization", because of dependence on various parameters.

ADVANCES IN KNOWLEDGE AND IMPLICATIONS FOR PATIENT CARE

This work presents for the first time experimental data on the influence of [¹⁸F]-radiation on MOs. The results suggest, that aseptic processing techniques are essential and that results of determination of sterility in radiopharmaceuticals should be considered with care (emphasis on importance of media fill campaigns).

A comparative uptake study of multiplexed PET tracers in mice with turpentine-induced inflammation

The potential value of multiplexed positron emission tomography (PET) tracers in mice with turpentine-induced inflammation was evaluated and compared with 2-[¹⁸F]fluoro-2-deoxy-D-glucose ([¹⁸F]FDG) for glucose metabolism imaging. These PET tracers included [¹⁸F]fluoromethylcholine ([¹⁸F]FCH) for choline metabolism imaging, (S-[¹¹C]methyl)-D-cysteine ([¹¹C]DMCYS) for amino acid metabolism imaging, [¹¹C]bis(zinc(II)-dipicolylamine) ([¹¹C]DPA-Zn²⁺) for apoptosis imaging, 2-(4-N-[¹¹C]-methylaminophenyl)-6-hydroxybenzothiazole ([¹¹C]PIB) for β amyloid binding imaging, and [¹⁸F]fluoride (¹⁸F⁻) for bone metabolism imaging. In mice with turpentine-induced inflammation mice, the biodistribution of all the tracers mentioned above at 5, 15, 30, 45, and 60 min postinjection was determined. Also, the time-course curves of the tracer uptake ratios for inflammatory thigh muscle (IM) to normal uninflammatory thigh muscle (NM), IM to blood (BL), IM to brain (BR), and IM to liver (LI) were acquired, respectively. Moreover, PET imaging with the tracers within 60 min postinjection on a clinical PET/CT scanner was also conducted. [¹⁸F]FDG and ¹⁸F⁻ showed relatively higher uptake ratios for IM to NM, IM to BL, IM to BR, and IM to LI than [¹⁸F]FCH, [¹¹C]DPA-Zn²⁺, [¹¹C]DMCYS and [¹¹C]PIB, which were highly consistent with the results delineated in PET images. The results demonstrate that ¹⁸F⁻ seems to be a potential PET tracer for inflammation imaging. [¹⁸F]FCH and [¹¹C]DMCYS, with lower accumulation in inflammatory tissue than [¹⁸F]FDG, are not good PET tracers for inflammation imaging. As a promising inflammatory tracer, the chemical structure of [¹¹C]DPA-Zn²⁺ needs to be further optimized.

[Adaptation of the (18)FDG module for the preparation of a sodium fluoride [(18)F] injection solution in agreement with the United States (USP 32) and European Pharmacopeia (PhEur 6)]

OBJECTIVE

To establish an automated procedure for the preparation of sodium fluoride (18)F injection using the resources available in our laboratory for the preparation of (18)FDG and to analyze the repercussion of the conditioning column of the fluoride ion entrapment on the characteristics of the final product.

MATERIAL AND METHOD

The sequence of an (18)FDG synthesis module prepared so that it traps the fluoride ion from the cyclotron in ion-exchange resin diluted with 0.9% sodium chloride. The final solution was dosified and sterilized in a final vial in an automatized dispensing module. Three different column conditioning protocols within the process were tested. Quality controls were run according to USP 32 and EurPh 6, adding control of ethanol levels of residual solvent and quality controls of the solution at 8 h post-preparation.

RESULTS

Activation of the resin cartridges with ethanol and water was the chosen procedure, with fluoride ion trapping > 95% and pH around 7. Ethanol levels were < 5.000 ppm. Quality controls at 8 h indicated that the solution was in compliance with the USP 32 and EurPh 6 specifications.

CONCLUSION

This is an easy, low-cost, reliable automated method for sodium fluoride preparation in PET facilities with existing equipment for (18)FDG synthesis and quality control.