The production, separation, and use of 67Cu for radioimmunotherapy: a review

Design and thermal-hydraulic analysis of multi-target system with 100 MeV proton linear accelerator for the production of 67Cu and 68Ge radioisotopes

Radioisotopes are widely used in the fields of medicine, science, and industry. The growing demand for medical radioisotopes has driven research on alternative production methods. In particular, both isotopes of 67Cu and 68Ge play vital roles in the medical environment in many countries to be used in the radio-immunotherapy and the positron emission tomography imaging, respectively. This study designed a multi-target system consisting of two Zn and one Ga2O3 plates to enable simultaneous production of the medical radioisotopes 67Cu and 68Ge using 100 MeV proton beams. To understand the thermal effect on the multi-targets, we examined the distribution of energy absorbed in each solid plate target when exposed to an accelerated proton beam through the thermal-fluid analysis based on ANSYS simulation. For confirming thermal stability for two Zn targets and one Ga2O3 target, the modified water flow path inside the multi-target system was designed effectively with the controlled distribution of multiple sub-holes between main inlet and the following four channels. It was confirmed that the newly designed multi-target system of Zn and Ga2O3 solid plates shows higher thermal stability than the case of uniform distribution of water inlet, which means it could be exposed to a higher current beam of 7.57% to decrease the processing time.

Selective removal of copper from complex biological media with an agarose-immobilized high-affinity PSP ligand

The elucidation of metal-dependent biological processes requires selective reagents for manipulating metal ion levels within biological solutions such as growth media or cell lysates. To this end, we immobilized a phosphine sulfide-stabilized phosphine (PSP) ligand on agarose to create a resin for the selective removal of copper from chemically complex biological media through simple filtration or centrifugation. Comprised of a conformationally preorganized phenylene-bridged backbone, the PSP-ligand binds Cu(I) with a 1:1 stoichiometry and exhibits a pH-independent Cu(I) dissociation constant in the low zeptomolar range. Neither Zn(II), Fe(II), nor Mn(II) interact with the ligand at millimolar concentrations, thus offering a much-improved selectivity towards copper over other commonly employed solid-supported chelators such as Chelex 100. As revealed by X-ray fluorescence elemental analysis, the immobilized chelator effectively removes copper from cell culture growth media and cell lysate isolated from mouse fibroblasts. In addition to preparing copper-depleted media or cell lysates for biological studies, PSP-immobilized ligands might prove equally useful for applications in radiochemistry, materials science, and environmental science.

Optimized Methods for the Production of High-Purity 203Pb Using Electroplated Thallium Targets

203Pb is a surrogate imaging match for 212Pb. This elementally matched pair is emerging as a suitable pair for imaging and targeted radionuclide therapy in cancer care. Because of the half-life (51.9 h) and low-energy γ-rays emitted, 203Pb is suitable for the development of diagnostic radiopharmaceuticals. The aim of this work was to optimize the production and separation of high-specific-activity 203Pb using electroplated thallium targets. We further investigated the radiochemistry optimization using a suitable chelator, tetraazacyclododecane-1,4,7-triacetic acid (DO3A), and targeting vector, VMT-α-NET (lead-specific chelator conjugated to tyr3-octreotide via a polyethylene glycol linker). Methods: Targets were prepared by electroplating of natural or enriched (205Tl) thallium metal. Scanning electron microscopy was performed to determine the structure and elemental composition of electroplated targets. Targets were irradiated with 24-MeV protons with varying current and beam time to investigate target durability. 203Pb was purified from the thallium target material using an extraction resin (lead resin) column followed by a second column using a weak cation-exchange resin to elute the lead isotope as [203Pb]PbCl2 Inductively coupled plasma mass spectrometry studies were used to further characterize the separation for trace metal contaminants. Radiolabeling efficiency was also investigated for DO3A chelator and VMT-α-NET (a peptide-based targeting conjugate). Results: Electroplated targets were prepared at a high plating density of 76-114 mg/cm2 using a plating time of 5 h. A reproducible separation method was established with a final elution in HCl (400 μL, 1 M) suitable for radiolabeling. Greater than 90% recovery yields were achieved, with an average specific activity of 37.7 ± 5.4 GBq/μmol (1.1 ± 0.1 Ci/μmol). Conclusion: An efficient electroplating method was developed to prepare thallium targets suitable for cyclotron irradiation. A simple and fast separation method was developed for routine 203Pb production with high recovery yields and purity.

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.

Modifications in cellular viability, DNA damage and stress responses inflicted in cancer cells by copper-64 ions

Due to combined therapeutical emissions, a high linear energy transfer Auger-electrons with the longer ranged β^- particles, ⁶⁴Cu-based radiopharmaceuticals raise particular theragnostic interest in cancer, by joined therapeutic and real-time PET imaging properties. The in vitro study aimed to investigate the biological and molecular background of ⁶⁴CuCl₂ therapy by analyzing the damages and stress responses inflicted in various human normal and tumor cell lines. Colon (HT29 and HCT116) and prostate carcinoma (DU145) cell lines, as well as human normal BJ fibroblasts, were treated up to 72 h with 2-40 MBq/mL ⁶⁴CuCl₂. Radioisotope uptake and retention were assessed, and cell viability/death, DNA damage, oxidative stress, and the expression of 84 stress genes were investigated at various time points after [⁶⁴Cu]CuCl₂ addition. All the investigated cells incorporated ⁶⁴Cu ions similarly, independent of their tumoral or normal status, but their fate after exposure to [⁶⁴Cu]CuCl₂ was cell-dependent. The most striking cytotoxic effects of the radioisotope were registered in colon carcinoma HCT116 cells, for which a substantial decrease in the number of metabolically active cells, and an increased DNA damage and oxidative stress were registered. The stress gene expression study highlighted the activation of both death and repair mechanisms in these cells, related to extrinsic apoptosis, necrosis/necroptosis or autophagy, and cell cycle arrest, nucleotide excision repair, antioxidant, and hypoxic responses, respectively. The in vitro study indicated that 40 MBq/mL [⁶⁴Cu]CuCl₂ delivers a therapeutic effect in human colon carcinoma, but its use is limited by harmful, yet lower effects on normal fibroblasts. The exposure of tumor cells to 20 MBq/mL [⁶⁴Cu]CuCl₂, might be used for a softer approach aiming for a lower radiotoxicity in normal fibroblasts as compared to tumor cells. This radioactive concentration was able to induce a persistent decrease in the number of metabolically active cells, accompanied by DNA damage and oxidative stress, associated with significant changes in stress gene expression in HCT116 colon cancer cells.

Cyclotron-Based Production of 67Cu for Radionuclide Theranostics via the 70Zn(p,α)67Cu Reaction

Theranostic matched pairs of radionuclides have aroused interest during the last couple of years, and in that sense, copper is one element that has a lot to offer, and although 61Cu and 64Cu are slowly being established as diagnostic radionuclides for PET, the availability of the therapeutic counterpart 67Cu plays a key role for further radiopharmaceutical development in the future. Until now, the 67Cu shortage has not been solved; however, different production routes are being explored. This project aims at the production of no-carrier-added 67Cu with high radionuclidic purity with a medical 30MeV compact cyclotron via the 70Zn(p,α)67Cu reaction. With this purpose, proton irradiation of electrodeposited 70Zn targets was performed followed by two-step radiochemical separation based on solid-phase extraction. Activities of up to 600MBq 67Cu at end of bombardment, with radionuclidic purities over 99.5% and apparent molar activities of up to 80MBq/nmol, were quantified.

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.

A feasibility study of the therapeutic application of a mixture of 67/64 Cu radioisotopes produced by cyclotrons with proton irradiation

PURPOSE

64 Cu and 67 Cu radioisotopes have nuclear characteristics suitable for nuclear medicine applications. The production of 64 Cu is already well established. However, the production of 67 Cu in quantities suitable to conduct clinical trials is more challenging as it leads to the coproduction of other Cu isotopes, in particular 64 Cu. The aim of this study is to investigate the possibility of using a CuCl2 solution with a mixture of 67/64 Cu radioisotopes for therapeutic purposes, providing an alternative solution for the cyclotron production problem.

METHODS

Copper radioisotopes activities were calculated by considering proton beam irradiation of the following targets: (i) 70 Zn in the energy range 70-45 MeV; (ii) 68 Zn in the energy range 70-35 MeV; (iii) a combination of 70 Zn (70-55 MeV) and 68 Zn (55-35 MeV). The contribution of each copper radioisotope to the human-absorbed dose was estimated with OLINDA/EXM software using the biokinetic model for CuCl2 published by ICRP 53. The total absorbed dose generated by the 67/64 CuCl2 mixture, obtained through different production routes, was calculated at different times after the end of the bombardment (EOB). A simple spherical model was used to simulate tumors of different sizes containing uniformly distributed 67/64 Cu mixture and to calculate the absorbed dose of self-irradiation. The biological damage produced by 67 Cu and 64 Cu was also evaluated through cellular dosimetry and cell surviving fraction assessment using the MIRDcell code, considering two prostate cancer cell lines with different radiosensitivity.

RESULTS

The absorbed dose to healthy organs and the effective dose (ED) per unit of administered activity of 67 CuCl2 are higher than those of 64 CuCl2 . Absorbed dose values per unit of administered activity of 67/64 CuCl2 mixture increase with time after the EOB because the amount of 67 Cu in the mixture increases. Survival data showed that the biological damage caused per each decay of 67 Cu is greater than that of 64 Cu, assuming that radionuclides remain accumulated in the cell cytoplasm. Sphere model calculations demonstrated that 64 Cu administered activity must be about five times higher than that of 67 Cu to obtain the same absorbed dose for tumor mass between 0.01 and 10 g and about 10 times higher for very small spheres. Consequently, the 64 CuCl2 -absorbed dose to healthy organs will reach higher values than those of 67 CuCl2 . The supplemental activity of the 67/64 CuCl2 mixture, required to get the same tumor-absorbed dose produced by 67 CuCl2 , triggers a dose increment (DI) in healthy organs. The waiting time post-EOB necessary to keep this DI below 10% (t10% ) depends on the irradiation methods employed for the production of the 67/64 CuCl2 mixture.

CONCLUSIONS

A mixture of cyclotron produced 67/64 Cu radioisotopes proved to be an alternative solution for the therapeutic use of CuCl2 with minimal DI to healthy organs compared with pure 67 Cu. Irradiation of a 70 Zn+68 Zn target in the 70-35 MeV proton energy range for 185 h appears to be the best option from among all the production routes investigated, as it gives the maximum amount of activity, the shortest t10% (10 h), and less than 1% of 61 Cu and 60 Cu impurities.

67Cu Production Capabilities: A Mini Review

Is the ⁶⁷Cu production worldwide feasible for expanding preclinical and clinical studies? How can we face the ingrowing demands of this emerging and promising theranostic radionuclide for personalized therapies? This review looks at the different production routes, including the accelerator- and reactor-based ones, providing a comprehensive overview of the actual ⁶⁷Cu supply, with brief insight into its use in non-clinical and clinical studies. In addition to the most often explored nuclear reactions, this work focuses on the ⁶⁷Cu separation and purification techniques, as well as the target material recovery procedures that are mandatory for the economic sustainability of the production cycle. The quality aspects, such as radiochemical, chemical, and radionuclidic purity, with particular attention to the coproduction of the counterpart ⁶⁴Cu, are also taken into account, with detailed comparisons among the different production routes. Future possibilities related to new infrastructures are included in this work, as well as new developments on the radiopharmaceuticals aspects.

Expanding the PET radioisotope universe utilizing solid targets on small medical cyclotrons

Molecular imaging with medical radioisotopes enables the minimally-invasive monitoring of aberrant biochemical, cellular and tissue-level processes in living subjects. The approach requires the administration of radiotracers composed of radioisotopes attached to bioactive molecules, the pairing of which considers several aspects of the radioisotope in addition to the biological behavior of the targeting molecule to which it is attached. With the advent of modern cellular and biochemical techniques, there has been a virtual explosion in potential disease recognition antigens as well as targeting moieties, which has subsequently opened new applications for a host of emerging radioisotopes with well-matched properties. Additionally, the global radioisotope production landscape has changed rapidly, with reactor-based production and its long-defined, large-scale centralized manufacturing and distribution paradigm shifting to include the manufacture and distribution of many radioisotopes via a worldwide fleet of cyclotrons now in operation. Cyclotron-based radioisotope production has become more prevalent given the commercial availability of instruments, coupled with the introduction of new target hardware, process automation and target manufacturing methods. These advances enable sustained, higher-power irradiation of solid targets that allow hospital-based radiopharmacies to produce a suite of radioisotopes that drive research, clinical trials, and ultimately clinical care. Over the years, several different radioisotopes have been investigated and/or selected for radiolabeling due to favorable decay characteristics (i.e. a suitable half-life, high probability of positron decay, etc.), well-elucidated chemistry, and a feasible production framework. However, longer-lived radioisotopes have surged in popularity given recent regulatory approvals and incorporation of radiopharmaceuticals into patient management within the medical community. This review focuses on the applications, nuclear properties, and production and purification methods for some of the most frequently used/emerging positron-emitting, solid-target-produced radioisotopes that can be manufactured using small-to-medium size cyclotrons (≤24 MeV).

Recent Advances in Radiometals for Combined Imaging and Therapy in Cancer

Nuclear medicine is defined as the use of radionuclides for diagnostic and therapeutic applications. The imaging modalities positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are based on γ-emissions of specific energies. The therapeutic technologies are based on β^- -particle-, α-particle-, and Auger electron emitters. In oncology, PET and SPECT are used to detect cancer lesions, to determine dosimetry, and to monitor therapy effectiveness. In contrast, radiotherapy is designed to irreparably damage tumor cells in order to eradicate or control the disease's progression. Radiometals are being explored for the development of diagnostic and therapeutic radiopharmaceuticals. Strategies that combine both modalities (diagnostic and therapeutic), referred to as theranostics, are promising candidates for clinical applications. This review provides an overview of the basic concepts behind therapeutic and diagnostic radiopharmaceuticals and their significance in contemporary oncology. Select radiometals that significantly impact current and upcoming cancer treatment strategies are grouped as clinically suitable theranostics pairs. The most important physical and chemical properties are discussed. Standard production methods and current radionuclide availability are provided to indicate whether a cost-efficient use in a clinical routine is feasible. Recent preclinical and clinical developments and outline perspectives for the radiometals are highlighted in each section.

Copper-67 radioimmunotheranostics for simultaneous immunotherapy and immuno-SPECT

Copper-67 (t1/2 = 2.58 days) decays by β- ([Formula: see text]: 562 keV) and γ-rays (93 keV and 185 keV) rendering it with potential for both radionuclide therapy and single-photon emission computed tomography (SPECT) imaging. Prompted by the recent breakthrough of 67Cu production with high specific activity, high radionuclidic purity, and sufficient quantities, the interest in the theranostic potential of 67Cu has been rekindled. This work addresses the practicability of developing 67Cu-labeled antibodies with substantially improved quality for cancer radioimmunotheranostics. Proof of concept is demonstrated with pertuzumab, a US-FDA-approved monoclonal antibody for combination therapies of HER2-positive breast cancer. With an average number of 1.9 chelators coupled to each antibody, we achieved a two-order of magnitude increase in radiolabeling efficiency compared to literature reports. In a preclinical therapeutic study, mice (n = 4-7/group) bearing HER2+ xenografts exhibited a 67Cu-dose dependent tumor-growth inhibition from 67Cu-labeled-Pertuzumab co-administered with trastuzumab. Furthermore, greater tumor size reduction was observed with 67Cu-labeled-pertuzumab formulations of higher specific activity. The potential of SPECT imaging with 67Cu radiopharmaceuticals was tested after 67Cu-labeled-Pertuzumab administration. Impressively, all tumors were clearly visualized by SPECT imaging with 67Cu-labeled-Pertuzumab even at day 5 post injection. This work demonstrates it is practical to use 67Cu radioimmunoconjugates for cancer radioimmunotheranostics.

Synthesis of DOTA-pyridine chelates for 64Cu coordination and radiolabeling of αMSH peptide

Background

⁶⁴Cu is one of the few radioisotopes that can be used for both imaging and therapy, enabling theranostics with identical chemical composition. Development of stable chelators is essential to harness the potential of this isotope, challenged by the presence of endogenous copper chelators. Pyridyl type chelators show good coordination ability with copper, prompting the present study of a series of chelates DOTA-xPy (x = 1–4) that sequentially substitute carboxyl moieties with pyridyl moieties on a DOTA backbone.

Results

We found that the presence of pyridyl groups significantly increases ⁶⁴Cu labeling conversion yield, with DOTA-2Py, −3Py and -4Py quantitatively complexing ⁶⁴Cu at room temperature within 5 min (1 × 10^− 4 M). [⁶⁴Cu]Cu-DOTA-xPy (x = 2–4) exhibited good stability in human serum up to 24 h. When challenged with 1000 eq. of NOTA, no transmetallation was observed for all three ⁶⁴Cu complexes. DOTA-xPy (x = 1–3) were conjugated to a cyclized α-melanocyte-stimulating hormone (αMSH) peptide by using one of the pendant carboxyl groups as a bifunctional handle. [⁶⁴Cu]Cu-DOTA-xPy-αMSH retained good serum stability (> 96% in 24 h) and showed high binding affinity (Ki = 2.1–3.7 nM) towards the melanocortin 1 receptor.

Conclusion

DOTA-xPy (x = 1–3) are promising chelators for ⁶⁴Cu. Further in vivo evaluation is necessary to assess the full potential of these chelators as a tool to enable further theranostic radiopharmaceutical development.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41181-020-00119-4.

Production scheme for diagnostic-therapeutic radioisotopes by accelerator neutrons

Interest has been growing in the development of medical radioisotopes used for noninvasive nuclear medicine imaging of disease and cancer therapy. Especially the development of an alternative production scheme of ⁹⁹Mo, the mother radioisotope of ^99mTc used for imaging, is required, because the current supply chain of the reactor product ⁹⁹Mo is fragile worldwide. We have proposed a new production scheme of ⁹⁹Mo as well as therapeutic radioisotopes, such as ⁶⁴Cu and ⁶⁷Cu, using accelerator neutrons provided by the ^natC(d,n) reaction. Based on this scheme we have obtained high-quality ^99mTc, ⁶⁴Cu, and ⁶⁷Cu suitable for clinical use by developing both production and separation methods of the radioisotopes. We proposed a new facility to constantly and reliably produce a wide variety of high-quality, carrier-free radioisotopes, including ⁹⁹Mo, with accelerator neutrons. We report on the development of the proposed scheme and future prospects of the facility toward the domestic production of medical radioisotopes.

Harnessing 64Cu/67Cu for a theranostic approach to pretargeted radioimmunotherapy

Over the past decade, theranostic imaging has emerged as a powerful clinical tool in oncology for identifying patients likely to respond to targeted therapies and for monitoring the response of patients to treatment. Herein, we report a theranostic approach to pretargeted radioimmunotherapy (PRIT) based on a pair of radioisotopes of copper: positron-emitting copper-64 (⁶⁴Cu, t _1/2 = 12.7 h) and beta particle-emitting copper-67 (⁶⁷Cu, t _1/2 = 61.8 h). This strategy is predicated on the in vivo ligation between a trans-cyclooctene (TCO)-bearing antibody and a tetrazine (Tz)-based radioligand via the rapid and bioorthogonal inverse electron-demand Diels-Alder reaction. Longitudinal therapy studies were conducted in a murine model of human colorectal carcinoma using an immunoconjugate of the huA33 antibody modified with TCO (huA33-TCO) and a ⁶⁷Cu-labeled Tz radioligand ([⁶⁷Cu]Cu-MeCOSar-Tz). The injection of huA33-TCO followed 72 h later by the administration of 18.5, 37.0, or 55.5 MBq of [⁶⁷Cu]Cu-MeCOSar-Tz produced a dose-dependent therapeutic response, with the median survival time increasing from 68 d for the lowest dose to >200 d for the highest. Furthermore, we observed that mice that received the highest dose of [⁶⁷Cu]Cu-MeCOSar-Tz in a fractionated manner exhibited improved hematological values without sacrificing therapeutic efficacy. Dual radionuclide experiments in which a single administration of huA33-TCO was followed by separate injections of [⁶⁴Cu]Cu-MeCOSar-Tz and [⁶⁷Cu]Cu-MeCOSar-Tz revealed that the positron emission tomography images produced by the former accurately predicted the efficacy of the latter. In these experiments, a correlation was observed between the tumoral uptake of [⁶⁴Cu]Cu-MeCOSar-Tz and the subsequent therapeutic response to [⁶⁷Cu]Cu-MeCOSar-Tz.

Preclinical Evaluation of a High-Affinity Sarcophagine-Containing PSMA Ligand for 64Cu/67Cu-Based Theranostics in Prostate Cancer

The application of small molecules targeting prostate-specific membrane antigen (PSMA) has emerged as a highly promising clinical strategy for visualization and treatment of prostate cancer. Ligands that integrate the ability to both quantify the distribution of radioactivity and treat disease through the use of a matched pair of radionuclides have particular value in clinical and regulatory settings. In this study, we describe the development and preclinical evaluation of RPS-085, a ligand that binds PSMA and serum albumin and exploits the ^64/67Cu radionuclide pair for prostate cancer theranostics. RPS-085 was synthesized by conjugation of a PSMA-targeting moiety, an N^ε-(2-(4-iodophenyl)acetyl)lysine albumin binding group, and a bifunctionalized MeCOSar chelator. The IC₅₀ of the metal-free RPS-085 was determined in a competitive binding assay. The affinity for human serum albumin of the radiolabeled compound was determined by high-performance affinity chromatography. Radiolabeling was performed in NH₄OAc buffer at 25 °C. The stability of the radiolabeled compounds was assessed in vitro and in vivo. The biodistribution of [^64/67Cu]Cu-RPS-085 was determined following intravenous administration to male BALB/c mice bearing LNCaP tumor xenografts. The radiochemical yields of [^64/67Cu]Cu-RPS-085 were nearly quantitative after 20 min. The metal-free complex is a potent inhibitor of PSMA (IC₅₀ = 29 ± 2 nM), and the radiolabeled compound has moderate affinity for human serum albumin (K_d = 9.9 ± 1.7 μM). Accumulation of the tracer in mice was primarily evident in tumor and kidneys. Activity in all other tissues, including blood, was negligible, and the radiolabeled compounds demonstrated high stability in vitro and in vivo. Tumor activity reached a maximum at 4 h post injection (p.i.) and cleared gradually over a period of 96 h. By contrast, activity in the kidney cleared rapidly from 4 to 24 h p.i. As a consequence, by 24 h p.i., the tumor-to-kidney ratio exceeds 2, and the predicted dose to tumors is significantly greater than the dose to kidneys. [⁶⁴Cu]Cu-RPS-085 combines rapid tissue distribution and clearance with prolonged retention in LNCaP tumor xenografts. The pharmacokinetics should enable radioligand therapy using [⁶⁷Cu]Cu-RPS-085. By virtue of its rapid kidney clearance, the therapeutic index of [⁶⁷Cu]Cu-RPS-085 likely compares favorably to its parent structure, [¹⁷⁷Lu]Lu-RPS-063, a highly avid PSMA-targeting compound. On this basis, [^64/67Cu]Cu-RPS-085 show great promise as PSMA-targeting theranostic ligands for prostate cancer imaging and therapy.

ImmunoPET: Concept, Design, and Applications

Immuno-positron emission tomography (immunoPET) is a paradigm-shifting molecular imaging modality combining the superior targeting specificity of monoclonal antibody (mAb) and the inherent sensitivity of PET technique. A variety of radionuclides and mAbs have been exploited to develop immunoPET probes, which has been driven by the development and optimization of radiochemistry and conjugation strategies. In addition, tumor-targeting vectors with a short circulation time (e.g., Nanobody) or with an enhanced binding affinity (e.g., bispecific antibody) are being used to design novel immunoPET probes. Accordingly, several immunoPET probes, such as 89Zr-Df-pertuzumab and 89Zr-atezolizumab, have been successfully translated for clinical use. By noninvasively and dynamically revealing the expression of heterogeneous tumor antigens, immunoPET imaging is gradually changing the theranostic landscape of several types of malignancies. ImmunoPET is the method of choice for imaging specific tumor markers, immune cells, immune checkpoints, and inflammatory processes. Furthermore, the integration of immunoPET imaging in antibody drug development is of substantial significance because it provides pivotal information regarding antibody targeting abilities and distribution profiles. Herein, we present the latest immunoPET imaging strategies and their preclinical and clinical applications. We also emphasize current conjugation strategies that can be leveraged to develop next-generation immunoPET probes. Lastly, we discuss practical considerations to tune the development and translation of immunoPET imaging strategies.

Mild and efficient 64Cu labeling of perhydro-1, 4-diazepine derivatives for potential use with large peptides, proteins and antibodies

DATA (6-Amino-1,4-diazapine-triacetate) and AAZTA (6-Amino-1,4-diazapine-tetracetate) chelators represent a novel approach representing hybrid-chelates: possessing significant cyclic and acyclic character. It is believed that flexibility of the acyclic part facilitates rapid complexation, whilst the preorganized cyclic part minimizes the energy barrier to complexation and inhibits decomplexation processes. So far, these chelators have been used exclusively with 44Sc and 68Ga only. Recent results with natCu predict high stabilities for Cu-AAZTA, yet no radioactive labeling of AAZTA or DATA with 64Cu or any additional radioactive isotope has been reported. We present the one pot synthesis of the bifunctional derivatives AAZTA5OMe and DATA5mOMe and their labeling with 64Cu. In addition, in vitro stability of the respective complexes are presented.

Production of 67Cu by enriched 70Zn targets: first measurements of formation cross sections of 67Cu, 64Cu, 67Ga, 66Ga, 69mZn and 65Zn in interactions of 70Zn with protons above 45 MeV

Despite its insufficient availability, Copper-67 is currently attracting much attention for its enormous potential for cancer therapy as theranostic radionuclide. This work aims to accurately measure the unexplored cross section 70Zn(p,x)67Cu in the energy range 45–70 MeV and to evaluate its potential advantages in the case of high-intensity proton beams provided by compact cyclotrons. Thin target foils of enriched 70Zn were manufactured by lamination at the INFN-LNL and irradiated at the ARRONAX facility using the stacked-foils method. A radiochemical procedure for the separation of Cu, Ga and Zn contaminants and the isolation of 67Cu from the irradiated material was developed. The efficiency of the chemical processing was determined for each foil by monitoring the activity of selected tracer radionuclides (61Cu, 66Ga and 69mZn) through γ-spectrometry. Experimental data of the 70Zn(p,x)67Cu, 64Cu, 67Ga, 66Ga, 69mZn, 65Zn cross sections were measured for the first time in the energy range 45–70 MeV and compared with the theoretical results obtained by using the TALYS code. The 67Cu production yield by using enriched 70Zn thick targets was compared with the results obtained by using 68Zn targets in the same irradiation conditions.

Simple separation of 67Cu from bulk zinc by coprecipitation using hydrogen sulfide gas and silver nitrate

Copper-67 (67Cu), a feasible radionuclide for diagnosis and radiotherapy, is commercially generated from a bulk zinc (Zn) target using the 68Zn(p, 2p)67Cu and 68Zn(γ, p)67Cu nuclear reactions. Because it uses a large amount of zinc, the separation is complex – requiring a combination of three ion exchange columns – and is time-consuming (about 1 day). We developed a quick and easy separation method referred to as “double coprecipitation” using H2S gas and silver nitrate as coprecipitation agents in place of ion exchange columns. We compared this method with a conventional separation method using three ion exchange columns (AG50W-X8, AG1-X8, and Chelex-100) for a natural zinc (natZn) target irradiated by a proton beam. The product quality and the recovery rate with the new method were competitive with the conventional method, and the total operation time was reduced from 1 day to <3 h.

Radiometals for imaging and theranostics, current production, and future perspectives

The aim of this review is to make the reader familiar with currently available radiometals, their production modes, capacities, and quality concerns related to their medical use, as well as new emerging radiometals and irradiation technologies from the perspective of their diagnostic and theranostic applications. Production methods of ¹⁷⁷ Lu serve as an example of various issues related to the production yield, specific activity, radionuclidic and chemical purity, and production economy. Other radiometals that are currently used or explored for potential medical applications, with particular focus on their theranostic value, are discussed. Using radiometals for diagnostic imaging and therapy is on the rise. The high demand for radiometals for medical use prompts investigations towards using alternative irradiation reactions, while using existing nuclear reactors and accelerator facilities. This review discusses these production capacities and what is necessary to cover the growing demand for theranostic nuclides.

Photonuclear production, chemistry, and in vitro evaluation of the theranostic radionuclide 47Sc

Background

In molecular imaging and nuclear medicine, theranostic agents that integrate radionuclide pairs are successfully being used for individualized care, which has led to rapidly growing interest in their continued development. These compounds, which are radiolabeled with one radionuclide for imaging and a chemically identical or similar radionuclide for therapy, may improve patient-specific treatment and outcomes by matching the properties of different radionuclides with a targeting vector for a particular tumor type. One proposed theranostic radionuclide is scandium-47 (⁴⁷Sc, T_1/2 = 3.35 days), which can be used for targeted radiotherapy and may be paired with the positron emitting radionuclides, ⁴³Sc (T_1/2 = 3.89 h) and ⁴⁴Sc (T_1/2 = 3.97 h) for imaging. The aim of this study was to investigate the photonuclear production of ⁴⁷Sc via the ⁴⁸Ti(γ,p)⁴⁷Sc reaction using an electron linear accelerator (eLINAC), separation and purification of ⁴⁷Sc, the radiolabeling of somatostatin receptor-targeting peptide DOTATOC with ⁴⁷Sc, and in vitro receptor-mediated binding of [⁴⁷Sc]Sc-DOTATOC in AR42J somatostatin receptor subtype two (SSTR2) expressing rat pancreatic tumor cells.

Results

The rate of ⁴⁷Sc production in a stack of natural titanium foils (n = 39) was 8 × 10⁷ Bq/mA·h (n = 3). Irradiated target foils were dissolved in 2.0 M H₂SO₄ under reflux. After dissolution, trivalent ⁴⁷Sc ions were separated from natural Ti using AG MP-50 cation exchange resin. The recovered ⁴⁷Sc was then purified using CHELEX 100 ion exchange resin. The average decay-corrected two-step ⁴⁷Sc recovery (n = 9) was (77 ± 7)%. A radiolabeling yield of > 99.9% of [⁴⁷Sc]Sc-DOTATOC (0.384 mg in 0.3 mL) was achieved using 1.7 MBq of ⁴⁷Sc. Blocking studies using Octreotide illustrated receptor-mediated uptake of [⁴⁷Sc]Sc-DOTATOC in AR42J cells.

Conclusions

⁴⁷Sc can be produced via the ⁴⁸Ti(γ,p)⁴⁷Sc reaction and separated from natural Ti targets with a yield and radiochemical purity suitable for radiolabeling of peptides for in vitro studies. The data in this work supports the potential use of eLINACs for studies of photonuclear production of medical radionuclides and the future development of high-intensity eLINAC facilities capable of producing relevant quantities of carrier-free radionuclides currently inaccessible via routine production pathways or limited due to costly enriched targets.

Electronic supplementary material

The online version of this article (10.1186/s13550-019-0515-8) contains supplementary material, which is available to authorized users.

A novel approach to medical radioisotope production using inverse kinematics: A successful production test of the theranostic radionuclide 67Cu

A novel method for the production of important medical radioisotopes has been developed. The approach is based on performing the nuclear reaction in inverse kinematics, namely sending a heavy-ion beam of appropriate energy on a light target (e.g. H, d, He) and collecting the isotope of interest. In this work, as a proof-of-concept, we studied the production of the theranostic radionuclide ⁶⁷Cu (T_1/2 = 62 h) via the reaction of a ⁷⁰Zn beam at 15 MeV/nucleon with a hydrogen gas target. The ⁶⁷Cu radionuclide alongside other coproduced isotopes, was collected after the gas target on an aluminum catcher foil and their radioactivity was measured by off-line γ-ray analysis. After 36 h post irradiation, apart from the product of interest ⁶⁷Cu, the main radioimpurity coming from the ⁷⁰Zn + p reaction was ^69mZn (T_1/2 = 13.8 h), which can be reduced by further radio-cooling. Moreover, along with the radionuclide of interest produced in inverse kinematics, the production of additional radioisotopes is possible by making use of the forward-focused neutrons from the reaction and allowing them to interact with a secondary target. A preliminary successful test of this concept was realized in the present study. The main requirement to obtain activities appropriate for preclinical studies is the development of high-intensity heavy-ion primary beams.

Perspectives on the Use of Liquid Extraction for Radioisotope Purification

The reliable and efficient production of radioisotopes for diagnosis and therapy is becoming an increasingly important capability, due to their demonstrated utility in Nuclear Medicine applications. Starting from the first processes involving the separation of ^99mTc from irradiated materials, several methods and concepts have been developed to selectively extract the radioisotopes of interest. Even though the initial methods were based on liquid-liquid extraction (LLE) approaches, the perceived difficulty in automating such processes has slowly moved the focus towards resin separation methods, whose basic chemical principles are often similar to the LLE ones in terms of chelators and phases. However, the emerging field of flow chemistry allows LLE to be easily automated and operated in a continuous manner, resulting in an even improved efficiency and reliability. In this contribution, we will outline the fundamentals of LLE processes and their translation into flow-based apparatuses; in addition, we will provide examples of radioisotope separations that have been achieved using LLE methods. This article is intended to offer insights about the future potential of LLE to purify medically relevant radioisotopes.

Radioactive Transition Metals for Imaging and Therapy

Nuclear medicine is composed of two complementary areas, imaging and therapy. Positron emission tomography (PET) and single-photon imaging, including single-photon emission computed tomography (SPECT), comprise the imaging component of nuclear medicine. These areas are distinct in that they exploit different nuclear decay processes and also different imaging technologies. In PET, images are created from the 511 keV photons produced when the positron emitted by a radionuclide encounters an electron and is annihilated. In contrast, in single-photon imaging, images are created from the γ rays (and occasionally X-rays) directly emitted by the nucleus. Therapeutic nuclear medicine uses particulate radiation such as Auger or conversion electrons or β^- or α particles. All three of these technologies are linked by the requirement that the radionuclide must be attached to a suitable vector that can deliver it to its target. It is imperative that the radionuclide remain attached to the vector before it is delivered to its target as well as after it reaches its target or else the resulting image (or therapeutic outcome) will not reflect the biological process of interest. Radiochemistry is at the core of this process, and radiometals offer radiopharmaceutical chemists a tremendous range of options with which to accomplish these goals. They also offer a wide range of options in terms of radionuclide half-lives and emission properties, providing the ability to carefully match the decay properties with the desired outcome. This Review provides an overview of some of the ways this can be accomplished as well as several historical examples of some of the limitations of earlier metalloradiopharmaceuticals and the ways that new technologies, primarily related to radionuclide production, have provided solutions to these problems.

Production, separation and supply prospects of 67Cu with the development of fast neutron sources and photonuclear technology

Experimental investigations have been carried out on the production of a promising therapeutic radionuclide 67Cu via the 67Zn(n,p)67Cu, 68Zn(n,x)67Cu, and 68Zn(γ,p)67Cu reaction routes. Natural zinc metal foils were irradiated with 14.1 MeV neutrons and bremsstrahlung of end-point energy 15 MeV. Radioactivity levels of 67Cu and other radioisotopes co-produced were determined by the quantification of photo-peaks by off-line γ-ray spectrometry. No carrier added 67Cu was separated from the irradiated zinc by solvent extraction. Yields >90% and high levels of radionuclidic purity were achieved. These studies indicate that the growth and development of intense fast neutron sources and photonuclear technology, will possibly aid in the sustained supply of 67Cu.

Development of novel radionuclides for medical applications

Medical radionuclide production technology is well established. There is, however, a constant need for further development of radionuclides. The present efforts are mainly devoted to nonstandard positron emitters (eg, ⁶⁴ Cu, ⁸⁶ Y, ¹²⁴ I, and ⁷³ Se) and novel therapeutic radionuclides emitting low-range β^- particles (eg, ⁶⁷ Cu and ¹⁸⁶ Re), conversion or Auger electrons (eg, ^117m Sn and ⁷⁷ Br), and α particles (eg, ²²⁵ Ac). A brief account of various aspects of development work (ie, nuclear data, targetry, chemical processing, and quality control) is given. For each radionuclide under consideration, the status of technology for clinical scale production is discussed. The increasing need of intermediate-energy multiple-particle accelerating cyclotrons is pointed out.

Measurements of excitation functions of α-particle induced reactions on natNi: possibility of production of the medical isotopes 61Cu and 67Cu

Excitation functions of the natNi(α,x)60,61Cu and 64Ni(α,p)67Cu reactions were measured using the stacked-foil activation technique. The experimental data achieved were compared with literature data as well as with nuclear model calculations performed using the code TALYS-1.8. Integral yields from the respective thresholds to 44 MeV were deduced from the measured excitation curves. The >99% pure 61Cu can be produced using the energy window of Eα=20→7 MeV, the yield amounting to 116 MBq/μAh. After a 2 h cooling time, the short-lived 60Cu (T1/2=23 min) impurity will be reduced to <0.1%. Due to low isotopic abundance of 64Ni, the enriched 64Ni target would be needed for the production of 67Cu via the (α,p) reaction. The cost would, however, be very high. In a few cases, particularly above 24 MeV, we have given new data points. In general, our measurements have strengthened the database.

Pilot Study of 64Cu(I) for PET Imaging of Melanoma

At present, ⁶⁴Cu(II) labeled tracers including ⁶⁴CuCl₂ have been widely applied in the research of molecular imaging and therapy. Human copper transporter 1 (hCTR1) is the major high affinity copper influx transporter in mammalian cells, and specially responsible for the transportation of Cu(I) not Cu(II). Thus, we investigated the feasible application of ⁶⁴Cu(I) for PET imaging. ⁶⁴Cu(II) was reduced to ⁶⁴Cu(I) with the existence of sodium L-ascorbate, DL-Dithiothreitol or cysteine. Cell uptake and efflux assay was investigated using B16F10 and A375 cell lines, respectively. Small animal PET and biodistribution studies were performed in both B16F10 and A375 tumor-bearing mice. Compared with ⁶⁴Cu(II), ⁶⁴Cu(I) exhibited higher cellular uptake by melanoma, which testified CTR1 specially influx of Cu(I). However, due to oxidation reaction in vivo, no significant difference between ⁶⁴Cu(I) and ⁶⁴Cu(II) was observed through PET images and biodistribution. Additionally, radiation absorbed doses for major tissues of human were calculated based on the mouse biodistribution. Radiodosimetry calculations for ^64/67Cu(I) and ^64/67Cu(II) were similar, which suggested that although melanoma were with high radiation absorbed doses, high radioactivity accumulation by liver and kidney should be noticed for the further application. Thus, ⁶⁴Cu(I) should be further studied to evaluate it as a PET imaging radiotracer.

Clinical evaluation of the radiolanthanide terbium-152: first-in-human PET/CT with 152Tb-DOTATOC

The existence of theragnostic pairs of radionuclides allows the preparation of radiopharmaceuticals for diagnostic and therapeutic purposes.

Nuclear data for production and medical application of radionuclides: Present status and future needs

INTRODUCTION

The significance of nuclear data in the choice and medical application of a radionuclide is considered: the decay data determine its suitability for organ imaging or internal therapy and the reaction cross section data allow optimisation of its production route. A brief discussion of reaction cross sections and yields is given.

STANDARD RADIONUCLIDES

The standard SPECT, PET and therapeutic radionuclides are enumerated and their decay and production data are considered. The status of nuclear data is generally good. Some existing discrepancies are outlined. A few promising alternative production routes of ^99mTc and ⁶⁸Ga are discussed.

RESEARCH-ORIENTED RADIONUCLIDES

The increasing significance of non-standard positron emitters in organ imaging and of low-energy highly-ionizing radiation emitters in internal therapy is discussed, their nuclear data are considered and a brief review of their status is presented. Some other related nuclear data issues are also mentioned.

PRODUCTION OF RADIONUCLIDES USING NEWER TECHNOLOGIES

The data needs arising from new directions in radionuclide applications (multimode imaging, theranostic approach, radionanoparticles, etc.) are considered. The future needs of data associated with possible utilization of newer irradiation technologies (intermediate energy cyclotron, high-intensity photon accelerator, spallation neutron source, etc.) are outlined.

CONCLUSION

Except for a few small discrepancies, the available nuclear data are sufficient for routine production and application of radionuclides. Considerable data needs exist for developing novel radionuclides for applications. The developing future technologies for radionuclide production will demand further data-related activities.

Feasibility of isotope harvesting at a projectile fragmentation facility: ⁶⁷Cu

The work presented here describes a proof-of-principle experiment for the chemical extraction of (67)Cu from an aqueous beam stop at the National Superconducting Cyclotron Laboratory (NSCL). A 76 MeV/A (67)Cu beam was stopped in water, successfully isolated from the aqueous solution through a series of chemical separations involving a chelating disk and anion exchange chromatography, then bound to NOTA-conjugated Herceptin antibodies, and the bound activity was validated using instant thin-layer chromatography (ITLC). The chemical extraction efficiency was found to be 88 ± 3% and the radiochemical yield was ≥95%. These results show that extraction of radioisotopes from an aqueous projectile-fragment beam dump is a feasible method for obtaining radiochemically pure isotopes.