Radioarsenic: A promising theragnostic candidate for nuclear medicine

Molecular imaging is a non-invasive process that enables the visualization, characterization, and quantitation of biological processes at the molecular and cellular level. With the emergence of theragnostic agents to diagnose and treat disease for personalized medicine there is a growing need for matched pairs of isotopes. Matched pairs offer the unique opportunity to obtain patient specific information from SPECT or PET diagnostic studies to quantitate in vivo function or receptor density to inform and tailor therapeutic treatment. There are several isotopes of arsenic that have emissions suitable for either or both diagnostic imaging and radiotherapy. Their half-lives are long enough to pair them with peptides and antibodies which take longer to reach maximum uptake to facilitate improved patient pharmacokinetics and dosimetry then can be obtained with shorter lived radionuclides. Arsenic-72 even offers availability from a generator that can be shipped to remote sites and thus enhances availability. Arsenic has a long history as a diagnostic agent, but until recently has suffered from limited availability, lack of suitable chelators, and concerns about toxicity have inhibited its use in nuclear medicine. However, new production methods and novel chelators are coming online and the use of radioarsenic in the pico and nanomolar scale is well below the limits associated with toxicity. This manuscript will review the production routes, separation chemistry, radiolabeling techniques and in vitro/in vivo studies of three medically relevant isotopes of arsenic (arsenic-74, arsenic-72, and arsenic-77).

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.