Wider Horizons for Pharmacists Radiopharmacy Prof. Roger Schibli Department of and Applied Biosciences ETHZ Center for Science ETH-PSI-USZ Radiopharmacy?

7.12.2012 Institute of Pharmaceutical Sciences, ETH Zurich 2 Radiopharmacy!

. Radiopharmacy (= Nuclear ) is a branch of pharmacy, which deals with the preparation, characterization and quality of radioactive materials for use in nuclear procedures . A Radiopharmaceutical (radiotracer, tracer) is a radioactive compound for diagnosis and of human .

7.12.2012 Institute of Pharmaceutical Sciences, ETH Zurich 3 The Center for Radiopharmaceutical Sciences (CRS)

 Founded 1997 (PSI-USZ); 2005 (ETH); 2010 new Head  Ca. 50 FTE (Prof., PhD, PostDocs, PhD students, staff)

Radiopharmacy Paul Scherrer Institute for Radiopharmacy Institut: Pharmaceutical University Sciences Non-standard medical Hospital Zurich: for ETH Zurich: Clinical research and diagnosis & therapy PET-tracer research; routine tracers Teaching

Dept. Chemistry and Department of Dept. for Nuclear Applied Biosciences and Medicine Chemistry The Radiotracer Principle . A is a in which one or more have been replaced by a radioisotope. It is applied in minimal amounts, therefore, it has no pharmacologic effect in vivo. It can also be used to explore the mechanism of bio-/chemical reactions by tracing the path that the radioisotope follows from reactant to product

Noble Prize (1943):„…"for his work on the use of as tracers in the study of chemical processes" “

George de Hevesy

5 Radiopharmazeutische Chemie ETHZ General Design of a Modern

Radioactive part Non-radioactive part Chemical and/or biological part

Defines the physical Defines the biological parameters biol parameters such as physical such as biological half-life ( T1/2) phy half-life ( T1/2) and type of and specificity for diagnosis or therapy

6 Principles of Nuclear Diagnosis

Spectrum of Imaging Techniques

Imaging Method Spatial Sensitivity resolution Morphology Ultrasound 50 µm 10-3 Mol

CT 50 µm 10-3 Mol MRI 100 µm 10-5 Mol

Bioluminescent 1-3 mm 10-8 Mol Function (depth!) Nuclear* > 5 mm 10-9-10-12 Mol

* E.g. 370 MBq Emission of 11C-tracer Tomography necessary - forPET a brain scan with 11CPIB corresponds to 100Single picogram total E missionmass injected. Computed Tomography - SPECT

Roger Schibli 8 CIMST Summer School 2013 Radiopharmaceuticals are also Role Models for «Theragnostics»

Diagnosis and Therapy with one and the same method Diagnostic Therapeutic isotopes

«Theragnosis» of Neuroendocrine Tumors

Diagnostics Therapy


Ga68 Lu177

Baum RP et al. THERANOSTICS: From Molecular Imaging UsingPET/CT Ga-68 Labeled post Tracers therapy and PET/CT to Personalized PET/CT pre therapy . Theragnostics. 2012 Prof. N. Schäfer wird verdankt Preparation of Radiopharmaceuticals: Daily a multidisciplinary endeavor

Nuclear- Radio- Quality Product Sterility Chemistry Physics Chemistry control release testing

1h 2h

Nuclear Medical Dept.

7.12.2012 Institute of Pharmaceutical Sciences, ETH Zurich 11 Radionuclide Production

Cyclotron Reactor: bombardment E.g.: I-131 Sm-153 Ho-166 Lu-177 W-188 On-site generators

E.g.: E.g.: C-11, N-13, O-15 Ga-68 F-18, Cu-64, In-111, I-123 Tc-99m Re-188

12 Radiosynthesis of [18F]-2-Fluordesoxy- (FDG)


Mannose [18F]-2-Fluordesoxy-glucose (FDG)

7.12.2012 Institute of Pharmaceutical Sciences, ETH Zurich 13 Synthesis of Radiopharmaceuticals according to GMP

7.12.2012 Institute of Pharmaceutical Sciences, ETH Zurich 14 Quality Control of Radiopharmaceuticals . Isotope purity & Radionuclide identity . Dosage of radioactivity . Radiochemical purity . Chemical purity . Sterility . Apyrogenicity . Visible purity . pH

7.12.2012 Institute of Pharmaceutical Sciences, ETH Zurich 15 Important β+ Emitters in Radiopharmacy

+ Radionuclide T1/2 Mean β Resolution (keV) (mm) 11C 20 min 386 1.1 15O 2 min 735 1.5 18F 110 min 250 0.7 64Cu 12.7 h 278 0.7 68Ga 1.1 h 830 2.4 76Br 16.3 h 1180 3.2 124I 4.17 d 820 2.3 89Zr 3.27 d 396 1.1 From decentralized to centralized production: Logistic & Commercial Challenges for Radiopharmacies

44 = optimal radius for Sc (T1/2 = 3.9 h)

18 = optimal radius for F (T1/2 = 110 min)

68 = optimal radius for Ga (T1/2 = 68 min)

Nucl. Med. Dept. . Pharm. with [18F]-FDG: The Working Horse in

. Number of [18F]-FDG scans in the USA(x1000)

Expert Rev. Mol. Diagn. Combination of Functional and Morphological Imaging (PET/CT) Changed the Patient Care in Medicine


[18F]-FDG/CT: (A) At staging, patient with diffuse large B- (B) Interim scanning after 2 cycles of showed complete response.

June 14 19 Clinically Approved Radiotracer Daily Produced

. 68Ga-DOTATATE . 99mTc-Nanocol . 177Lu-DOTATATE . 99mTc-MAG3 90 . Y-Zevalin 223 . RaCl2 . Na18F . 99mTc-HMPAO . 18F-FDG . 99mTc-EDC . 18F- . 153Sm-EDTMP . 18F-DOPA . Na131I . 18F-FET . 131I-MIBG . 11F-Flutametamol . 131I-Bexxar . 15O-H O 2 . 18F-MISO . 13 N-NH3 . … . 99mTc- 99m . Tc-MDP

7.12.2012 Institute of Pharmaceutical Sciences, ETH Zurich 20

There are Master and Post Graduate Courses in Radiopharmacy

«Radiopharmaceutical Chemistry» is a mandatory part of the ETH Bachelor Pharmacy curriculum (2 ECT)

7.12.2012 Institute of Pharmaceutical Sciences, ETH Zurich 22 Accreditation of Courses by the European Soc. Nuclear Medicine

Prof. T. Gmeiner Stopar

Prof. M. Schulz-Siegmund

7.12.2012 Institute of Pharmaceutical Sciences, ETH Zurich 23 Post-Graduate Course in Radiopharmacy in Europe

Completed a nationally University postgraduate acceptable course on diploma courses (three radiation safety. modules à 2 weeks)

Open for pharmacists, , biochemists Completed a two-year and biologists (min. period of experience in a Master level) radiopharmacy

7.12.2012 Institute of Pharmaceutical Sciences, ETH Zurich 24 Content of the Post Graduate Course

Block 1: Pharmacy (Uni. Ljubljana) Radiopharmaceutical chemistry . Pharmaceutical Technology . Physics of radioactivity . Implications of GMP . Production of radionuclides in . Sterile Manufacture and cyclotron . Pharmaceutical microbiology . Targetry, , . Parenteral Products generators . 18 . Formulation and Packaging PET - radiopharmaceuticals ( F, 11C, 13N, 15O) . Pharmaceutical Analysis Synthesis of labelled compounds . Pharmacopoeia monographs . Bioconjugation chemistry . Quality Control Procedures . Radionuclides in analytics, Stability and Shelf Life autoradiography . Biopharmacy (Pharmacokinetics, . 99mTc-radiopharmaceuticals membrane transport, . biodistribution, ) Animal models . . …. …

7.12.2012 Institute of Pharmaceutical Sciences, ETH Zurich 25 Content of the Post Graduate Course & Conditions for EANM Certificate Block 3: Clinical Radiopharmacy Practical Components (2 years) . . Working in a sterile environment . Toxicology . Design and application of a . Aspects of and quality assurance program . Use of safe radiation practices, . interventions and . Use, maintenance and interactions/ adverse reactions calibration of equipment used in . Nuclear Medicine - aspects of radiopharmacies clinical practice . Procurement of . and other Radiopharmaceuticals imaging modalities. . Radiopharmaceutical preparation . . Quality control of . Statistics: practical exercize radiopharmaceuticals . Supply of radiopharmaceuticals . …. . … 7.12.2012 Institute of Pharmaceutical Sciences, ETH Zurich 26

Radiopharmacists are national and international organized in Societies

7.12.2012 Institute of Pharmaceutical Sciences, ETH Zurich 27 Summary & Conclusion . Radiopharmacy and radiopharmaceutical preparation is multi-disciplinary endeavor . There is a clear trend from decentralized to centralized radiopharmaceutical production with qualified personnel in qualified environment due to increasing regulations . Pharmaceutical, (radio)chemical and radiophysical/ know-how is essential . Education of radiopharmacists is necessary at the University level (master or higher) to cope with complexity . International standards have to be achieved to shape the future of radiopharmacy

7.12.2012 Institute of Pharmaceutical Sciences, ETH Zurich 28 Acknowledgment . President of Scientific Committee (Prof. Dr. Borut Božič) . Prof. Irena Mlinarič-Raščan . Prof. Prof. T. Gmeiner Stopar

. Dr. Angela Küng & Regular Furegati (ETH)

7.12.2012 Institute of Pharmaceutical Sciences, ETH Zurich 29

Radiotracer and radiopharmaceuticals play an important role in

Pre-disposition .Diagnosis & Therapy control (Genetics) . Protein expression (receptors, enzymes) . Protein function(transport, metabolism) Surveilance and . Assessment of biological function (e.g. prevention flow) .Drug development Diagnosis . Efficiency . Pharmacokinetics Choice of therapy .Therapy . Optimize therapy of specific

Therapy control Examinations and certificates 2011/12

Module Module II Module III

participants 28 26 21 examinees 26 22 20 examination centers 7 6 10 success rate 100 % 100 % 100 % graduates of CAS 6 2 9

17 graduates at present cycle

7.12.2012 Institute of Pharmaceutical Sciences, ETH Zurich 32 Financial aspects

7.12.2012 Institute of Pharmaceutical Sciences, ETH Zurich 33 Costs for entire CAS program Study fees payable to ETH “Schulgeld” CHF 17’400.-

Advisory board meeting CHF 3’500.- Promotion (Advertisement, Flyers, Mailing, Website) CHF 6’000.- ETH visit of partner university during course CHF 2’000.- total CHF 28’900.-

(occuring biannually, based on 30 participants)

Imaging from Mice-to-Men

Pre-clinical Clinical

35 Radiopharmazeutische Chemie ETHZ Radiopharmaceuticals are ideal for non-invasive imaging

Detection of beta-, the pathologic hallmarks of Alzheimer's in brain tissue via 11C-PIB

Hieronymus Bosch Entfernung () des Wahnsinnssteines