|Year : 2022 | Volume
| Issue : 1 | Page : 50-53
Fully automated synthesis of nitrogen-13-NH3 by SHIs HM-18 cyclotron and dedicated module for routine clinical studies: Our institutional experiences
Singh K Akhilesh, Nilesh Shanker, Kheruka C Subhash, Gambhir Sanjay, Manish Dixit
Department of Nuclear Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
|Date of Submission||15-Jun-2021|
|Date of Decision||06-Aug-2021|
|Date of Acceptance||31-Aug-2021|
|Date of Web Publication||25-Mar-2022|
Dr. Manish Dixit
Department of Nuclear Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aims: The production of nitrogen-13 (13N)-NH3 by ethanol method using automated synthesizer and accessing the production yield, quality control for clinical application. Context: 13N, together with 18F, 15O, and 11C, is one of the positron emitters that can be produced on the multi-gigabecquerel scale in biomedical cyclotrons. (13N)-ammonia is frequently used for cardiac PET studies. It is widely applied for the evaluation of myocardial perfusion in the clinical assessment of cardiac disorders. Simple, fast, and reliable preparation methods have contributed to the routine application of this tracer. Although only two methods are available, a challenge remains to adopt a more efficient and consistent approach to its production. For clinical application, routine production of this tracer is mandatory in compliance with regulatory guidelines. Being at hospital radiopharmacy it is our responsibility to support the clinical service with uninterrupted production and supply of (13N)-NH3. Materials and Methods: The chemicals were used commercially available from Sigma Aldrich, India, Ltd., and Fisher Scientific, India, Ltd. (Mumbai, India), Sep-Pak CM cartridges (Waters India, Pvt., Ltd.,). Radio-thin layer chromatography was carried out using aluminum sheets precoated with silica gel 60 F254 (E. Merck, India). Results: The protocol developed with MPS-100 synthesizer yield (13N)-NH3 95–97% (EOB) with a synthesis time of around 7 min. Conclusions: With the installation of HM-18 cyclotron at our hospital, center is capable to produce (13N)-NH3 of good yield and purity through the ethanol method, for mycocardial perfusion studies. Our protocol is simple, reproducible, and robust.
Keywords: Nitrogen-13-NH3, automation, quality control, synthesizer
|How to cite this article:|
Akhilesh SK, Shanker N, Subhash KC, Sanjay G, Dixit M. Fully automated synthesis of nitrogen-13-NH3 by SHIs HM-18 cyclotron and dedicated module for routine clinical studies: Our institutional experiences. Indian J Nucl Med 2022;37:50-3
|How to cite this URL:|
Akhilesh SK, Shanker N, Subhash KC, Sanjay G, Dixit M. Fully automated synthesis of nitrogen-13-NH3 by SHIs HM-18 cyclotron and dedicated module for routine clinical studies: Our institutional experiences. Indian J Nucl Med [serial online] 2022 [cited 2022 May 25];37:50-3. Available from: https://www.ijnm.in/text.asp?2022/37/1/50/340865
| Introduction|| |
Cardiovascular disease remains the leading cause of death in developed countries as well as in most of developing countries. Myocardial perfusion imaging, a noninvasive measure of blood flow in the heart, is commonly used to determine areas of reversible ischemia, characterize infarcted tissue, and assess left ventricular function. At present, single-photon emission computed tomography imaging with the radioactive transition metal technetium-99 m (99mTc; t1/2 = 6.2 h) incorporated into monocationic complexes (e.g. 99mTc-sestamibi, 99mTc-tetrofosmin) is widely used., Following intravenous injection, these 99mTc complexes distribute into heart tissue in proportion to blood flow and remain trapped for times sufficient to image perfusion territories.
13N was one of the earliest positron emitters to be produced; it was discovered in 1934 by Joliot and Curie. The (13N)-NH3 has been widely used for myocardial perfusion scans.,,, The centers having biomedical cyclotron and suitable infrastructure to produce the (13N)-NH3 use these PET tracer-based studies. It could be used in the assessment of the ischemic area and severity level of coronary artery disease and also provides absolute quantification imaging and valuable information for prognosis and strategy selection for precision treatment. Thus, the clinical demand and significance of (13N)-NH3 are continuously increasing over time. Synthesis of (13N)-NH3 is well documented in the literature but with two routes of production: (1) DeVarda's method and (2) Ethanol method.,,, In DeVardas's method, the produced (13N)-NOx through 16O (p, a) 13N reaction subsequently reduced with DeVarda's alloy to yield the (13N)-NH3 wherein ethanol method, 5 mM of EtOH (aq) as an additive in O-16 water target is used to produce the (13N)-NH3 directly during irradiation. The ethanol method is currently widely used in most centers around the globe. It has the advantage of low input cost, ease of handling, and higher production yield. The addition of a small amount of ethanol works as a scavenger that is capable to oxidize hydroxyl radical during irradiation whereas, in DeVarda's method, the alloy acts as a reducing agent to reduce the oxides of nitrogen to ammonium ions, high input cost, handling or preparation of DeVarda's alloys, needs special care and precaution, although this having good yield.
The production of (13N)-NH3 by alpha-particle irradiation of boron nitride followed by heating with sodium hydroxide was first proposed by Joliot and Curie. Hunter et al. also used a similar synthetic strategy for the production of 13N, they produced it by irradiation of an Al4C3 solid-state target with 8-12 MeV deuterons followed by target treatment with KOH aqueous solution, and (13N)-NH3 was distilled and trapped in an acidic solution as (13N)-NH4OH. The Welch and Lifton, using 7 MeV deuteron energy, studied the formation of 13N-labeled species in different inorganic carbides but Al4C3 yielded a maximum percentage of (13N)-NH3(75%–90%) depending on integrated current in the target. During irradiation of aluminum carbide with deuterons, 28Al is also produced (2.4 min half-life, high energy gamma, and beta radiation); to prevent the formation of this by-product, an alternative method based on the irradiation of continuously flowing methane with 8 MeV deuterons was proposed. Several other production protocols are using different organic phases such as acetic acid, but only two (DeVarda's alloy method and Ethanol methods) are mostly used for the production of (13N)-NH3 in clinical studies by different groups as summarized in below [Table 1].
Hence, every radiopharmacy has its challenges to achieve as respective hospital demands. At hospital pharmacy, the daily challenges for production of radiopharmaceuticals are (i) need for rapid and reliable manufacturing, (ii) adhere by radiation safety protocols due to production of multi curie amount, (iii) follow current good manufacturing practice (cGMP) as recommended by regulatory bodies (the Food and Drug Administration [FDA] 21CFR212, EU),, and (iv) cost-effective to be bear by patients. All this applies to the production of (13N)-NH3 too. Hence, keeping the above points, the production of (13N)-NH3 is exclusively shifted to automated protocols, which compiles the clinical use of it as a drug following 21CFR212 (FDA) or local compliances. Various commercial dedicated automated radio-synthesizers are available such as Tracsis, GE TracerLab MX, Bioscan, Inc., IBA Synthera, and Sumitomo's MPS-100 which are designed to produce (13N)-NH3 as per GMP standards and it complies the quality controls tests. These synthesizers are mostly cassette-based modules, run by software template that is sterile, manufactured according to cGMP, and are compatible with validated clinical procedures and used for producing a large quantity of (13N)-NH3. In addition, the transition to automated systems ensures safety to radiochemists while adhering to the as low as reasonably achievable principle during producing an excessively larger quantity of production.
All the commercially available synthesis modules work on the trap and release method, of which in the target (13N)-NH3 was first trapped over anion exchange cartridge and finally eluted with the 0.9% sterile saline to product vial through 0.22 mm sterile filter.
We, at our center, have established routine production of (13N)-NH3 as required by our hospital. For this purpose, the production and quality assurance of (13N)-NH3 by using the ethanol method was through dedicated multipurpose automated synthesizers termed as MPS-100. In this paper, we document our experience in synthesizing the (13N)-NH3 by automated and QC tests of the final product.
| Materials and Methods|| |
The chemicals were used without any further purification and were commercially available from Sigma Aldrich India Ltd and Fisher Scientific, India, Ltd. (Mumbai, India). USP-grade 0.9% NaCl, and sterile water for injection were purchased from B. Braun India Pvt. Ltd., Sep-Pak CM cartridges (Waters India Pvt. Ltd., WAT20550) were used. Radio-thin layer chromatography (TLC) was carried out using aluminum sheets precoated with silica gel 60 F254 (E. Merck, India) (ratio of propionic acid: acetone: water: 2:2:1 as mobile phase).
| Discussion|| |
Production of 13N-radionuclide through 16O (p, a) 13N nuclear reaction
The production of (13N)-Nitrogen radionuclide was achieved by nuclear reaction of 16O (p, a) 13N at Sumitomo Heavy Industries HM-18 Cyclotron having liquid target capacity. The cyclotron is equipped with Niobium as chamber material with a target volume of 2.5 ml and a target holding volume of 1.7 ml. The production yield of the (13N)-NH3 is in the range of 8.0-15 GBq at 30 mA with of bombardment time of 8–15 min [Scheme 1].
Automated synthesis of (13N)-NH3 using MPS-100 synthesis module
The synthesis of (13N)-NH3 was performed in this dedicated synthesizer. The system was configured with a synthesis software template and hardware named ammonia tray. This tray consists of the two-syringe unit and four magnetic valves [as depicted in [Figure 1]] for performing the different commands for the production of (13N)-NH3.
|Figure 1: Pictorial presentation of the synthesizer MPS-100 ammonia tray|
Click here to view
Our priority was to establish the synthesis of (13N)-NH3 and then to access its quality for clinical application. Performed the optimization runs using the chemistry protocol as programmed with synthesis module [Figure 2].
The (13N)-NH3 solution is a clear, colorless, and isotonic solution. It is subjected to pass the quality tests before being used for clinical studies. After successfully performing ten hot runs and analyzing the QC data, the (13N)-NH3 PET Tracer is used for clinical studies.
Summarizing the synthesis of (13N)-NH3 through the ethanol method [Table 1], we first bombarded the 10 mm ethanolic water with a proton at 30 mA beam current designated energy and time (around 10 min for each run), after that the target water was transferred to the synthesis module from the cyclotron target through delivery line, the target water pass through the precondition ion exchange cartridge (Waters Accell Plus CM, 10 ml water and then 10 ml 0.9% saline) which traps 13N-ammonium ion and pass through the excess water to waste vial. The cartridge was washed with the water twice to remove any impurities and finally the (13N)-NH3 was eluted out with 5 ml of 0.9% saline to the product vial through the sterile syringe filter into the product vial and this product is delivered for clinical studies.
Each batch of the production was subjected to various quality control tests as summarized in [Table 2] for five runs of (13N)-NH3, such as appearance, pH of the final solution, radionuclide purity, radiochemical purity, half-life, sterility, bacterial endotoxin test were performed before releasing for clinical studies. Since the beginning of the production till date, the average yield is in the range of 10 GBq at the end of the synthesis with 10 min of bombardment time.
| Results|| |
Quality control test
Summarized the different quality tests performed for each batch of (13N)-NH3 produced [Table 2]. All the parameters of the different quality tests comply with the standard set by the various regulatory agencies for clinical usage. The synthesizers have produced the final product in more than 95% radiochemical purity. The program template designed for MPS-100 complies with the test parameters that are set for the QC data to product required yield and purity of the final product.
With this production setup, uninterrupted service to the patients is offered. The installation of the cyclotron facility as well radiochemistry facility in the year 2015 and the number of scans, as well as the number of successful hot runs self-explain the robustness and reliability of the machine.
| Conclusions|| |
The ethanol method of production of (13N)-NH3 is well developed in our center, and our experience concluded that it has numerous benefits such as lower cost, low exposure to the worker, shorter synthesis time, and ease of operation. With our MPS-100 automated synthesizer, we have produced the clinical usable (13N)-NH3. Hence, our protocol is simple, reproducible, and robust to work over it.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bonow RO. Clinical practice. Should coronary calcium screening be used in cardiovascular prevention strategies? N Engl J Med 2009;361:990-7.
Beller GA. Recent advances and future trends in multimodality cardiac imaging. Heart Lung Circ 2010;19:193-209.
Slart RH, Bax JJ, van Veldhuisen DJ, van der Wall EE, Dierckx RA, Jager PL. Imaging techniques in nuclear cardiology for the assessment of myocardial viability. Int J Cardiovasc Imaging 2006;22:63-80.
Joliot F, Curie I. Artificial production of a new kind of radioelement. Nature 1934;133:201-2.
Phelps ME, Hoffman EJ, Raybaud C. Factors which affect cerebral uptake and retention of 13NH3. Stroke 1977;8:694-702.
Schelbert HR, Phelps ME, Mazziota JC, Schelbert HR. PET Studies of the Heart in Positron Emission Tomography and Autoradiography. New York: Raven Press; 1986. p. 581-662.
Monahan WG, Tilbury RS, Laughlin JS. Uptake of 13N label ammonia. J Nucl Med 1972;13:274-7.
Walsh WF, Fill HR, Harper PV. Nitrogen-13-labeled ammonia for myocardial imaging. Semin Nucl Med 1977;7:59-66.
Vaalburg W, Kamphuis JA, Beerling-van der Molen HD, Rijskamp A, Woldring MG. An improved method for the cyclotron production of 13N-labelled ammonia. Int J Appl Radiat Isot 1975;26:316-8.
Slegers G, Vandecasteele C, Sambre J. Cyclotron production of 13N-labelled ammonia for medical use. J Radioanal Nucl Chem 1980;59:585-7.
Tilbury RS, Dahl JR. 13N species formed by proton irradiation of water. Radiat Res 1979;79:22-33.
Wieland B, Bida G, Padgett H, Hendry G, Zippi E, Kabalka G, et al.
In-target production of (13
N) ammonia via proton irradiation of dilute aqueous ethanol and acetic acid mixtures. Int J Rad Appl Instrum A 1991;42:1095-8.
Harper PV, Lathrop KA, Krizek H, Lembares N, Stark V, Hoffer PB. Clinical feasibility of myocardial imaging with 13 NH 3. J Nucl Med 1972;13:278-80.
Hunter WW, Monahan WG. [N-13]-ammonia: A new physiologic radiotracer for molecular medicine. J Nucl Med 1971;12:368.
Welch MJ, Lifton JF. The fate of nitrogen13 formed by the 12C (d, n) 13N reaction in inorganic carbides. J Am Chem Soc 1971;93:3385-8.
Shefer RE, Hughey BJ, Klinkowstein RE, Welch MJ, Dence CS. A windowless 13N production target for use with low energy deuteron accelerators. Nucl Med Biol 1994;21:977-86.
Schwarz SW, Dick D, VanBrocklin HF, Hoffman JM. Regulatory requirements for PET drug production. J Nucl Med 2014;55:1132-7.
United States Department of Health and Human Services. Food and Drug Administration, Center for Drug Evaluation and Research (CDER), 2009. Guidance: PET Drugs-Current Good Manufacturing Practice (CGMP): Draft Guidance.
[Figure 1], [Figure 2]
[Table 1], [Table 2]