The present status of radiopharmaceuticals in the country.

Abstract

Radiopharmaceuticals are the major and essential component in nuclear medicine and are the most prominent aspect of peaceful applications of nuclear sciences in human being’s daily life. These radioactive materials are formulated in appropriate forms for administration to human being for the diagnosis and the therapy of human diseases. Diagnostic radiopharmaceuticals are the majorly applied radiopharmaceuticals worldwide (>90%), while therapeutic applications are still in the growing process. Production of radiopharmaceuticals almost started in 1980’s in Iran with the fabrication of 99 Mo/ 99m Tc generators, the most widely used component in the nuclear medicine practice. Since then, many Tc-99m kits for single photon emission computed tomography (SPECT) were prepared and developed in the country together with other diagnostic and therapeutic radiopharmaceuticals in last 3 decades. Recently, positron emission tomography (PET) has been initiated in the country using the most important PET tracer, i.e. 18 F-FDG. The advances of radiopharmaceutical sciences in Iran have been recently reported at international levels (1), with great position compared to other countries in the Middle East (2). In this editorial, the status of production and availability of radiopharmaceuticals in the country has been presented. Although the research and development of radiopharmaceuticals has a long history in the country, however, the initiation of National Iranian Radiopharmaceutical Project in 2010 led to initiation of many new pre-clinical/clinical evaluations pushing the developed radiopharmaceuticals into clinical applications and market (3). Tc-99m is used in more than 80% of diagnostic procedures and is usually prepared in a 99 Mo/ 99m Tc generator form using high specific activity (fission moly) or low specific activity (gel moly) Mo-99 loaded on a column shielded in proper lead container to be sent to nuclear medicine centres. The generator systems are then eluted using appropriate aqueous solution and the 99m TcO 4 - radio-anion is then mixed with appropriate cold kits containing a ligand and some other additives (reducing agent, stabilizer, filler, …) to obtain an injectable IV solution. Based on the nature of the kit ligands used, the radiopharmaceutical can be used in the diagnosis of various human diseases, such as malignancies, bone problems, heart disorders, liver diseases, etc. Table 1 demonstrates a list of available Tc-99m radiopharmaceuticals in the country which have been routinely used in human. Other important diagnostic tracer in form of 131 I-NaI oral solution or capsules is routinely used in the detection of thyroid related diseases and metastasis usually in low doses, the radioisotope is produced by the irradiation of natural tellurium target in research reactor. At higher doses this radiopharmaceutical is used for the treatment of hyperthyroid disease and targeted therapy of thyroid malignancies. Another important I-131 based radiopharmaceutical is the synthetic homologue of neuroamines called I-131 meta-iodobenzyl guanidine ( 131 I-MIBG) used in the diagnosis of neural crest derived tumors,