The main issues of quality assurance of radiopharmaceuticals

One of the prerequisites for successful application of nuclear medicine technologies is the production and clinical use of radiopharmaceuticals (RPs) of a reliably high quality. The aim of the review is to discuss specific properties of RPs, which stipulate specific approaches to their production (or preparation) and quality control. The decisive requirement for the management of RPs at all stages of their life cycle is the observance of the radiation safety rules and regulations. The paper considers the main approaches to assessing the risks of medical radiation exposure to patients and radiation protection of nuclear medicine staff. The choice of a particular quality parameter and the corresponding analytical procedure should be made taking into account the duration of the test, which, like the production time, should be comparable with the radionuclide half-life. The feasibility of the analytical procedure should also be taken into account, given the high radioactivity of the samples tested. Now that theranostics has caught on, new approaches are being developed all over the world concerning regulatory aspects of transition from preclinical studies of RPs to clinical trials, because, according to experts, this is becoming a key condition for rapid implementation of nuclear medicine achievements. The results and conclusions of the present study can be used in the development and expert review of monographs and other specifications required for RP marketing and use. The results of the analysis suggest that it is necessary to develop specific requirements and guidelines for RP testing and evaluation for their successful promotion on the EAEU market

Основные проблемы обеспечения качества радиофармацевтических лекарственных препаратов

One of the prerequisites for successful application of nuclear medicine technologies is the production and clinical use of radiopharmaceuticals (RPs) of a reliably high quality. The aim of the review is to discuss specific properties of RPs, which stipulate specific approaches to their production (or preparation) and quality control. The decisive requirement for the management of RPs at all stages of their life cycle is the observance of the radiation safety rules and regulations. The paper considers the main approaches to assessing the risks of medical radiation exposure to patients and radiation protection of nuclear medicine staff. The choice of a particular quality parameter and the corresponding analytical procedure should be made taking into account the duration of the test, which, like the production time, should be comparable with the radionuclide half-life. The feasibility of the analytical procedure should also be taken into account, given the high radioactivity of the samples tested. Now that theranostics has caught on, new approaches are being developed all over the world concerning regulatory aspects of transition from preclinical studies of RPs to clinical trials, because, according to experts, this is becoming a key condition for rapid implementation of nuclear medicine achievements. The results and conclusions of the present study can be used in the development and expert review of monographs and other specifications required for RP marketing and use. The results of the analysis suggest that it is necessary to develop specific requirements and guidelines for RP testing and evaluation for their successful promotion on the EAEU market.Одним из основных условий, определяющих успешное применение технологий ядерной медицины, является получение и введение пациенту радиофармацевтического лекарственного препарата (РФЛП) гарантированно высокого качества. Цель обзора — обсуждение специфических свойств РФЛП, обусловливающих специальные подходы к их производству (или изготовлению) и контролю качества. Определяющим требованием к обращению РФЛП на всех стадиях их жизненного цикла является соблюдение норм и правил радиационной безопасности. Рассмотрены основные подходы к оценке рисков медицинского облучения пациентов и радиационной защите персонала, работающего в области ядерной медицины. Выбор того или иного показателя качества и соответствующей аналитической методики должен определяться в соответствии со временем проведения анализа, которое так же, как и время синтеза, должно быть соизмеримо с периодом полураспада радионуклида, а также с возможностью реализации аналитического определения в условиях работы с высокорадиоактивными образцами. С развитием тераностики в мировой практике вырабатываются новые подходы к регуляторным вопросам перехода от доклинических исследований радиофармпрепаратов к клиническим, поскольку, по мнению экспертов, это становится определяющим для быстрого внедрения достижений ядерной медицины. Результаты и выводы работы могут быть использованы при разработке и экспертизе фармакопейных статей и другой нормативной документации, сопровождающей обращение РФЛП. Проведенный анализ показал, что необходима разработка отдельных требований и руководств по испытаниям и экспертизе РФЛП для успешного продвижения их на рынок ЕАЭС

Possible Impurities in Radiopharmaceuticals and Corresponding Test Methods

The main quality attributes of radiopharmaceuticals that ensure their effectiveness and safety and are unique to their specifications are activity, radionuclide identity, radionuclide purity, and radiochemical purity. The aim of this study was to analyse the possibility of formation and methods for determination of various impurities in radiopharmaceuticals based on radionuclides of several groups: technetium-99m and rhenium-188; iodine and fluorine-18 isotopes; and gallium-68 and some other metallic radionuclides used in theranostic schemes combining radionuclide diagnostics and radionuclide therapy. The article analyses the sources for the formation of radionuclide, radiochemical, and chemical impurities; the influence of these impurities on visualisation quality and dosimetric characteristics of radiopharmaceuticals; various approaches to the methods of impurity detection and quantification; compendial requirements to the quality of radiopharmaceuticals; and research results reported in publications. The article demonstrates the need for the development and certification of Russian reference standards for testing quality attributes of radiopharmaceuticals as part of harmonisation of the State Pharmacopoeia of the Russian Federation with the Pharmacopoeia of the Eurasian Economic Union and the European Pharmacopoeia

Присутствие возможных примесей в радиофармацевтических лекарственных препаратах и методы их определения

The main quality attributes of radiopharmaceuticals that ensure their effectiveness and safety and are unique to their specifications are activity, radionuclide identity, radionuclide purity, and radiochemical purity. The aim of this study was to analyse the possibility of formation and methods for determination of various impurities in radiopharmaceuticals based on radionuclides of several groups: technetium-99m and rhenium-188; iodine and fluorine-18 isotopes; and gallium-68 and some other metallic radionuclides used in theranostic schemes combining radionuclide diagnostics and radionuclide therapy. The article analyses the sources for the formation of radionuclide, radiochemical, and chemical impurities; the influence of these impurities on visualisation quality and dosimetric characteristics of radiopharmaceuticals; various approaches to the methods of impurity detection and quantification; compendial requirements to the quality of radiopharmaceuticals; and research results reported in publications. The article demonstrates the need for the development and certification of Russian reference standards for testing quality attributes of radiopharmaceuticals as part of harmonisation of the State Pharmacopoeia of the Russian Federation with the Pharmacopoeia of the Eurasian Economic Union and the European Pharmacopoeia.Основными показателями качества любого радиофармацевтического лекарственного препарата, которые обеспечивают его эффективность и безопасность, и при этом отсутствуют в спецификациях других лекарственных средств, являются подлинность по радионуклиду, активность, радионуклидная чистота и радиохимическая чистота. Цель работы – анализ возможности образования различных видов примесей в радиофармацевтических лекарственных препаратах и методов определения этих примесей. Рассмотрены препараты на основе радионуклидов различных групп: технеция-99м и рения-188; изотопов йода и фтора-18; галлия-68 и некоторых других радионуклидов-металлов, применяемых в тераностических схемах «радионуклидная диагностика/радионуклидная терапия». Проанализированы источники образования радионуклидных, радиохимических и химических примесей, их влияние на качество визуализации и дозиметрические характеристики радиофармпрепаратов, различные подходы к методам обнаружения и количественного определения примесей,  фармакопейные требования к качеству радиофармпрепаратов и результаты исследований, опубликованные в научной литературе. Показана необходимость разработки и аттестации отечественных стандартных образцов для определения показателей качества радиофармацевтических лекарственных препаратов в рамках гармонизации отечественной фармакопеи с Фармакопеей Евразийского экономического союза и Европейской фармакопеей

Опыт проведения валидации методик определения радиохимических примесей в радиофармацевтических лекарственных препаратах

Most important quality attributes of any radiopharmaceutical (RPh) are its radiochemical purity (RCP) or content of radiochemical impurities (RCIs) that have to comply with respective norms and limits. However, at present, there is no unified approach to validation of analytical methods in the context of highly radioactive samples.The aim of the study was to develop an approach to validation of methods for determination of RCI content in RPhs.Materials and methods: the authors determined the content of RCIs in a radiopharmaceutical formulation containing a complex of technetium-99m and methylenediphosphonic acid by the radiometric method after isolation of impurities from the main compound by thin-layer chromatography using silica gel and methyl ethyl ketone (for sodium pertechnetate determination) and silica gel and 13.6% sodium acetate solution (for determination of hydrolysed reduced technetium-99m). The radioactivity was registered by a chromatogram scanner with a detector of gamma-rays with energies from 0.05 to 1.5 MeV.Results: the paper analyses existing official approaches to validation of analytical procedures and compares them with the results of experimental studies described in available publications. It assesses the validation parameters for compliance with the acceptance criteria set forth in the current regulations and substantiates selectivity of chromatographic determination of impurities under the selected test conditions. Coefficients of variation for repeatability, reproducibility, and accuracy did not exceed 4.5, 2.8, and 8.9%, respectively, given the relative error of not more than 10.5%. The study demonstrated signal linearity for the 10-fold dilution of the standardised sodium pertechnetate solution, it also demonstrated correspondence between the applied and detected radioactivity when performing the test in the impurity content range of 0.5–5%. The validation procedure was associated with significant radiation burden for the personnel of the quality control laboratory.Conclusions: the authors suggested a methodological approach to validation of methods for determination of RCI content in technetium-99m-based RPhs. This approach may be used in the development of a guideline on validation of analytical methods for RCP/RCI determination in RPhs, or for introduction of relevant sections into existing documents.Важнейшими показателями качества любого радиофармацевтического лекарственного препарата (РФЛП) являются его радиохимическая чистота (РХЧ) или содержание радиохимических примесей (РХП), значения которых нормированы. Однако в настоящее время не существует единого подхода к валидации аналитических методик в условиях работы с высокорадиоактивными образцами.Цель работы: формирование подхода к валидации методики определения содержания РХП в РФЛП.Материалы и методы: количественное определение РХП в радиофармацевтической композиции, содержащей комплекс технеция-99м с метилендифосфоновой кислотой, проводили радиометрическим методом после разделения примесей и основного соединения с помощью тонкослойной хроматографии в системе силикагель–метилэтилкетон для определения натрия пертехнетата и в системе силикагель — 13,6% раствор натрия ацетата для определения гидролизованного восстановленного технеция-99м. Регистрация радиоактивности проводилась с помощью хроматограмм-сканера с детектором, регистрирующим гамма-кванты с энергией от 0,05 до 1,5 МэВ.Результаты: рассмотрены и проанализированы существующие нормативные подходы к валидации аналитических методик в сравнении с результатами описанных в литературе экспериментальных исследований, проведена оценка валидационных параметров на соответствие критериям приемлемости, предъявляемым действующими нормативными документами. Доказана селективность хроматографического определения примесей в выбранных условиях анализа. Коэффициенты вариации при выполнении тестов «Повторяемость, воспроизводимость и правильность» не превышали 4,5; 2,8 и 8,9% соответственно при относительной погрешности не более 10,5%. Продемонстрирована линейность сигнала при разведении в 10 раз модельного раствора натрия пертехнетата, доказано соответствие нанесенной и детектируемой радиоактивности при анализе в диапазоне содержания примесей 0,5–5%. Показано, что выполнение процедуры валидации связано со значительными радиационными нагрузками на персонал лаборатории контроля качества.Выводы: предложен методологический подход к валидации методик определения содержания РХП в РФЛП на основе технеция-99м, который в дальнейшем может быть использован при разработке отдельного документа по валидации аналитических методик определения РХЧ или РХП для РФЛП или внесения соответствующих разделов в действующие документы

QUALITY CONTROL OF RADIOPHARMACEUTICALS IN MEDICAL INSTITUTIONS

One of the major nuclear medicine agent is radiopharmaceutical (RPh) which is a composition comprising a radioactive isotope in certain chemical form. Quality control, namely the determination of radiochemical purity of radiopharmaceuticals produced in a medical institution, prior to administration to the patient is mandatory in all developed countries of the world since the mid-1980s. In our country, virtually the same procedure has been mandatory since the beginning of 2016, along with other measures, the implementation of which should guarantee the high quality and safety of nuclear medicine procedures according to the Order of the Ministry of Health of the Russian Federation from 27.04.2015 N 211n «On approval of the radiopharmaceutical preparation directly in medical institutions», which came into force from January 01, 2016. This article presents the main approaches to the implementation of quality control (determination of radiochemical purity) of radiopharmaceuticals manufactured directly in the medical institutions

Experience in Validation of Methods for Determination of Radiochemical Impurities in Radiopharmaceuticals

Most important quality attributes of any radiopharmaceutical (RPh) are its radiochemical purity (RCP) or content of radiochemical impurities (RCIs) that have to comply with respective norms and limits. However, at present, there is no unified approach to validation of analytical methods in the context of highly radioactive samples.The aim of the study was to develop an approach to validation of methods for determination of RCI content in RPhs.Materials and methods: the authors determined the content of RCIs in a radiopharmaceutical formulation containing a complex of technetium-99m and methylenediphosphonic acid by the radiometric method after isolation of impurities from the main compound by thin-layer chromatography using silica gel and methyl ethyl ketone (for sodium pertechnetate determination) and silica gel and 13.6% sodium acetate solution (for determination of hydrolysed reduced technetium-99m). The radioactivity was registered by a chromatogram scanner with a detector of gamma-rays with energies from 0.05 to 1.5 MeV.Results: the paper analyses existing official approaches to validation of analytical procedures and compares them with the results of experimental studies described in available publications. It assesses the validation parameters for compliance with the acceptance criteria set forth in the current regulations and substantiates selectivity of chromatographic determination of impurities under the selected test conditions. Coefficients of variation for repeatability, reproducibility, and accuracy did not exceed 4.5, 2.8, and 8.9%, respectively, given the relative error of not more than 10.5%. The study demonstrated signal linearity for the 10-fold dilution of the standardised sodium pertechnetate solution, it also demonstrated correspondence between the applied and detected radioactivity when performing the test in the impurity content range of 0.5–5%. The validation procedure was associated with significant radiation burden for the personnel of the quality control laboratory.Conclusions: the authors suggested a methodological approach to validation of methods for determination of RCI content in technetium-99m-based RPhs. This approach may be used in the development of a guideline on validation of analytical methods for RCP/RCI determination in RPhs, or for introduction of relevant sections into existing documents

SYNTHESIS OF RADIOPHARMACEUTICAL WITH RHENIUM-188 AND LIPIODOL

Radiopharmaceutical with rhenium-188 and lypiodol is synthesized in medical organizations from a kit of reagents and eluate from the 188W/188Re generator. The kit of reagents consists of three vials: lyophilized reagent N 1 containing tin dichloride, lyophilized reagent N 2 - sodium dithiobenzoate, and reagent N 3 - lipiodol. A domestic technology was developed for obtaining a lyophilized reagent containing tin dichloride. Quality control of the sodium perrhenate, 188Re solution obtained from the generator (eluate) should be carried out before each synthesis of the radiopharmaceutical. The results of quality control of radiopharmaceuticals synthesized from lyophilized reagent N 1 of domestic and imported production, showed their identity by index «radiochemical purity»

Development of Radiopharmaceutical Composition for Radionuclide Diagnostics of Malignant Melanoma

Introduction. Skin cancers came first in Russia in numbers of oncological diseases. Melanoma, making up only a small part of these cases, leads to the most serious consequences. The nuclear medicine methods application is necessary at the stages of clarifying the diagnosis, searching for remote metastases and the treatment monitoring. The work is devoted to one of the stages of the radiopharmaceutical development for the diagnostics of malignant melanoma and its metastases based on the synthetic analog of α-melanocyte stimulating hormone (SAH) and radionuclide Tc-99m.Aim. The selection of optimal conditions for the preparation of the SAH ∙ 99mTc complex and the study of the using possibility it as a diagnostic tool in in vitro experiments.Materials and methods. Experimental work was carried out to optimize the conditions for obtaining the complex compound SAH ∙ 99mTc. The binding and internalization of this compound by B16-F0 melanoma cells has been studied.Results and discussion. The results of labeling SAH with a 99mTc radionuclide under a wide range of conditions were obtained both by the direct method and using the intermediate complex. The target compound rapidly binds to B16-F0 melanoma cells. The degree of internalization is more than 85 %.Conclusion. Based on the results of chemical experiments and data from in vitro experiments, optimal conditions for obtaining a complex compound SAH ∙ 99mTc with a radiochemical yield of more than 90 % were found. The mechanism of binding of this compound to malignant melanoma cells has been established