By Tim Lougheed

Most Canadians received a rude introduction to the exotic world of medical isotopes in 2009, when a nuclear reactor located in the small Ontario town of Chalk River went off-line. This single breakdown eliminated the source material for almost half of the world’s output of technetium-99, a radioactive element used in millions of cancer imaging scans every year. Spot shortages forced many doctors in Canada and the US to postpone these diagnostic procedures, which are crucial to determining a patient’s status and course of treatment.

While this crisis was relatively short-lived, it shone a very public spotlight on the critical role that radioactive materials play in a variety of medical settings. Organizations with the facilities and expertise in this field subsequently took the opportunity to develop new strategies for their work.

Perhaps nowhere has this planning been more ambitious than TRIUMF, a joint venture owned and operated by 20 member universities that covers five hectares on the University of British Columbia campus and is home to a sophisticated array of cyclotron technology.

TRIUMF is in the midst of a multi-year effort to establish an Institute for Advanced Medical Isotopes (IAMI), which would feature major infrastructure for creating and handling these radioactive products, as well as laboratories for testing them in scientific and clinical settings. While similar work takes place in a variety of university and hospital settings across the country, this facility is intended to concentrate all aspects of such work — from the creation of raw materials to clinical trial work of potential therapies — in a single location.

The backbone of IAMI will be a cyclotron, a room-sized instrument that accelerates streams of protons to high velocities and drives them into targets made of specially selected elements, which in turn spawns radioactive versions of other elements. Dozens of hospitals across the country already have medical cyclotrons, which provide isotopes such as those injected into patients for procedures like PET scanning, which offers highly detailed imagery and biochemical information about what is happening in a living person’s body.

But these isotopes last just a few hours. IAMI would produce technetium-99m – a next generation isotope that is used in almost all cardiac scans and shows real promise in the treatment of cancer and other diseases. TRIUMF has developed a new technology for producing technetium, one that can be produced locally.

“We would be providing isotopes for the patients of BC, but also then providing a model that could be replicated across the country,” says TRIUMF director Jonathan Bagger. “It’s a game changer in nuclear medicine.”

TRIUMF hosts Canada’s most extensive collection of cyclotrons and affiliated laboratories, featuring one machine installed in the late 1960s that is still the largest in the world. Since it was created in 1968, TRIUMF has received more than $1 billion in investment from the federal and British Columbia governments. But its operational funding has been flat for most of the past 15 years, resulting in a deferred maintenance list that the organization warns is threatening Canada’s global leadership in nuclear medicine.

According to Paul Schaffer, who oversees TRIUMF’s Life Sciences division, the potential value of medical isotopes — financially as well as in terms of human health — has made them a top priority that is now being reflected by the establishment of a dedicated R&D body. He recalls first floating this idea to a colleague in 2012, during a casual conversation outside his office while unlocking his bicycle. The suggestion took off and is on its way to becoming the $35.5-million capital undertaking that is IAMI. The facility is intended to serve as an interface between TRIUMF’s deep and extensive expertise in isotope production and the wider national and international nuclear medicine communities.

“TRIUMF is at a sweet spot,” says Schaffer, who argues that decades’ worth of academic work on the design and application of cyclotrons has positioned the organization to lead the way in what has become a strategic niche of nuclear medicine. “With isotope production dramatically shifting, we’re still trying to keep up with the innovations of this place.”

TRIUMF has already raised $11 million to build IAMI, which is expected to occupy a new 2,500 sq-m building with its own research infrastructure and laboratories within the next few years. That money started showing up in 2014, when Western Economic Diversification Canada invested $5.5 million toward the purchase of a state-of-the-art cyclotron from Richmond, BC manufacturer Advanced Cyclotron Systems. The rest of the necessary capital funding is being sought from provincial and federal government agencies in collaboration with IAMI’s three regional partners — UBC, BC Cancer Agency, and Simon Fraser University .Ongoing operational costs would be covered through the sale of isotopes.

“Because it benefits British Columbia but also the nation, it seemed appropriate to us that responsibility could be divided between the federal and provincial governments,” says Bagger, who points to the member universities across the country and other research partners that will eventually be able to take advantage of IAMI’s capabilities.

In contrast to many academic or engineering R&D efforts, those capabilities will also include Good Manufacturing Practices (GMP), which means products developed at IAMI will already meet Health Canada’s standards for use in patients. Kathryn Hayashi, who leads the commercialization arm known as TRIUMF Innovations, regards the establishment of GMP facilities as a game-changing move that will allow the institute to support clinical trials for the next generation of radioactive pharmaceutical agents that are just starting to be studied.

“There is new interest in nuclear medicine in the drug development world and we’re well positioned to be a part of that story,” she says. “The space would allow industry partners, other academic researchers, and clinicians to interact at TRIUMF as part of this hub in a way that we haven’t been able to do before.”

TRIUMF is also developing a new five-year plan (2020-2025) and encouraging stakeholders to put forward innovative ideas, in particular “initiatives that bridge across individual fields of research and take advantage of TRIUMF’s diverse capabilities”. The deadline for submissions is October 16 and TRIUMF expects to complete its internal review of proposals by December.

“Though TRIUMF has historically been funded as a nuclear physics lab, it actually contributes to discovery and innovation and excitement in many ways across Canada,” says Bagger. “I look forward to talking to government on other ways TRIUMF can advance Canada’s innovation priorities.”

With files from Debbie Lawes.

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