Multicenter Experience with Good Manufacturing Practice Production of [C]PiB for Amyloid Positron Emission Tomography Imaging.

Alzheimer's disease (AD) is a neurodegenerative disorder with increasing global prevalence and accounts for over half of all dementia cases. Early diagnosis is paramount for not only the management of the disease, but also for the development of new AD treatments. The current golden standard for diagnosis is performed by positron emission tomography (PET) scans with the tracer [C]Pittsburg Compound B ([C]PiB), which targets amyloid beta protein (A) that builds up as plaques in the brain of AD patients. The increasing demand for AD diagnostics is in turn expected to drive an increase in [C]PiB-PET scans and the setup of new [C]PiB production lines at PET centers globally. Here, we present the [C]PiB production setups, experiences, and use from four Danish PET facilities and discuss the challenges and potential pitfalls of [C]PiB production. We report on the [C]PiB production performed with the 6-OH-BTA-0 precursor dissolved in either dry acetone or 2-butanone and by using either [C]CO or [C]CH as C- precursors on three different commercial synthesis modules: TracerLab FX C Pro, ScanSys, or TracerMaker. It was found that the [C]CO method gives the highest radioactive yield (1.5 to 3.2 GBq vs. 0.8 ± 0.3 GBq), while the highest molar activity (98.0 ± 61.4 GBq/μmol vs. 21.2 to 95.6 GBq/μmol) was achieved using [C]CH. [C]PiB production with [C]CO on a TracerLab FX C Pro offered the most desirable results, with the highest yield of 3.17 ± 1.20 GBq and good molar activity of 95.6 ± 44.2 GBq/μmol. Moreover, all reported methods produced [C]PiB in quantities suitable for clinical applications, thus providing a foundation for other PET facilities seeking to establish their own [C]PiB production.