Mo99 and Tc99m in personalized medicine: easing the supply crisis
François Labarre, IBA Molecular.
8 Sept 2010
As the healthcare industry seeks to increasingly improve
diagnoses, issues regarding efficiency, patient outcomes and cost
continue to be top-of-mind.
Personalized medicine, or “the use of new methods of molecular
analysis to better manage a patient’s disease or predisposition to
disease” , can provide patients with safer and more effective
treatments; provide practitioners with access to innovative
technologies; and reduce treatment costs for healthcare systems. So
much so that PricewaterhouseCoopers anticipates the market for
personalized medicine will grow to US$452 billion by 2015 .
One of the most significant components of personalized medicine
is nuclear medicine, a discipline where small amounts of radioactive
materials, known as radiopharmaceuticals, are used to diagnose or
treat disease on a very individual basis. Particularly used in
cardiology, oncology and neurology, nuclear medicine is able to
measure the biological function of cells.
Current studies show that 40% of pharmaceutical treatments are
inefficient, as they do not accurately target the underlying
problem. Positron Emission Tomography (PET) and Single Photon
Emission Computed Tomography (SPECT) are non-invasive diagnostic
imaging methods involving gamma rays that are used in nuclear
medicine to visualize detailed, biological processes. By providing
doctors with information about a body’s structure and function,
diseases and their responses to treatment can be imaged and
pinpointed at a very early stage, which can therefore lead to
earlier, safer and more adequate treatments.
But currently impacting the efficiency of nuclear medicine is an
ongoing shortage of the radioisotope Molybdenum 99 (Mo99). The
production of this sensitive raw material is central in the
production of Technetium 99m (Tc99m), which is used in nearly 60% of
all patient scans conducted by nuclear medicine imaging specialists.
Mo99, which has a half life of 60 hours, decays into TC99m,
which has a half life of 6 hours. Due to its longer half life Mo99
is transported to medical facilities, where the TC99m is produced
onsite as needed in technetium-99m generators. The need for Mo99 is
estimated to be increasing at a rate of 3% each year.
Most of the Mo99 is produced from highly enriched uranium
from only five nuclear reactors around the world. The manufacturing
and supply issues are the result of aging reactors around the globe
which are experiencing repeated technical issues. For instance, two
of the most important Mo99 suppliers, located in Canada and the
Netherlands, have been shut down for repair due to their age. This
has caused a recurrent shortage since 2009 with a severe occurrence
this summer, and has been compounded by the fact that both reactors
broke down at the same time. Other methods of producing Mo99 are
possible but none so far are available to produce it in sufficient
These ongoing shortages severely affect the nuclear medicine
industry — particularly imaging specialists — and as a result, their
patients. Any halt in the production of Mo99 decreases the supply of
products that specialists use in patient scans, resulting in fewer
scans and a critical lack of diagnosis and treatment of potentially
fatal diseases. Already there has been an estimated ten to 30% drop
in patient scans since the first major shortage began on July 1.
Easing the Current Crisis
While the Mo99 shortage is clearly a major nuclear medicine
hurdle, industry leaders such as IBA Molecular have implemented a
number of measures to provide solutions and lessen the impact of the
shortage for healthcare workers, and ultimately their patients.
During times of shortage, Mo99 is a scarce resource and its cost
increases. IBA Molecular, for example, has focused on investing more
to obtain additional supply needed to help alleviate the crisis for
imaging specialists, even though this, in turn, has a direct impact
on the price of the related solutions that these specialists use.
The company secured a larger quantity of Mo99 by negotiating
supplies from five reactors worldwide, and reorganized its
production schedule to accommodate different delivery schedules of
the raw material to provide equally for all customers, regardless of
On September 1, IBA Molecular announced a partnership with the
IRE (Institute for Radioelements) and the CEA (The French
Alternative Energies and Atomic Energy Commission) to secure Tc99m
supply beyond 2015 to meet the needs of approximately eight million
tests per year in Europe.
Before the recent crisis began, IBA Molecular also reached out to
nuclear medicine specialists to inform them that this crisis would
take place. The company wanted to ensure that specialists understood
the reasons behind the shortage and the expected rise in product
costs, both of which are industry-wide issues. Early communication
better enables specialists to prioritize and plan to adopt and
implement new solutions at their disposal.
IBA Molecular’s extensive PET radiopharmaceutical network enables
the company to provide widespread and accelerated solutions to the
industry when it is affected by such manufacturing crises.
Alternative products from its radiopharmaceuticals portfolio were
put forward for use as substitutes for products affected by Mo99,
including sodium fluoride, used for bone scintigraphy, and thallium
chloride, a long-standing product in IBA’s portfolio, to conduct
myocardial scintigraphy. These can both be used without relying on
While these are important options to ease the Mo99 crisis in the
short-term, a long-term vision in nuclear medicine is imperative to
be able to fulfill the substantial potential within personalized
medicine. For example, despite efforts to upgrade existing nuclear
reactors that are breaking down, new ones will need to be built in
order to lessen the risk of future shortages and optimize production
Over the long haul, the industry must adopt a number of changes,
in particular related to the supply chain. While the industry
expects that new reactors will be built, investments will need to be
made by industry and government alike to secure the Mo99 supply
chain. It is crucial to have cooperation from and with industry
associations such as the European Association of Nuclear Medicine,
the Association of Imaging Producers & Equipment Suppliers (AIPES),
and governments throughout Europe to help make new projects and
product solutions become a reality.
During this current crisis, and during any future ones, nuclear
medicine producers must continue to focus on providing a pipeline of
safe and reliable solutions to medical specialists in every corner
of the globe, regardless of industry issues.
Looking ahead: developments in personalized medicine
Personalized medicine is an emerging discipline that will help
overcome the substantial challenges healthcare systems face, by
answering two main questions. Who is going to suffer from a disease?
Is the treatment we deliver efficient, or will it be efficient? On
one side is “diagnosis,” and on the other, “prognosis”. These
questions address not only the health aspect of medicine, but the
treatment costs involved as well, and a solid supply chain is
imperative to ensure that these can be answered.
Looking forward, genetics, blood markers and imaging modalities
such as CT and MRI will help to answer the diagnosis question, by
screening a large scale of the population and predicting who will be
affected by a disease.
But molecular imaging, by way of nuclear medicine, will be an
extremely important tool to address the prognosis question. For
instance, apoptosis tracers are currently being developed to help
solve largely unmet medical needs in the area of cancer treatment,
and reduce the overall cost of treating patients. These tracers
could give a rapid view on the efficiency of a chemo- or
radiotherapy in different types of cancer. By evaluating the
efficiency of radiation treatment within days of treatment, instead
of waiting for several months, chances will increase for the patient
to receive the most appropriate therapy at the most appropriate
Additionally, new amyloid plaque tracers could allow for an
accurate diagnosis and follow-up of Alzheimer’s disease, thus
ensuring that the drug is being given to the right patients and is
delivering the expected outcome.
Furthermore, nuclear medicine’s area of focus will eventually
shift from disease diagnosis and evaluation of drug efficacy to
encompass diagnosis, evaluation as well as therapy. Some
therapeutics are currently being used in nuclear medicine, for
example to alleviate pain from bone metastases. However they are not
widely known, and represent only five percent of the nuclear
medicine industry’s global activity.
As the nuclear medicine discipline continues to grow, and safe
and reliable solutions consistently come to fruition, personalized
medicine’s full potential will become clearer across all parts of
the health ecosystem.
1. Personalized Medicine Coalition.
The PMC has produced a
The case for personalised medicine. This details how
personalized medicine plays an increasingly integral role in
delivering high-quality, cost-effective health care and presents
evidence that personalized medicine will continue to grow in
importance as scientific breakthroughs are translated into a new
generation of targeted therapeutics.
2. PricewaterhouseCoopers. The Science of Personalized Medicine:
Translating the Promise into Practice. 8 December 2009.
François Labarre is senior vice president,
Europe at IBA Molecular.
IBA Molecular is global developer, manufacturer and distributor
of next generation radiopharmaceutical products and supporting
services used in molecular imaging that respond to medical needs.
The company’s radiopharmaceutical discovery-to-delivery development
capabilities address major indications including oncology,
cardiology and neurology, in PET, SPECT and therapy.
Please visit www.iba-molecular.com and www.iba-worldwide.com for
more information about IBA Molecular and IBA group.