South Africa playing a big role in global cancer treatments

South Africa is one of the world’s biggest manufacturers of radioisotopes for diagnosing cancer and a new state-of-the-art nuclear medicine facility could further boost its contribution to research in the field.

Ingestible, inhaled, or injected nuclear medicine contains small amounts of radioisotopes, which can detect signs of cancer early on.

The South African Nuclear Energy Corporation’s (Necsa’s) subsidiary NTP Radioisotopes produces roughly a quarter of global medical radioisotopes at the Pelindaba nuclear facility near Hartbeespoort, northwest of Pretoria.

Its molybdenum-99 radioisotopes are used in around 40 million medical diagnostic images annually, making NTP the world’s third-biggest producer and supplier of radioisotopes.

The radioisotopes come from the Safari-1 nuclear reactor, commissioned in 1965. The reactor was initially constructed to perform high-level nuclear physics research.

Its role in cancer diagnosis started when a team at Pelindaba began producing the iodine-131 radioisotope at the facility in 1973, and the first processing facility was established in 1977.

A far-off view of parts of Necsa’s Pelindaba nuclear research facility

When South Africa voluntarily scaled down its nuclear programme in the early 1990s, a group of scientists and engineers at Safari-1 presented a plan for large-scale production and export of molybdenum-99, an important radioisotope in cancer diagnosis.

That plan included repurposing hot-cell complexes used to test nuclear fuel assemblies at the Koeberg nuclear power plant.

In the first year, the researchers exceeded their initial production and income targets, ensuring a future for SAFARI-1 and nuclear medicine in South Africa.

Within a decade, NTP recovered 90% of the annual operating and maintenance costs of the Safari-1 reactor. The remaining costs were absorbed by Necsa to fund other research activities.

NTP grew from around 30 to 400 employees, and its annual turnover now exceeds R1.2 billion.

In addition to molybdenum-99 for diagnosing cancer and other diseases, Pelindaba manufactures lutetium-177, a relatively new medical isotope used for treating cancer.

President Ramaphosa’s cabinet approved a plan to construct a new multi-purpose reactor to succeed Safari-1 in September 2021.

While Safari-1 has operated for around 59 years without serious incident, the MPR will expand research capabilities and outputs substantially due to a the fitting of a cold neutron source in the new reactor.

This will extend the delivered range of neutrons to long wavelengths, useful for studying polymers, biological materials, and magnetic materials with complex structures.

The Safari-1 building at Pelindaba

More recently, the Department of Science and Innovation celebrated the opening of the main centre of the Nuclear Medicine Research Infrastructure (NuMeRI).

The open-access national research facility consists of a distributed network, with its headquarters at Steve Biko Hospital in Pretoria and a node for inception imaging at Tygerberg Hospital in Cape Town.

It previously had an interim pre-clinical imaging facility at Pelindaba but recently opened a one-stop shop with this capability at Steve Biko.

Higher education and science minister Blade Nzimande labelled the opening of the facility as another important milestone in the development of scientific infrastructure in South Africa, embodied by the fact that the NuMeRI is the “first of its kind” on the African continent.

Several publications reported this to mean that it was the “first-ever” nuclear medicine research facility on the continent, which is not the case.

Steve Biko Academic Hospital in Pretoria. Editorial credit: Rich T Photo / Shutterstock.com

Nevertheless, NuMeRI’s establishment could be a boon for radiopharmacology capacity and innovation in South Africa.

NuMeRI has a research cyclotron — a type of particle accelerator — that can be used to produce carbon-11, fluorine-18, zirconium-89, and other radioisotopes.

It will still need to source molybdenum-99 and lutetium-177 from Pelindaba.

The primary objectives of NuMeRI are to strengthen nuclear medicine capacity in South Africa and Africa and enhance South African research in medicinal chemistry.

This will help expedite the development of drugs to address national priority diseases and enable new pharmaceuticals to reach the market sooner.

NuMeRI also intends to make generic drugs that are more affordable to developing nations.