125I is a reactor-produced radionuclide and is available in large quantities. Its production involves the two following nuclear reactions:
The irradiation target is the primordial nuclide 124Xe, which is the target isotope for making 125I by neutron capture. It is loaded into irradiation capsules of the zirconium alloy zircaloy-2 (a corrosion resisting alloy transparent to neutrons) to a pressure of about 100 bar (~ 100 atm). Upon irradiation with slow neutrons in a nuclear reactor, several radioisotopes of xenon are produced. However, only the decay of 125Xe leads to a radioiodine: 125I. The other xenon radioisotopes decay either to stable xenon, or to various caesium isotopes, some of them radioactive (a.o., the long-lived 135Cs (t½ = 1.33 Ma) and 137Cs (t½ = 30 a)).
Long irradiation times are disadvantageous. Iodine-125 itself has a neutron capture cross section of 900 barns, and consequently during a long irradiation, part of the 125I formed will be converted to 126I, a beta-emitter and positron-emitter with a half-life of 12.93 days,4 which is not medically useful. In practice, the most useful irradiation time in the reactor amounts to a few days. Thereafter, the irradiated gas is allowed to decay for three or four days to eliminate short-lived unwanted radioisotopes, and to allow the newly produced xenon-125 (t½ = 17 hours) to decay to iodine-125.
To isolate radio-iodine, the irradiated capsule is first cooled at low temperature (to condense the free iodine gas onto the capsule inner wall) and the remaining Xe gas is vented in a controlled way and recovered for further use. The inner walls of the capsule are then rinsed with a dilute NaOH solution to collect iodine as soluble iodide (I−) and hypoiodite (IO−), according to the standard disproportionation reaction of halogens in alkaline solution. Any caesium atom present immediately oxidizes and passes into the water as Cs+. In order to eliminate any long-lived 135Cs and 137Cs which may be present in small amounts, the solution is passed through a cation-exchange column, which exchanges Cs+ for another non-radioactive cation (e.g., Na+). The radioiodine (as anion I− or IO−) remains in solution as a mixture iodide/hypoiodite.
Iodine-125 is commercially available in dilute NaOH solution as 125I-iodide (or the hypohalite sodium hypoiodite, NaIO). The radioactive concentration lies at 4 to 11 GBq/mL and the specific radioactivity is > 75 GBq/μmol (7.5 × 1016 Bq/mol). The chemical and radiochemical purity is high. The radionuclidic purity is also high; some 126I (t1/2 = 12.93 d)5 is unavoidable due to the neutron capture noted above. The 126I tolerable content (which is set by the unwanted isotope interfering with dose calculations in brachytherapy) lies at about 0.2 atom % (atom fraction) of the total iodine (the rest being 125I).
As of October 2019, there were two producers of iodine-125, the McMaster Nuclear Reactor in Hamilton, Ontario, Canada; and a VVR-SM research reactor in Uzbekistan.6 The McMaster reactor is presently the largest producer of iodine-125, producing approximately 60 per cent of the global supply in 2018;7 with the remaining global supply produced at the reactor based in Uzbekistan. Annually, the McMaster reactor produces enough iodine-125 to treat approximately 70,000 patients.8
In November 2019, the research reactor in Uzbekistan shut down temporarily in order to facilitate repairs. The temporary shutdown threatened the global supply of the radioisotope by leaving the McMaster reactor as the sole producer of iodine-125 during the period.910
Prior to 2018, the National Research Universal (NRU) reactor at Chalk River Laboratories in Deep River, Ontario, was one of three reactors to produce iodine-125.11 However, on March 31, 2018, the NRU reactor was permanently shut down ahead of its scheduled decommissioning in 2028, as a result of a government order.1213 The Russian nuclear reactor equipped to produce iodine-125, was offline as of December 2019.14
The detailed decay mechanism to form the stable daughter nuclide tellurium-125 is a multi-step process that begins with electron capture, which produces a tellurium-125 nucleus in an excited state with a half-life of 1.6 ns. The excited tellurium-125 nucleus may undergo gamma decay, emitting a gamma photon at 35.5 keV, or undergo internal conversion to emit an electron. The electron vacancy from internal conversion results in a cascade of electron relaxation as the core electron hole moves toward the valence orbitals. The cascade involves many characteristic X-rays and Auger transitions. In the case the excited tellurium-125 nucleus undergoes gamma decay, a different electron relaxation cascade follows before the nuclide comes to rest. Throughout the entire process an average of 13.3 electrons are emitted (10.3 of which are Auger electrons), most with energies less than 400 eV (79% of yield).15 The internal conversion and Auger electrons from the radioisotope have been found in one study to do little cellular damage, unless the radionuclide is directly incorporated chemically into cellular DNA, which is not the case for present radiopharmaceuticals which use 125I as the radioactive label nuclide.16 Rather, cellular damage results from the gamma and characteristic X-ray photons.
As with other radioisotopes of iodine, accidental iodine-125 uptake in the body (mostly by the thyroid gland) can be blocked by the prompt administration of stable iodine-127 in the form of an iodide salt.1718 Potassium iodide (KI) is typically used for this purpose.19
However, unjustified self-medicated preventive administration of stable KI is not recommended in order to avoid disturbing the normal thyroid function. Such a treatment must be carefully dosed and requires an appropriate KI amount prescribed by a specialised physician.
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