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[00:03] Osama Baig: On this episode of The Climate Challengers. [00:06] Jennifer Chapin: If you picture a core filled with paintballs that are you're trying to turn them pink. So you need to leave them in there until everything is fully coated in paint and then you can pull them out. [00:16] Dr. David Laidley: Studies have shown that this treatment is highly effective for the treatment of patients and prostate cancer. [00:22] Osama Baig: Hello and welcome to another episode of The Climate Challengers. I'm your host, Osama Baig, and I'm excited to take you on a journey today into the world of medical isotopes and nuclear medicine. Most people know that Ontario has nuclear power plants generating emissions free electricity 24 hours a day, 365 days a year. But how many Ontarians know that our nuclear assets are also saving lives every single day? [00:48] Here in Ontario and around the world? This is the groundbreaking world of nuclear medicine. An astounding 40 million nuclear medicine procedures are performed each year and range from the diagnosis of cancer or heart disease to the targeting and killing of tumor cells. And Ontario, with this CANDU nuclear reactors is a global leader. This complex medical technology relies on what is happening inside a reactor cores. [01:12] The place where the energy is generated by inserting specially developed targets into the core and irradiating them with neutrons. We can create a variety of radio isotopes that both diagnose and treat a wide range of diseases. This means Ontario's nuclear sector is not just a source of clean power. It has also created a whole industry for nuclear medicine-- [01:32] --boosting Ontario's innovation economy while saving lives. To help us understand how this works and the impact it has on patients, we will speak today with Dr. David Laidley, a nuclear medicine doctor and researcher with London Health Sciences Center. But first, to take us inside the reactor core where all of this begins. We have Jennifer Chapin, the director of projects for the Laurentis Energy Partners, which is a subsidiary of OPG, a leader and innovator in the clean energy sector and a producer of medical isotopes. [02:03] So, Jennifer, welcome to the Climate Challengers. Thank you so much for being here. So, Jennifer, could you tell me a little bit about what you do at Laurentis? [02:11] Jennifer Chapin: For sure. So I'll start by just saying that I'm a longtime OPG employee. I started with Ontario power generation in 2003 and I’ve have had the privilege of working in a number of roles across the company. My role within Laurentis is heading up our commercial projects division. And so that includes a number of really cool isotope projects. So making molybdenum 99 at Darlington, which I believe we're going to talk about today, producing helium three at Darlington. [02:39] So my portfolio includes all of that. And we're a fairly large group at this point. So my division has just shy of 50 people in it right now for project leads and as well as our own engineering team and a strong team of regulatory specialists. [02:53] Osama Baig: Could you walk us through the way in which a radio medical isotope is harvested from a nuclear power reactor? Because most folks, when they think of nuclear power reactors is difficult for them to understand how medical isotopes are produced at the same time that electricity is also being produced. So could you walk us through that process? [03:12] Jennifer Chapin: Sure, of course. So, I mean, for context and history, Cobalt 60 has been produced at the Pickering Station since 1971. So it's in the medical industry. It wouldn't be considered a radio medical isotope, but it has a lot of applications that do relate to health care and medicine, and that's produced with cobalt 59 rods which were inserted when the reactors in an outage and then those are retrieved and in the following year cycle. [03:44] What we're doing with the Laurentis project around Raleigh 99 is very different in terms of how it is we're going to be accessing the reactor. And I think that is part of why there's so many questions coming forward about how exactly we're going to do this without disturbing reactor operation. [04:00] So the project that we're doing with [04:01] medical is to create what we've called the target delivery system which will interface with the reactor through one of the adjuster [] reports located at the top of the reactor. Darlington has quite a number of unused adjuster absorbers that are locked out of court, and they have been for several decades. [04:21] Osama Baig: Okay. No. So that's really good to know, Jennifer. And say for example if you want to simplify that for the general public because I know it's difficult for the ordinary person to understand where adjusters are and configuration of the reactor or things like outages. How would you simplify that to just like an average person, the whole process? [04:48] Jennifer Chapin: CANDU reactors are very much, they look very much like a tin can turn on its side with all of the fuel running sideways through it. And in this case, we have a tube. It runs vertically from the top of the can to the bottom of the can through the water, but which does not touch the fuel. It's just near proximity to the fuel. [05:10] And so those targets are lowered in a little basket down the tube and then they hang out and then back up the tube and then they get put in a shipping flask and put on a truck. The shipping flask is roughly the size of a beer keg. It's not so big that it's not easily manageable, in terms of putting it in the back of-- pickup trucks, probably an understatement here. [05:33] But being able to put it in the back of the truck and send it down the road. The targets are very small in size. The shielding that you require is proportionately small in size. And so to visualize the entire process, I think the tin can works reasonably well. [05:50] Osama Baig: Yeah, I think that's a great way of explaining it. When those targets are lowered into the reactor, would you use it analogy of these targets almost being cooked or baked while the reactors operating? [06:05] Jennifer Chapin: I would go with baking. Baking works well. So neutrons are what make a nuclear reactor run. The whole deal with turning on a nuclear reactor is essentially you turn on the neutrons and the neutrons start flying around and that's what makes the power. The targets that we're putting in there are absorbing some of those neutrons. So instead of absorbing neutrons and making power, they're absorbing neutrons and becoming activated radio isotopes So Molly 98 becomes Molly 99 because it's absorbing those neutrons. [06:37] And so the baking analogy works well. Paintball analogy works well. If you picture a core filled with paint balls that you're trying to turn them pink. So you need to leave them in there until everything is fully coated in paint and then you can pull them out. To just the second part of your question, what's really about-- [07:01] Like how does it get from, hey, [] Arlington Power Reactor to a patient at a hospital? We're really the very front end of the chain there. So the targets are actually manufactured in Peterborough, Ontario, at the same facility that makes the fuel for Darlington, the Pickering reactors. So it's a bit of [] facility. The targets are approximately three inches long and one inch in diameter. [07:28] I wish I had a little sample when I could carry around and show people because they're really cool and pretty simple, but we receive them in strings of eight obviously. So we put them in the reactor, we irradiate for their designated time, which is in the neighborhood of a week. And then they come out and they go into a shipping container. [07:46] Those shipping containers get put on the road to Ottawa. So [] medical has a facility just outside of Ottawa in Canada where then those, the whole flask goes into a [07:57] and gets opened. And then all of those targets are opened. And then there's a chemistry process which basically dissolves the solid metals. And then that gets turned into a pharmacy product which gets sent out to hospitals and is able to be used for patient care. So there's many, many steps that follow pulling targets out of the core that actually help to impact patient treatment. [08:25] Osama Baig: So what is Ontario's role in the global supply of these medical isotopes? [08:30] Jennifer Chapin: I mean, that's a great question. The historic picture is that when NIU was an operation at Chalk River, they were substantial producer of medical isotopes for the world. And when that reactor close at the end of its life in around 2016 is when they stopped producing medical isotopes. There definitely was a very large gap left in the marketplace. [08:53] Here at Darlington, we're looking obviously to produce Morley 99 and to become actually one of the dominant suppliers globally once that system comes fully online. Bruce Power has also launched a project for Lutetium 177. They are partnered with I believe it's ITM in Germany for lutetium 177 which is primarily used in the treatment of prostate cancer, but also being explored for other metastatic cancers for their treatment. [09:27] So they're overall in Ontario based on the resources that we have for reactors and available neutrons where we're utilizing them quite well. I think that program's going to continue to grow over the next five years. [09:41] Osama Baig: Just want to end off by giving a big thank you to Jennifer for joining us today and really giving us a glimpse into your fascinating world of medical isotopes. Really excited to keep updated on exciting projects that Laurentis has upcoming in the future. And also, best of luck with these exciting projects. [10:00] Jennifer Chapin: Well, thank you so much for having me. We're always so excited to share our projects and what's going on and it's so cool to be seeing how nuclear can impact lives in so many positive ways. [10:15] Osama Baig: Now, to go from inside the reactor core to inside the hospital, my next guest is Dr. David Laidley. Dr. Laidley is a practicing nuclear medicine physician based in London, Ontario, who also does research that is pushing this field toward new applications and new ways of finding and fighting disease. Hi, Dr. Laidley, welcome to Climate Challengers. Just want to start off with you introducing to us the way nuclear isotopes are used in diagnostic and treatments. What is the process and how does it work and why does it work? [10:50] Dr. David Laidley: All right. It's great question. So thank you for inviting me to participate today. Nuclear medicine and nuclear isotopes are fascinating in terms of how they work. So, I mean, at the basic level, we're giving patients radioactive materials which are usually given intravenously using the body's mechanisms, depending on how they're labeled. They have the ability to sort of mirror or sort of parallel the normal functions of the body or target specific tumors in the body to use better highly disease processes or functional status of patients. [11:31] So at the basic level, we're kind of using the body's mechanisms to sort of image patients and sort of improve function in terms of detection of disease, in terms of heart disease or cancer, renal problems or [11:47] disease. So in terms of how it works, I mean, there's different isotopes. Some of them have a diagnostic component. So they're typically only used to image patients. They don't have any therapeutic benefit. And we use these type of isotopes all the time to detect various disease processes. And then, of course, we have different isotopes that have other properties that have the higher energy that can kill cancer cells. [12:18] And we also use different therapeutic isotopes in parallel with the sort of diagnostic. So we often will scan patients with a diagnostic isotope. And then we have a therapeutic pairing and we're able to then introduce these therapeutic isotopes for targeting specific cancers and tumor cells. So that's sort of the basics of how sort of diagnostic and therapeutic nuclear medicine works and happy to discuss things in further detail. [12:50] Osama Baig: Could you go into depth as to-- some people may regularly ask that how are these medical isotopes killing my cancer or how are they removing this cancer from my body? Could you explain the process in which these medical isotopes interface with the human body? [13:08] Dr. David Laidley: Sure. So depending on, again, the isotope we use, as I said we kind of broadly put them in a diagnostic and therapeutic category. So the diagnostic ones have sort of this what we call gamma radiation that we able to detect with, not hard to understand with gamma cameras. So they have this ability to detect this gamma radiation and then turn that into an image. [13:33] So on the therapeutic side, again, using these ability of having a specific type of drug which binds to a tumor label to an isotope, we're able to sort of deliver that radiopharmaceutical into the patient. And then just because of physiology, circulation in the blood, affinity of these receptors to the radiopharmaceutical, they will bind to these tumors. [13:59] Sometimes they'll be taken into the tumors. And these therapeutic isotopes have different types of radiation that admit that they emit. So Lutetium has a different type of beta mission, which is basically a mission of electron which can target the DNA of the tumor. And as that radiation is being admitted a very short distance, it's interacting with those tumor cells and basically causing single strand DNA breaks. [14:29] And these DNA breaks are very difficult for tumors to repair. And if any of these DNA breaks happen in normal tissue, our bodies have this ability to sort of oftentimes repair these damages and save the normal tissue. As another innovation in nuclear medicine and coming out of different reactors and facilities in Canada is another type of radiation called latinium [14:37]. [14:57] So this is a different type of radiation, which is like an alpha emitter. So this is basically emitting a very large particle with really high energy, very short distance. So again, they get bound to the tumor cells. Sometimes they get internalized into the tumor and then they emit their alpha particles. And these type of radiation can produce what we call double stranded DNA breaks. [15:20] So these are very, very lethal to tumor cells. And again, because of the very short distance, we expect that the amount of damage to normal tissue will be very minimal. So, again, the beta emissions from the lutetium and the alpha emissions from products like Atheneum causing these double stranded DNA breaks and single stranded DNA breaks are sort of the foundation of how these tumor treating agents work. [15:52] Osama Baig: Okay. That's quite fascinating, Dr. Laidley. So you kind of categorized medical isotope into two categories. One is for diagnostics and then the second one is for actually killing the cancer cells, right? In regards to the nuclear isotopes that are coming out of the nuclear reactors here in Ontario, which ones can you point to that are used extensively in the medical industry? [16:19] Dr. David Laidley: So the big one that we would use in nuclear medicine for diagnostic work would be technetium-99m. This comes from molybdenum, which is basically harvested from reactors and then put it into what we call generators. And those generators are provided to nuclear medicine department. So we basically, we have these on site and then we would basically take off some of that technetium-99m every day and use that for diagnostic purposes. [16:48] That is kind of our workhorse for nuclear medicine. We use that and probably 100% of all nuclear medicine departments. And it is essentially the backbone of diagnostic nuclear medicine. And then in terms of other isotopes that we get from reactors, I-123 is another isotope that we get from reactors which we often use for detection of thyroid problems or different types of malignancy. [17:16] And in terms of therapeutic isotopes, the big one coming out of reactors right now would be like I-131 which we use for treatment of thyroid malignancies or labeling it to other real pharmaceuticals that target different cancers. And lutetium-177 would be, I guess the newest kid on the block that we're sort of using now to treat cancers. [17:45] have a number of targets that we used to treat with lutetium-177. So I think those would be the sort of two or three big isotopes that are being harvested from reactors right now. [17:59] Osama Baig: So in regards to future nuclear medicine and the potential to use isotopes to treat a wider variety of diseases, what are your thoughts on this? Like are there other areas in medicine and in specifically the human body where medical isotopes can be used to treat different diseases other than cancer? [18:21] Dr. David Laidley: I mean, going back to cancer for one second, the biggest area that we're going to expect to see for treatment and diagnosis of patients, and this is probably coming in the next three to six months is going to be in the in the area prostate cancer. We're expecting there to be a very pivotal Health Canada approval for treatment and diagnosis of prostate cancer with Lutetium-PSMA. And this area, unfortunately, is a very large burden of disease across Canada for men. And studies shown that this treatment is highly effective for the treatment of patients with prostate cancer. [19:05] And we expecting, again, the approval to come within the next three to six months. So, this is a tremendous patient population right now with unmet need. And we are expecting that to sort of be filled hopefully in the next few months. So again, and going back to supply of the tissue products having that reliable supply chain for the amount of patients unfortunately that have this disease is going to be critical moving forward in the future. [19:38] So this other isotopes can be sort of used for other diseases, breast cancer. We use isotopes for diagnosis of cardiac disease. So, we kind of are involved in, say, many areas and in disease processes, be it oncology and non-oncological. So there's always new innovations coming. But I would say the prostate area with the [20:09] that we're using now for PSM and then lutetium regions for the treatment, this is going to be a huge part of our practice in the coming years. [20:19] Osama Baig: Well, I think this was really fun conversation. I learned a lot personally. I think this is some incredible research and ongoing work that you're doing, Dr. Laidley. So really want to take the time to thank you for joining us on this episode for The Climate Challengers. Thank you so much, Dr. Laidley. I really appreciate your time and is there any other last words you'd like to see on the podcast for our listeners? [20:47] Dr. David Laidley: Well, I'm just excited about the future nuclear medicine. And the more partnership we can have with our nuclear reactors, nuclear medicine programs. I think the more collaboration we have together will potentially help try to solve some of the health issues affecting or prepare our patients across Canada. [21:11] Osama Baig: Thank you so much, Dr. Laidley. I really appreciate your time, especially during this busy time. I'm sure our listeners are also very appreciative and I hope you have a nice day I want to thank Jennifer Chapman and Dr. David Laidley for joining us on this episode of The Climate Challengers, and thank you for listening. Ontario's nuclear power reactors have obvious climate benefits, generating clean emissions free power around the clock. [21:37] But it is fascinating to learn about other, less obvious benefits of nuclear power and the ways in which Ontario is a leader and innovator in using nuclear byproducts to diagnose diseases and save lives. To learn more about this topic, please check out our website climatechallengers.com. Until next time, this is Osama Baig. The Climate Challengers podcast tech is managed by Podium Podcast Production [https://www.podiumpodcastco.com/]