Assessment of myocardial fibrosis in patients with systemic sclerosis using [Ga-68]Ga-FAPI-04-PET-CT

Treutlein C, Distler J, Tascilar K, Chenguiti Fakhouri S, Györfi AH, Atzinger A, Matei AE, Dees C, Büttner-Herold M, Kuwert T, Prante O, Bäuerle T, Uder M, Schett G, Schmidkonz C, Bergmann C (2022)

Publication Type: Journal article

Publication year: 2022

Journal

European Journal of Nuclear Medicine and Molecular Imaging Springer Verlag (Germany)

DOI: 10.1007/s00259-022-06081-4

Abstract

Purpose Myocardial fibrosis (MF) is a factor of poor prognosis in systemic sclerosis (SSc). Direct in-vivo visualization of fibroblast activation as early readout of MF has not been feasible to date. Here, we characterize (68)Gallium-labeled-Fibroblast-Activation-Inhibitor-04 ([Ga-68]Ga-FAPI-04)-PET-CT as a diagnostic tool in SSc-related MF.Methods In this proof-of-concept trial, six SSc patients with and eight without MF of the EUSTAR cohort Erlangen underwent [Ga-68]Ga-FAPI-04-PET-CT and cardiac MRI (cMRI) and clinical and serologic investigations just before baseline and during follow-up between January 2020 and December 2020. Myocardial biopsy was performed as clinically indicated.Results [Ga-68]Ga-FAPI-04 tracer uptake was increased in SSc-related MF with higher uptake in SSc patients with arrhythmias, elevated serum-NT-pro-BNP, and increased late gadolinium enhancement (LGE) in cMRI. Histologically, myocardial biopsies from cMRI- and [Ga-68]Ga-FAPI-04-positive regions confirmed the accumulation of FAP(+) fibroblasts surrounded by collagen deposits. We observed similar but not equal spatial distributions of [Ga-68]Ga-FAPI-04 uptake and quantitative cMRI-based techniques. Using sequential [Ga-68]Ga-FAPI-04-PET-CTs, we observed dynamic changes of [Ga-68]Ga-FAPI-04 uptake associated with changes in the activity of SSc-related MF, while cMRI parameters remained stable after regression of molecular activity and rather indicated tissue damage.Conclusions We present first in-human evidence that [Ga-68]Ga-FAPI-04 uptake visualizes fibroblast activation in SSc-related MF and may be a diagnostic option to monitor cardiac fibroblast activity in situ.

Authors with CRIS profile

Christoph Treutlein Institute of Radiology Jörg Distler Professur für Molekulare Mechanismen der Organfibrose Koray Tascilar Department of Medicine 3 – Rheumatology and Immunology Sara Chenguiti Fakhouri Department of Medicine 3 – Rheumatology and Immunology Andrea-Hermina Györfi Department of Medicine 3 – Rheumatology and Immunology Armin Atzinger Department of Nuclear Medicine Alexandru-Emil Matei Department of Medicine 3 – Rheumatology and Immunology Clara Dees Department of Medicine 3 – Rheumatology and Immunology Maike Büttner-Herold Department of Nephropathology Torsten Kuwert Lehrstuhl für Klinische Nuklearmedizin Olaf Prante Professur für Molekulare Bildgebung und Radiochemie Tobias Bäuerle Professur für Multimodale Bildgebung in der präklinischen Forschung Michael Uder Lehrstuhl für Diagnostische Radiologie Georg Schett Lehrstuhl für Innere Medizin III Christian Schmidkonz Lehrstuhl für Klinische Nuklearmedizin

How to cite

APA:

Treutlein, C., Distler, J., Tascilar, K., Chenguiti Fakhouri, S., Györfi, A.-H., Atzinger, A.,... Bergmann, C. (2022). Assessment of myocardial fibrosis in patients with systemic sclerosis using [Ga-68]Ga-FAPI-04-PET-CT. European Journal of Nuclear Medicine and Molecular Imaging. https://doi.org/10.1007/s00259-022-06081-4

MLA:

Treutlein, Christoph, et al. "Assessment of myocardial fibrosis in patients with systemic sclerosis using [Ga-68]Ga-FAPI-04-PET-CT." European Journal of Nuclear Medicine and Molecular Imaging (2022).

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