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- Title
Assessment of myocardial fibrosis in patients with systemic sclerosis using [<sup>68</sup>Ga]Ga-FAPI-04-PET-CT.
- Authors
Treutlein, Christoph; Distler, Jörg H. W.; Tascilar, Koray; Fakhouri, Sara Chenguiti; Györfi, Andrea-Hermina; Atzinger, Armin; Matei, Alexandru-Emil; Dees, Clara; Büttner-Herold, Maike; Kuwert, Torsten; Prante, Olaf; Bäuerle, Tobias; Uder, Michael; Schett, Georg; Schmidkonz, Christian; Bergmann, Christina
- 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 68Gallium-labeled-Fibroblast-Activation-Inhibitor-04 ([68Ga]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 [68Ga]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: [68Ga]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 [68Ga]Ga-FAPI-04-positive regions confirmed the accumulation of FAP+ fibroblasts surrounded by collagen deposits. We observed similar but not equal spatial distributions of [68Ga]Ga-FAPI-04 uptake and quantitative cMRI-based techniques. Using sequential [68Ga]Ga-FAPI-04-PET-CTs, we observed dynamic changes of [68Ga]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 [68Ga]Ga-FAPI-04 uptake visualizes fibroblast activation in SSc-related MF and may be a diagnostic option to monitor cardiac fibroblast activity in situ.
- Subjects
SYSTEMIC scleroderma; CARDIAC magnetic resonance imaging; FIBROSIS; FIBROBLASTS; PROOF of concept
- Publication
European Journal of Nuclear Medicine & Molecular Imaging, 2023, Vol 50, Issue 6, p1629
- ISSN
1619-7070
- Publication type
Article
- DOI
10.1007/s00259-022-06081-4