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Quinn C, Moulton K, Farwell M, Le W, Wilson I, Goel N, McConathy J, Greenberg SA. Imaging With PET/CT of Diffuse CD8 T-Cell Infiltration of Skeletal Muscle in Patients With Inclusion Body Myositis. Neurology 2023; 101:e1158-e1166. [PMID: 37487752 PMCID: PMC10513879 DOI: 10.1212/wnl.0000000000207596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/12/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Inclusion body myositis (IBM) is a progressive autoimmune skeletal muscle disease in which cytotoxic CD8+ T cells infiltrate muscle and destroy myofibers. IBM has required a muscle biopsy for diagnosis. Here, we administered to patients with IBM a novel investigational PET tracer 89Zr-Df-crefmirlimab for in vivo imaging of whole body skeletal muscle CD8 T cells. This technology has not previously been applied to patients with autoimmune disease. METHODS Four patients with IBM received 89Zr-Df-crefmirlimab followed by PET/CT imaging 24 hours later, and the results were compared with similar imaging of age-matched patients with cancer. Mean standardized uptake value (SUVmean) was measured for reference tissues using spherical regions of interest (ROIs). RESULTS 89Zr-Df-crefmirlimab was safe and well-tolerated. PET imaging demonstrated diffusely increased uptake qualitatively and quantitatively in IBM limb musculature. Quantitation of 89Zr-Df-crefmirlimab intensity in ROIs demonstrated particularly increased CD8 T-cell infiltration in patients with IBM compared with patients with cancer in quadriceps (SUVmean 0.55 vs 0.20, p < 0.0001), biceps brachii (0.62 vs 0.26, p < 0.0001), triceps (0.61 vs 0.25, p = 0.0005), and forearm finger flexors (0.71 vs 0.23, p = 0.008). DISCUSSION 89Zr-Df-crefmirlimab uptake in muscles of patients with IBM was present at an intensity greater than the comparator population. The ability to visualize whole body in vivo cytotoxic T-cell tissue infiltration in the autoimmune disease IBM may hold utility as a biomarker for diagnosis, disease activity, and therapeutic development and potentially be applicable to other diseases with cytotoxic T-cell autoimmunity.
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Affiliation(s)
- Colin Quinn
- From the Departments of Neurology (C.Q., K.M.), and Radiology (M.F.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; ImaginAb (W.L., I.W.), Inc., Inglewood, CA; Department of Medicine (N.G.), Duke University School of Medicine, Durham, NC; Abcuro, Inc., Newton, MA; Department of Radiology (J.M.), University of Alabama at Birmingham, Heersink School of Medicine; and Department of Neurology (S.A.G.), Brigham and Women's Hospital and Boston Childrens Hospital, Harvard Medical School, MA.
| | - Kelsey Moulton
- From the Departments of Neurology (C.Q., K.M.), and Radiology (M.F.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; ImaginAb (W.L., I.W.), Inc., Inglewood, CA; Department of Medicine (N.G.), Duke University School of Medicine, Durham, NC; Abcuro, Inc., Newton, MA; Department of Radiology (J.M.), University of Alabama at Birmingham, Heersink School of Medicine; and Department of Neurology (S.A.G.), Brigham and Women's Hospital and Boston Childrens Hospital, Harvard Medical School, MA
| | - Michael Farwell
- From the Departments of Neurology (C.Q., K.M.), and Radiology (M.F.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; ImaginAb (W.L., I.W.), Inc., Inglewood, CA; Department of Medicine (N.G.), Duke University School of Medicine, Durham, NC; Abcuro, Inc., Newton, MA; Department of Radiology (J.M.), University of Alabama at Birmingham, Heersink School of Medicine; and Department of Neurology (S.A.G.), Brigham and Women's Hospital and Boston Childrens Hospital, Harvard Medical School, MA
| | - William Le
- From the Departments of Neurology (C.Q., K.M.), and Radiology (M.F.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; ImaginAb (W.L., I.W.), Inc., Inglewood, CA; Department of Medicine (N.G.), Duke University School of Medicine, Durham, NC; Abcuro, Inc., Newton, MA; Department of Radiology (J.M.), University of Alabama at Birmingham, Heersink School of Medicine; and Department of Neurology (S.A.G.), Brigham and Women's Hospital and Boston Childrens Hospital, Harvard Medical School, MA
| | - Ian Wilson
- From the Departments of Neurology (C.Q., K.M.), and Radiology (M.F.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; ImaginAb (W.L., I.W.), Inc., Inglewood, CA; Department of Medicine (N.G.), Duke University School of Medicine, Durham, NC; Abcuro, Inc., Newton, MA; Department of Radiology (J.M.), University of Alabama at Birmingham, Heersink School of Medicine; and Department of Neurology (S.A.G.), Brigham and Women's Hospital and Boston Childrens Hospital, Harvard Medical School, MA
| | - Niti Goel
- From the Departments of Neurology (C.Q., K.M.), and Radiology (M.F.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; ImaginAb (W.L., I.W.), Inc., Inglewood, CA; Department of Medicine (N.G.), Duke University School of Medicine, Durham, NC; Abcuro, Inc., Newton, MA; Department of Radiology (J.M.), University of Alabama at Birmingham, Heersink School of Medicine; and Department of Neurology (S.A.G.), Brigham and Women's Hospital and Boston Childrens Hospital, Harvard Medical School, MA
| | - Jonathan McConathy
- From the Departments of Neurology (C.Q., K.M.), and Radiology (M.F.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; ImaginAb (W.L., I.W.), Inc., Inglewood, CA; Department of Medicine (N.G.), Duke University School of Medicine, Durham, NC; Abcuro, Inc., Newton, MA; Department of Radiology (J.M.), University of Alabama at Birmingham, Heersink School of Medicine; and Department of Neurology (S.A.G.), Brigham and Women's Hospital and Boston Childrens Hospital, Harvard Medical School, MA
| | - Steven A Greenberg
- From the Departments of Neurology (C.Q., K.M.), and Radiology (M.F.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; ImaginAb (W.L., I.W.), Inc., Inglewood, CA; Department of Medicine (N.G.), Duke University School of Medicine, Durham, NC; Abcuro, Inc., Newton, MA; Department of Radiology (J.M.), University of Alabama at Birmingham, Heersink School of Medicine; and Department of Neurology (S.A.G.), Brigham and Women's Hospital and Boston Childrens Hospital, Harvard Medical School, MA
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