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Noversa de Sousa R, Tascilar K, Corte G, Atzinger A, Minopoulou I, Ohrndorf S, Waldner M, Schmidkonz C, Kuwert T, Knieling F, Kleyer A, Ramming A, Schett G, Simon D, Fagni F. Metabolic and molecular imaging in inflammatory arthritis. RMD Open 2024; 10:e003880. [PMID: 38341194 PMCID: PMC10862311 DOI: 10.1136/rmdopen-2023-003880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
It is known that metabolic shifts and tissue remodelling precede the development of visible inflammation and structural organ damage in inflammatory rheumatic diseases such as the inflammatory arthritides. As such, visualising and measuring metabolic tissue activity could be useful to identify biomarkers of disease activity already in a very early phase. Recent advances in imaging have led to the development of so-called 'metabolic imaging' tools that can detect these changes in metabolism in an increasingly accurate manner and non-invasively.Nuclear imaging techniques such as 18F-D-glucose and fibroblast activation protein inhibitor-labelled positron emission tomography are increasingly used and have yielded impressing results in the visualisation (including whole-body staging) of inflammatory changes in both early and established arthritis. Furthermore, optical imaging-based bedside techniques such as multispectral optoacoustic tomography and fluorescence optical imaging are advancing our understanding of arthritis by identifying intra-articular metabolic changes that correlate with the onset of inflammation with high precision and without the need of ionising radiation.Metabolic imaging holds great potential for improving the management of patients with inflammatory arthritis by contributing to early disease interception and improving diagnostic accuracy, thereby paving the way for a more personalised approach to therapy strategies including preventive strategies. In this narrative review, we discuss state-of-the-art metabolic imaging methods used in the assessment of arthritis and inflammation, and we advocate for more extensive research endeavours to elucidate their full field of application in rheumatology.
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Affiliation(s)
- Rita Noversa de Sousa
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Serviço de Medicina Interna, Hospital Pedro Hispano, Matosinhos, Portugal
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Koray Tascilar
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Giulia Corte
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Armin Atzinger
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ioanna Minopoulou
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Waldner
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Christian Schmidkonz
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Institute for Medical Engineering, Ostbayerische Technische Hochschule Amberg-Weiden, Amberg, Germany
| | - Torsten Kuwert
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Filippo Fagni
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Uzuegbunam BC, Rummel C, Librizzi D, Culmsee C, Hooshyar Yousefi B. Radiotracers for Imaging of Inflammatory Biomarkers TSPO and COX-2 in the Brain and in the Periphery. Int J Mol Sci 2023; 24:17419. [PMID: 38139248 PMCID: PMC10743508 DOI: 10.3390/ijms242417419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Inflammation involves the activation of innate immune cells and is believed to play an important role in the development and progression of both infectious and non-infectious diseases such as neurodegeneration, autoimmune diseases, pulmonary and cancer. Inflammation in the brain is marked by the upregulation of translocator protein (TSPO) in microglia. High TSPO levels are also found, for example, in macrophages in cases of rheumatoid arthritis and in malignant tumor cells compared to their relatively low physiological expression. The same applies for cyclooxgenase-2 (COX-2), which is constitutively expressed in the kidney, brain, thymus and gastrointestinal tract, but induced in microglia, macrophages and synoviocytes during inflammation. This puts TSPO and COX-2 in the spotlight as important targets for the diagnosis of inflammation. Imaging modalities, such as positron emission tomography and single-photon emission tomography, can be used to localize inflammatory processes and to track their progression over time. They could also enable the monitoring of the efficacy of therapy and predict its outcome. This review focuses on the current development of PET and SPECT tracers, not only for the detection of neuroinflammation, but also for emerging diagnostic measures in infectious and other non-infectious diseases such as rheumatic arthritis, cancer, cardiac inflammation and in lung diseases.
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Affiliation(s)
| | - Christoph Rummel
- Institute of Veterinary Physiology and Biochemistry, Justus Liebig University Giessen, 35392 Gießen, Germany;
- Center for Mind Brain and Behavior, Universities Giessen and Marburg, 35043 Marburg, Germany;
| | - Damiano Librizzi
- Department of Nuclear Medicine, Philipps University of Marburg, 35043 Marburg, Germany;
| | - Carsten Culmsee
- Center for Mind Brain and Behavior, Universities Giessen and Marburg, 35043 Marburg, Germany;
- Institute of Pharmacology and Clinical Pharmacy, Philipps University of Marburg, 35037 Marburg, Germany
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3
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Jamar F, van der Laken CJ, Panagiotidis E, Steinz MM, van der Geest KSM, Graham RNJ, Gheysens O. Update on Imaging of Inflammatory Arthritis and Related Disorders. Semin Nucl Med 2023; 53:287-300. [PMID: 36155690 DOI: 10.1053/j.semnuclmed.2022.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/30/2022] [Indexed: 11/11/2022]
Abstract
Arthritis and other rheumatic disorders are very frequent in the general population and responsible for a huge physical and disability burden to affected patients as well as a major cost to the society. Precise evaluation often relies on clinical data only but additional imaging may be required i) for a more objective assessment of the disease status, such as in rheumatoid arthritis (RA) or ankylosing spondyloarthritis (AS), ii) for providing prognostic information and evaluating response to treatment or iii) for establishing diagnosis, in patients with unclear clinical picture, such as polymyalgia rheumatica (PMR) and large-vessel vasculitis (LVV). Besides radiological techniques (x-rays, ultrasound, and MRI), functional and molecular imaging has emerged as a valid tool for this purpose in several disorders. Bone scanning has long been a method of choice but is now more used as a triage tool in patients with unclear complaints, including degenerative disorders (eg osteoarthritis). 18F-FDG-PET/CT (FDG) proved efficient in assessing the extent of the disease and response to treatment in RA and related disorders, and to provide accurate diagnosis in some systemic disorders, including PMR and LVV. Based on glucose metabolism, FDG-PET/CT is able to show increased metabolism in peripheral cells involved in inflammation (eg neutrophils, lymphocytes or monocytes/macrophages) but also in fibroblasts that proliferate in the pannus. The lack of specificity of FDG is a limitation and many alternative tracers were developed at the preclinical stage or applied in the clinics, especially within clinical trials. They include imaging of macrophages using translocator protein (TSPO), folate-receptors or other targets on activated cells. These new tools will undoubtedly become more and more available in the everyday clinical workup of patients with rheumatisms. Finally, it should be kept in mind that a very simple tracer, 18F-fluoride is widely more performant in AS than FDG.
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Affiliation(s)
- François Jamar
- Department of Nuclear Medicine, Cliniques universitaires St-Luc and Institute for Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium.
| | - Conny J van der Laken
- Department of Rheumatology, Amsterdam University Medical Center - location VU Medical Center, Amsterdam, The Netherlands
| | | | - Maarten M Steinz
- Department of Rheumatology, Amsterdam University Medical Center - location VU Medical Center, Amsterdam, The Netherlands
| | - Kornelis S M van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Richard N J Graham
- Radiology Department, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques universitaires St-Luc and Institute for Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
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4
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Verweij NJF, de Jongh J, Wee MMT, Zwezerijnen GJC, Yaqub M, Voskuyl AE, Lammertsma AA, van Schaardenburg D, Boers M, Lems WF, van der Laken CJ. Whole-Body Macrophage Positron Emission Tomography Imaging for Disease Activity Assessment in Early Rheumatoid Arthritis. J Rheumatol 2022; 49:871-877. [PMID: 35428723 DOI: 10.3899/jrheum.210928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the potential of whole-body positron emission tomography/computed tomography (PET/CT) with a macrophage tracer to image arthritis in patients with early rheumatoid arthritis (RA). METHODS Thirty-five previously untreated, clinically active patients with early RA underwent whole-body PET/CT scanning with the macrophage tracer (R)-[11C]PK11195 in addition to clinical assessment (Disease Activity Score in 44 joints [DAS44]). Tracer uptake was assessed quantitatively as standardized uptake values (SUVs). In addition, 2 readers blinded to clinical assessment visually scored tracer uptake in joints. Clinical and PET variables were compared using Cohen , linear regression/correlation, and t tests, where appropriate. RESULTS All but 1 patient showed enhanced tracer uptake in at least 1 joint. Twelve percent of all joints (171/1470) were visually positive on the PET scan, most frequently the small joints in feet (40%) and hands (37%), followed by wrists (15%). Correlations of visual scores with clinical findings both at patient and joint levels were absent or weak. In contrast, average SUVs in the hands, feet, and whole body showed significant correlations with DAS44 scores, with the best correlation seen in the feet (R2 = 0.29, P < 0.01). CONCLUSION Clinically active patients with early RA had increased joint uptake of a macrophage PET tracer, especially in the feet. Quantitative, but not visual PET measures of whole body and joint groups, particularly the feet, showed moderate and statistically significant correlations with clinical outcome.
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Affiliation(s)
- Nicki J F Verweij
- N.J.F. Verweij, MD, J. de Jongh, MSc, A.E. Voskuyl, MD, Professor, WF. Lems, MD, Professor, C.J. van der Laken, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit
| | - Jerney de Jongh
- N.J.F. Verweij, MD, J. de Jongh, MSc, A.E. Voskuyl, MD, Professor, WF. Lems, MD, Professor, C.J. van der Laken, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit
| | - Marieke M Ter Wee
- M.M. ter Wee, PhD, M. Boers, MD, Professor, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, and Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit
| | - Gerben J C Zwezerijnen
- G.J.C. Zwezerijnen, MD, M. Yaqub, PhD, A.A. Lammertsma, PhD, Professor, Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit
| | - Maqsood Yaqub
- G.J.C. Zwezerijnen, MD, M. Yaqub, PhD, A.A. Lammertsma, PhD, Professor, Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit
| | - Alexandre E Voskuyl
- N.J.F. Verweij, MD, J. de Jongh, MSc, A.E. Voskuyl, MD, Professor, WF. Lems, MD, Professor, C.J. van der Laken, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit
| | - Adriaan A Lammertsma
- G.J.C. Zwezerijnen, MD, M. Yaqub, PhD, A.A. Lammertsma, PhD, Professor, Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit
| | - Dirkjan van Schaardenburg
- D. van Schaardenburg, MD, Professor, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, the Netherlands
| | - Maarten Boers
- M.M. ter Wee, PhD, M. Boers, MD, Professor, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, and Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit
| | - Willem F Lems
- N.J.F. Verweij, MD, J. de Jongh, MSc, A.E. Voskuyl, MD, Professor, WF. Lems, MD, Professor, C.J. van der Laken, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit
| | - Conny J van der Laken
- N.J.F. Verweij, MD, J. de Jongh, MSc, A.E. Voskuyl, MD, Professor, WF. Lems, MD, Professor, C.J. van der Laken, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit
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5
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van der Geest KSM, Sandovici M, Nienhuis PH, Slart RHJA, Heeringa P, Brouwer E, Jiemy WF. Novel PET Imaging of Inflammatory Targets and Cells for the Diagnosis and Monitoring of Giant Cell Arteritis and Polymyalgia Rheumatica. Front Med (Lausanne) 2022; 9:902155. [PMID: 35733858 PMCID: PMC9207253 DOI: 10.3389/fmed.2022.902155] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/13/2022] [Indexed: 12/26/2022] Open
Abstract
Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are two interrelated inflammatory diseases affecting patients above 50 years of age. Patients with GCA suffer from granulomatous inflammation of medium- to large-sized arteries. This inflammation can lead to severe ischemic complications (e.g., irreversible vision loss and stroke) and aneurysm-related complications (such as aortic dissection). On the other hand, patients suffering from PMR present with proximal stiffness and pain due to inflammation of the shoulder and pelvic girdles. PMR is observed in 40-60% of patients with GCA, while up to 21% of patients suffering from PMR are also affected by GCA. Due to the risk of ischemic complications, GCA has to be promptly treated upon clinical suspicion. The treatment of both GCA and PMR still heavily relies on glucocorticoids (GCs), although novel targeted therapies are emerging. Imaging has a central position in the diagnosis of GCA and PMR. While [18F]fluorodeoxyglucose (FDG)-positron emission tomography (PET) has proven to be a valuable tool for diagnosis of GCA and PMR, it possesses major drawbacks such as unspecific uptake in cells with high glucose metabolism, high background activity in several non-target organs and a decrease of diagnostic accuracy already after a short course of GC treatment. In recent years, our understanding of the immunopathogenesis of GCA and, to some extent, PMR has advanced. In this review, we summarize the current knowledge on the cellular heterogeneity in the immunopathology of GCA/PMR and discuss how recent advances in specific tissue infiltrating leukocyte and stromal cell profiles may be exploited as a source of novel targets for imaging. Finally, we discuss prospective novel PET radiotracers that may be useful for the diagnosis and treatment monitoring in GCA and PMR.
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Affiliation(s)
- Kornelis S. M. van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Maria Sandovici
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Pieter H. Nienhuis
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Riemer H. J. A. Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Biomedical Photonic Imaging Group, University of Twente, Enschede, Netherlands
| | - Peter Heeringa
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - William F. Jiemy
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Steinz MM, Ezdoglian A, Khodadust F, Molthoff CFM, Srinivasarao M, Low PS, Zwezerijnen GJC, Yaqub M, Beaino W, Windhorst AD, Tas SW, Jansen G, van der Laken CJ. Folate Receptor Beta for Macrophage Imaging in Rheumatoid Arthritis. Front Immunol 2022; 13:819163. [PMID: 35185910 PMCID: PMC8849105 DOI: 10.3389/fimmu.2022.819163] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/11/2022] [Indexed: 12/30/2022] Open
Abstract
Non-invasive imaging modalities constitute an increasingly important tool in diagnostic and therapy response monitoring of patients with autoimmune diseases, including rheumatoid arthritis (RA). In particular, macrophage imaging with positron emission tomography (PET) using novel radiotracers based on differential expression of plasma membrane proteins and functioning of cellular processes may be suited for this. Over the past decade, selective expression of folate receptor β (FRβ), a glycosylphosphatidylinositol-anchored plasma membrane protein, on myeloid cells has emerged as an attractive target for macrophage imaging by exploiting the high binding affinity of folate-based PET tracers. This work discusses molecular, biochemical and functional properties of FRβ, describes the preclinical development of a folate-PET tracer and the evaluation of this tracer in a translational model of arthritis for diagnostics and therapy-response monitoring, and finally the first clinical application of the folate-PET tracer in RA patients with active disease. Consequently, folate-based PET tracers hold great promise for macrophage imaging in a variety of (chronic) inflammatory (autoimmune) diseases beyond RA.
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Affiliation(s)
- Maarten M Steinz
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, VU University Medical Center (VUmc), Amsterdam, Netherlands
| | - Aiarpi Ezdoglian
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, VU University Medical Center (VUmc), Amsterdam, Netherlands
| | - Fatemeh Khodadust
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, VU University Medical Center (VUmc), Amsterdam, Netherlands
| | - Carla F M Molthoff
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Center, VU, Amsterdam, Netherlands
| | | | - Philip S Low
- Department of Chemistry, Purdue University, West Lafayette, IN, United States
| | - Gerben J C Zwezerijnen
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Center, VU, Amsterdam, Netherlands
| | - Maqsood Yaqub
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Center, VU, Amsterdam, Netherlands
| | - Wissam Beaino
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Center, VU, Amsterdam, Netherlands
| | - Albert D Windhorst
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Center, VU, Amsterdam, Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, AMC, Amsterdam, Netherlands
| | - Gerrit Jansen
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, VU University Medical Center (VUmc), Amsterdam, Netherlands
| | - Conny J van der Laken
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, VU University Medical Center (VUmc), Amsterdam, Netherlands
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7
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Verweij N, Zwezerijnen G, Ter Wee M, de Jongh J, Yaqub M, van Schaardenburg D, Lammertsma A, Voskuyl A, Lems W, Boers M, van der Laken C. Early prediction of treatment response in rheumatoid arthritis by quantitative macrophage PET. RMD Open 2022; 8:rmdopen-2021-002108. [PMID: 35149604 PMCID: PMC8845317 DOI: 10.1136/rmdopen-2021-002108] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/25/2022] [Indexed: 11/22/2022] Open
Abstract
Objective To determine whether macrophage positron emission tomography (PET)/computed tomography (CT) imaging using (R)-[11C]PK11195 at 0 and 2 weeks is associated with clinical response at 13 weeks in patients with early rheumatoid arthritis (RA). Methods Whole-body (R)-[11C]PK11195 PET/CT scans were performed at baseline and after 2 weeks of COBRA-light (combination therapy of methotrexate and prednisone) treatment in 35 patients with clinically active early RA. Clinical assessment (Disease Activity Score of 44 joints (DAS44)) was performed at 0, 2 and 13 weeks of treatment. PET/CT scans were assessed visually by two blinded, experienced readers, and by calculating standardised uptake values (SUVs) for shoulders, elbows, hips, knees, and hand and feet joints. Clinical and PET variables were compared using (multivariate) linear regression. Results 18 males and 17 females were included (baseline DAS44=3.2 ± 1.0). 171 out of 1470 joints were visually PET positive at baseline, decreasing to 100 joints after 2 weeks. In general, small feet joints showed the highest uptake at baseline, and the largest decrease after 2 weeks (Δ0-2). Neither baseline nor Δ0-2 PET measures correlated with DAS44 at 13 weeks. However, at 2 weeks, average SUV of the feet significantly correlated with DAS44 at 13 weeks (R2=0.14, p=0.04). In a multivariable model, DAS44 and average SUV of the feet at 2 weeks showed substantial combined predictive value (combined R2=0.297, p<0.01). Conclusion Quantitative macrophage PET assessment of feet joints, together with DAS44, after 2 weeks of COBRA light treatment in patients with early RA correlates with clinical response after 3 months of treatment.
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Affiliation(s)
- Nicki Verweij
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Gerben Zwezerijnen
- Department of Radiology & Nuclear Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Marieke Ter Wee
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands.,Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Jerney de Jongh
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Maqsood Yaqub
- Department of Radiology & Nuclear Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | | | - Adriaan Lammertsma
- Department of Radiology & Nuclear Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Alexandre Voskuyl
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Willem Lems
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Maarten Boers
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands.,Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Conny van der Laken
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
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8
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Bouman CAM, van Herwaarden N, Blanken AB, Van der Laken CJ, Gotthardt M, Oyen WJG, den Broeder AA, van der Maas A, van den Ende CH. 18F-FDG PET-CT scanning in rheumatoid arthritis patients tapering TNFi: reliability, validity and predictive value. Rheumatology (Oxford) 2021; 61:SI6-SI13. [PMID: 34791068 DOI: 10.1093/rheumatology/keab842] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/03/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To investigate the reliability and validity of 18F-FDG PET-CT scanning (FDG-PET) in rheumatoid arthritis (RA) patients with low disease activity tapering tumor necrosis factor inhibitors (TNFi) and its' predictive value for successful tapering or discontinuation. METHODS Patients in the tapering arm of the DRESS study, a randomized controlled trial on TNFi tapering in RA, underwent FDG-PET before tapering (baseline) and after maximal tapering. 48 joints per scan were scored: 1) visually (FDG-avid joint (FAJ) y/n), 2) quantitatively (maximal and mean standardized uptake values (SUVmax and SUVmean)). Interobserver agreement was calculated in 10 patients at baseline. Quantitative and visual FDG-PET scores were investigated for: 1) (multilevel) association with clinical parameters both on joint and patient level and 2) predictive value at baseline and change between baseline and maximal tapering (delta) for successful tapering and discontinuation at 18 months. RESULTS 79 patients underwent FDG-PET. For performance of identification of FAJs on PET, Cohen's kappa was 0.49 (0.35-0.63). For SUVmax and SUVmean, ICCs were 0.80 (0.77-0.83) and 0.96 (0.9-1.0), respectively. On joint level, swelling was significantly associated with SUVmax and SUVmean (B coefficients with 95%CI 1.0 (0.73-1.35) and 0.2 (0.08-0.32) respectively). On patient level only correlation with acute phase reactants was found. FDG-PET scores were not predictive for successful tapering or discontinuation. CONCLUSIONS Quantitative FDG-PET arthritis scoring in RA patients with low disease activity is reliable and has some construct validity. However, no predictive values were found for FDG-PET parameters for successful tapering and/or discontinuation of TNFi.
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Affiliation(s)
- Chantal A M Bouman
- Department of Rheumatology, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Noortje van Herwaarden
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Farmacology-Toxicology, Radboudumc, Nijmegen, The Netherlands
| | - Annelies B Blanken
- Department of Rheumatology, AmsterdamUMC-location VU Medical Center, Amsterdam, The Netherlands.,Department of Rheumatology, Reade, Amsterdam, The Netherlands
| | - Conny J Van der Laken
- Department of Rheumatology, AmsterdamUMC-location VU Medical Center, Amsterdam, The Netherlands
| | - Martin Gotthardt
- Department of Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Wim J G Oyen
- Department of Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands.,Department of Nuclear Medicin, Humanitas University and Clinical and Research Center, Milan, Italy.,Department of Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Alfons A den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Rheumatology, Radboudumc, Nijmegen, The Netherlands
| | - Aatke van der Maas
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Cornelia H van den Ende
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Rheumatology, Radboudumc, Nijmegen, The Netherlands
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9
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Skoczynska M, Figus F, Arena V, Massazza G, Iagnocco A. The role of PET in a clinically silent and ultrasound negative synovitis in the course of rheumatoid arthritis - a case report. Reumatismo 2021; 73:64-66. [PMID: 33874650 DOI: 10.4081/reumatismo.2021.1253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/19/2021] [Indexed: 11/22/2022] Open
Abstract
We present a case report of a rheumatoid arthritis patient, who underwent a PET scan, which revealed inflammation of multiple joints, which was missed by both physical and ultrasound examinations. A 55-year old woman with a long-term rheumatoid arthritis, who had undergone arthroplasty of the left knee in the past, consulted with the rheumatologist for pain in the left knee. The physical examination revealed signs of inflammation in the left knee and right elbow. The inflammatory parameters were high. Ultrasound showed intraarticular effusion without signs of active synovitis in the left knee. The ultrasound assessment of the other joints (hands, wrists and feet) was also negative for active synovitis, while positron-emission tomography (PET) revealed increased glucose metabolism at the level of the medial side of the left knee, left radio-ulno-carpal joint, I-II-III metacarpo-phalangeal joints bilaterally, right II metatarso-phalangeal joint, and left II-III metatarso-phalangeal joints. This case report demonstrates that PET might be more sensitive than ultrasound in detecting subclinical joint inflammation.
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Affiliation(s)
- M Skoczynska
- Rheumatology Centre and Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy; Department and Clinic of Rheumatology and Internal Diseases, Wroclaw Medical University, Wroclaw.
| | - F Figus
- Rheumatology Centre and Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin.
| | - V Arena
- Affidea Irmet Torino, Turin.
| | - G Massazza
- Division of Physical Medicine and Rehabilitation, MFRU, Università degli Studi di Torino, Turin.
| | - A Iagnocco
- Rheumatology Centre and Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin.
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10
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Imaging Inflammation with Positron Emission Tomography. Biomedicines 2021; 9:biomedicines9020212. [PMID: 33669804 PMCID: PMC7922638 DOI: 10.3390/biomedicines9020212] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/28/2021] [Accepted: 02/12/2021] [Indexed: 12/19/2022] Open
Abstract
The impact of inflammation on the outcome of many medical conditions such as cardiovascular diseases, neurological disorders, infections, cancer, and autoimmune diseases has been widely acknowledged. However, in contrast to neurological, oncologic, and cardiovascular disorders, imaging plays a minor role in research and management of inflammation. Imaging can provide insights into individual and temporospatial biology and grade of inflammation which can be of diagnostic, therapeutic, and prognostic value. There is therefore an urgent need to evaluate and understand current approaches and potential applications for imaging of inflammation. This review discusses radiotracers for positron emission tomography (PET) that have been used to image inflammation in cardiovascular diseases and other inflammatory conditions with a special emphasis on radiotracers that have already been successfully applied in clinical settings.
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11
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Helo Y, Searle GE, Borghese F, Abraham S, Saleem A. Specificity of translocator protein-targeted positron emission tomography in inflammatory joint disease. EJNMMI Res 2020; 10:147. [PMID: 33284369 PMCID: PMC7721924 DOI: 10.1186/s13550-020-00736-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/23/2020] [Indexed: 12/02/2022] Open
Abstract
Objective Expression of the translocator protein (TSPO) on inflammatory cells has facilitated imaging of synovitis with TSPO-targeted positron emission tomography (PET). We aimed to quantitatively assess the specificity of the second-generation TSPO PET radioligand, [11C]PBR28, and to generate simplified PET protocols in patients with inflammatory joint disease (IJD) in this pilot study. Methods Three IJD patients (two rheumatoid arthritis and one osteoarthritis) with knee involvement underwent dynamic [11C]PBR28-PET scans before and after administration of 90 mg of oral emapunil (XBD-173), a TSPO ligand the same day. Radial arterial blood sampling was performed throughout the scan, and total radioactivity and radioactive metabolites were obtained. A semi-automated method was used to generate regions of interest. Standardized uptake value (SUV) and SUV ratio corrected for activity in bone and blood between 50 and 70 min (SUVr50–70 bone, SUVr50–70 blood, respectively) and PET volume of distribution (VT) of the radioligand were calculated. Results A mean [11C]PBR28 radioactivity of 378 (range 362–389) MBq was administered. A significant decrease (p < 0.05) in VT, SUVr50–70 bone and SUVr50–70 blood observed after oral emapunil confirmed the TSPO specificity of [11C]PBR28. A decrease in SUV was not observed in the post-block scan. Conclusion [11C]PBR28 is TSPO-specific radioligand in IJD patients. Simplified PET protocols with static PET acquisition can be used in the management and evaluation of novel therapeutics that target TSPO overexpressing cells.
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Affiliation(s)
- Yusuf Helo
- Invicro, A Konica Minolta Company, Burlington Danes Building, Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK
| | - Graham E Searle
- Invicro, A Konica Minolta Company, Burlington Danes Building, Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK
| | - Federica Borghese
- Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK
| | - Sonya Abraham
- Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK
| | - Azeem Saleem
- Invicro, A Konica Minolta Company, Burlington Danes Building, Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK. .,Hull York Medical School, Allam Medical Building, University of Hull, Cottingham Road, Hull, HU6 7RX, UK.
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12
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Shen P, Jiao Y, Miao L, Chen J, Momtazi‐Borojeni AA. Immunomodulatory effects of berberine on the inflamed joint reveal new therapeutic targets for rheumatoid arthritis management. J Cell Mol Med 2020; 24:12234-12245. [PMID: 32969153 PMCID: PMC7687014 DOI: 10.1111/jcmm.15803] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/21/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory syndrome designated by synovial joint inflammation leading to cartilage degradation and bone damage as well as progressive disability. Synovial inflammation is promoted through the infiltration of mononuclear immune cells, dominated by CD4+ T cells, macrophages and dendritic cells (DCs), together with fibroblast-like synoviocytes (FLS), into the synovial compartment. Berberine is a bioactive isoquinoline alkaloid compound showing various pharmacological properties that are mainly attributed to immunomodulatory and anti-inflammatory effects. Several lines of experimental study have recently investigated the therapeutic potential of berberine and its underlying mechanisms in treating RA condition. The present review aimed to clarify determinant cellular and molecular targets of berberine in RA and found that berberine through modulating several signalling pathways involved in the joint inflammation, including PI3K/Akt, Wnt1/β-catenin, AMPK/lipogenesis and LPA/LPA1 /ERK/p38 MAPK can inhibit inflammatory proliferation of FLS cells, suppress DC activation and modulate Th17/Treg balance and thus prevent cartilage and bone destruction. Importantly, these molecular targets may explore new therapeutic targets for RA treatment.
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Affiliation(s)
- Peng Shen
- Department of StomatologyClinical Department of Aerospace CityNorthern Beijing Medical DistrictChinese PLA General HospitalBeijingChina
| | - Yang Jiao
- Department of StomatologyThe 7th Medical CenterChinese PLA General HospitalBeijingChina
- Outpatient Department of PLA Macao GarrisonMacaoChina
| | - Li Miao
- Department of StomatologyThe 7th Medical CenterChinese PLA General HospitalBeijingChina
| | - Ji‐hua Chen
- National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology & Shaanxi Key Laboratory of Oral DiseasesDepartment of ProsthodonticsSchool of StomatologyThe Fourth Military Medical UniversityXi'anChina
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13
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Quantitative Assessment of Arthritis Activity in Rheumatoid Arthritis Patients Using [ 11C]DPA-713 Positron Emission Tomography. Int J Mol Sci 2020; 21:ijms21093137. [PMID: 32365551 PMCID: PMC7246669 DOI: 10.3390/ijms21093137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 11/29/2022] Open
Abstract
Treatment for rheumatoid arthritis (RA) should be started as early as possible to prevent destruction of bone and cartilage in affected joints. A new diagnostic tool for both early diagnosis and therapy monitoring would be valuable to reduce permanent joint damage. Positron emission tomography (PET) imaging of macrophages is a previously demonstrated non-invasive means to visualize (sub)clinical arthritis in RA patients. We developed a kinetic model to quantify uptake of the macrophage tracer [11C]DPA-713 (N,N-diethyl-2-[2-(4-methoxyphenyl)-5,7-dimethylpyrazolo [1,5-a]pyrimidin-3-yl]acetamide) in arthritic joints of RA patients and to assess the performance of several simplified methods. Dynamic [11C]DPA-713 scans of 60 min with both arterial and venous blood sampling were performed in five patients with clinically active disease. [11C]DPA-713 showed enhanced uptake in affected joints of RA patients, with tracer uptake levels corresponding to clinical presence and severity of arthritis. The optimal quantitative model for assessment of [11C]DPA-713 uptake was the irreversible two tissue compartment model (2T3k). Both Ki and standardized uptake value (SUV) correlated with the presence of arthritis in RA patients. Using SUV as an outcome measure allows for a simplified static imaging protocol that can be used in larger cohorts.
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14
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Dam TT, Hanaoka H, Nakajima T, Yamaguchi A, Okamura K, Chikuda H, Tsushima Y. 64Cu-ATSM and 99mTc(CO) 3-DCM20 potential in the early detection of rheumatoid arthritis. Mod Rheumatol 2020; 31:350-356. [PMID: 32252574 DOI: 10.1080/14397595.2020.1751945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Molecular imaging constitutes a promising technique for the early detection of rheumatoid arthritis (RA). Macrophages and hypoxia play significant roles in inflamed synovium. In the present study, we evaluated the efficacy of radiopharmaceuticals that target macrophage mannose receptors (99mTc-labeled mannosylated dextran or 99mTc(CO)3-DCM20) and hypoxia (copper(II) diacetyl-di(N4-methylthiosemicarbazone) or Cu-ATSM) for the early detection of RA in collagen-induced arthritis (CIA) mice models. METHODS CIA model was developed in DBA/1 mice, and the clinical score for arthritis was visually assessed on a regular basis. Two biodistribution studies were performed in a paired-labeled format using 2-deoxy-2-18F-fluoro-D-glucose (18F-FDG) as a reference: (1) 99mTc(CO)3-DCM20 with 18F-FDG and (2) 67Cu-ATSM with 18F-FDG. RESULTS The accumulation levels of 99mTc(CO)3-DCM20 and 67Cu-ATSM in forepaws, hindpaws, and knee joints of CIA mice were significantly higher than that of control mice. In contrast, 18F-FDG uptake in hindpaws and knee joints showed no significant difference between CIA and control mice. The radioactivity levels of 99mTc(CO)3-DCM20 and 67Cu-ATSM were significantly correlated with the clinical scores for the paws. CONCLUSION These results suggest the potential usefulness of 99mTc(CO)3-DCM20 and radiolabeled Cu-ATSM for the imaging and early detection of RA.
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Affiliation(s)
- Trang Thuy Dam
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hirofumi Hanaoka
- Department of Bioimaging Information Analysis, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takahito Nakajima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Aiko Yamaguchi
- Department of Bioimaging Information Analysis, Gunma University Graduate School of Medicine, Maebashi, Japan.,Texas Therapeutics Institute, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, TX, USA
| | - Koichi Okamura
- Deparment of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hirotaka Chikuda
- Deparment of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.,Research Program for Diagnostic and Molecular Imaging, Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Gunma University Graduate School of Medicine, Maebashi, Japan
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15
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Mandl P, Aletaha D. The role of ultrasound and magnetic resonance imaging for treat to target in rheumatoid arthritis and psoriatic arthritis. Rheumatology (Oxford) 2020; 58:2091-2098. [PMID: 31518423 DOI: 10.1093/rheumatology/kez397] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/04/2019] [Accepted: 08/07/2019] [Indexed: 01/04/2023] Open
Abstract
The treat-to-target (T2T) approach has revolutionized the way we treat patients with rheumatic and musculoskeletal diseases. Recent attention has focused on imaging techniques, in particular musculoskeletal ultrasound and MRI as a focus for T2T strategies. Recently, a number of randomized clinical trials have been performed that compared tight clinical control vs control augmented by imaging techniques. While the three published trials have concluded that imaging does not add to tight clinical care, implementing imaging into the T2T strategy has actual advantages, such as the detection of subclinical involvement, and information on joint involvement/pathology and may possess potential advantages as evidenced by certain secondary endpoints. This review examines the findings of these studies and discusses the advantages and disadvantages of incorporating imaging into the T2T strategy.
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Affiliation(s)
- Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
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16
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Abstract
This review discusses nuclear imaging of inflammation using molecular probes beyond fluoro-d-glucose, is structured by cellular targets, and focuses on those tracers that have been successfully applied clinically.
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Affiliation(s)
- Malte Kircher
- Department of Nuclear Medicine, University Hospital Augsburg, Stenglinstr. 2, Würzburg 86156, Germany
| | - Constantin Lapa
- Department of Nuclear Medicine, University Hospital Augsburg, Stenglinstr. 2, Würzburg 86156, Germany.
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17
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Imaging disease activity of rheumatoid arthritis by macrophage targeting using second generation translocator protein positron emission tomography tracers. PLoS One 2019; 14:e0222844. [PMID: 31553762 PMCID: PMC6760780 DOI: 10.1371/journal.pone.0222844] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 09/09/2019] [Indexed: 11/19/2022] Open
Abstract
Background Positron emission tomography (PET) imaging of macrophages using the translocator protein (TSPO) tracer (R)-[11C]PK11195 has shown the promise to image rheumatoid arthritis (RA). To further improve TSPO PET for RA imaging, second generation TSPO tracers [11C]DPA-713 and [18F]DPA-714 have recently been evaluated pre-clinically showing better imaging characteristics. Objective A clinical proof of concept study to evaluate [11C]DPA-713 and [18F]DPA-714 to visualize arthritis in RA patients. Methods RA patients (n = 13) with at least two active hand joints were included. PET/CT scans of the hands were obtained after injection of [18F]DPA-714, [11C]DPA-713 and/or (R)-[11C]PK11195 (max. 2 tracers pp). Standardized uptake values (SUVs) and target-to-background (T/B) ratios were determined. Imaging data of the 3 different tracers were compared by pooled post-hoc testing, and by a head to head comparison. Results Clinically active arthritis was present in 110 hand joints (2–17 pp). Arthritic joints were visualized with both [11C]DPA-713 and [18F]DPA-714. Visual tracer uptake corresponded with clinical signs of arthritis in 80% of the joints. Mean absolute uptake in PET-positive joints was significantly higher for [11C]DPA-713 than for [18F]DPA-714, the latter being not significantly different from (R)-[11C]PK11195 uptake. Background uptake was lower for both DPA tracers compared with that of (R)-[11C]PK11195. Higher absolute uptake and lower background resulted in two-fold higher T/B ratios for [11C]DPA-713. Conclusions [11C]DPA-713 and [18F]DPA-714 visualize arthritic joints in active RA patients and most optimal arthritis imaging results were obtained for [11C]DPA-713. Second generation TSPO macrophage PET provides new opportunities for both early diagnosis and therapy monitoring of RA.
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18
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Hayer S, Zeilinger M, Weiss V, Dumanic M, Seibt M, Niederreiter B, Shvets T, Pichler F, Wadsak W, Podesser BK, Helbich TH, Hacker M, Smolen JS, Redlich K, Mitterhauser M. Multimodal [ 18 F]FDG PET/CT Is a Direct Readout for Inflammatory Bone Repair: A Longitudinal Study in TNFα Transgenic Mice. J Bone Miner Res 2019; 34:1632-1645. [PMID: 31063606 PMCID: PMC6852546 DOI: 10.1002/jbmr.3748] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/05/2019] [Accepted: 04/14/2019] [Indexed: 12/22/2022]
Abstract
In rheumatoid arthritis (RA), chronic joint inflammation leading to bone and cartilage damage is the major cause of functional impairment. Whereas reduction of synovitis and blockade of joint damage can be successfully achieved by disease modifying antirheumatic therapies, bone repair upon therapeutic interventions has only been rarely reported. The aim of this study was to use fluorodeoxyglucose ([18 F]FDG) and [18 F]fluoride µPET/CT imaging to monitor systemic inflammatory and destructive bone remodeling processes as well as potential bone repair in an established mouse model of chronic inflammatory, erosive polyarthritis. Therefore, human tumor necrosis factor transgenic (hTNFtg) mice were treated with infliximab, an anti-TNF antibody, for 4 weeks. Before and after treatment period, mice received either [18 F]FDG, for detecting inflammatory processes, or [18 F]fluoride, for monitoring bone remodeling processes, for PET scans followed by CT scans. Standardized uptake values (SUVmean ) were analyzed in various joints and histopathological signs of arthritis, joint damage, and repair were assessed. Longitudinal PET/CT scans revealed a significant decrease in [18 F]FDG SUVs in affected joints demonstrating complete remission of inflammatory processes due to TNF blockade. In contrast, [18 F]fluoride SUVs could not discriminate between different severities of bone damage in hTNFtg mice. Repeated in vivo CT images proved a structural reversal of preexisting bone erosions after anti-TNF therapy. Accordingly, histological analysis showed complete resolution of synovial inflammation and healing of bone at sites of former bone erosion. We conclude that in vivo multimodal [18 F]FDG µPET/CT imaging allows to quantify and monitor inflammation-mediated bone damage and reveals not only reversal of synovitis but also bone repair upon TNF blockade in experimental arthritis. © 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Silvia Hayer
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Markus Zeilinger
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria.,Faculty of Engineering, University of Applied Sciences Wiener Neustadt, Wiener Neustadt, Austria
| | - Volker Weiss
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria.,Faculty of Health Sciences, University of Applied Sciences Wiener Neustadt, Wiener Neustadt, Austria
| | - Monika Dumanic
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Seibt
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Birgit Niederreiter
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Tetyana Shvets
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Florian Pichler
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria.,Faculty of Engineering, University of Applied Sciences Wiener Neustadt, Wiener Neustadt, Austria
| | - Wolfgang Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria.,Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Bruno K Podesser
- Center of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Kurt Redlich
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Markus Mitterhauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute of Applied Diagnostics, Vienna, Austria
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19
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Berberine attenuates arthritis in adjuvant-induced arthritic rats associated with regulating polarization of macrophages through AMPK/NF-кB pathway. Eur J Pharmacol 2019; 852:179-188. [DOI: 10.1016/j.ejphar.2019.02.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 01/22/2023]
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20
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Szentesi M, Nagy Z, Géher P, Papp I, Kampen WU. A prospective observational study on the long-term results of 90Yttrium citrate radiosynoviorthesis of synovitis in osteoarthritis of the knee joint. Eur J Nucl Med Mol Imaging 2019; 46:1633-1641. [DOI: 10.1007/s00259-019-04350-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/16/2019] [Indexed: 01/21/2023]
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21
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Chandrupatla DMSH, Molthoff CFM, Lammertsma AA, van der Laken CJ, Jansen G. The folate receptor β as a macrophage-mediated imaging and therapeutic target in rheumatoid arthritis. Drug Deliv Transl Res 2019; 9:366-378. [PMID: 30280318 PMCID: PMC6328514 DOI: 10.1007/s13346-018-0589-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Macrophages play a key role in the pathophysiology of rheumatoid arthritis (RA). Notably, positive correlations have been reported between synovial macrophage infiltration and disease activity as well as therapy outcome in RA patients. Hence, macrophages can serve as an important target for both imaging disease activity and drug delivery in RA. Folate receptor β (FRβ) is a glycosylphosphatidyl (GPI)-anchored plasma membrane protein being expressed on myeloid cells and activated macrophages. FRβ harbors a nanomolar binding affinity for folic acid allowing this receptor to be exploited for RA disease imaging (e.g., folate-conjugated PET tracers) and therapeutic targeting (e.g., folate antagonists and folate-conjugated drugs). This review provides an overview of these emerging applications in RA by summarizing and discussing properties of FRβ, expression of FRβ in relation to macrophage polarization, FRβ-targeted in vivo imaging modalities, and FRβ-directed drug targeting.
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Affiliation(s)
- Durga M S H Chandrupatla
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Carla F M Molthoff
- Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Conny J van der Laken
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Gerrit Jansen
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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22
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Jiemy WF, Heeringa P, Kamps JA, van der Laken CJ, Slart RH, Brouwer E. Positron emission tomography (PET) and single photon emission computed tomography (SPECT) imaging of macrophages in large vessel vasculitis: Current status and future prospects. Autoimmun Rev 2018; 17:715-726. [DOI: 10.1016/j.autrev.2018.02.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/07/2018] [Indexed: 12/21/2022]
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23
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Bugatti S, Sakellariou G, Luvaro T, Greco MI, Manzo A. Clinical, Imaging, and Pathological Suppression of Synovitis in Rheumatoid Arthritis: Is the Disease Curable? Front Med (Lausanne) 2018; 5:140. [PMID: 29868592 PMCID: PMC5962817 DOI: 10.3389/fmed.2018.00140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/24/2018] [Indexed: 12/18/2022] Open
Abstract
The management of patients with rheumatoid arthritis (RA) has witnessed a dramatic revolution in recent years, and disease remission has become an increasingly achievable outcome. Rheumatologists are now facing the urgent question of whether, once remission has been achieved and stably maintained, drugs can be tapered, and even discontinued. The concept of disease remission however encompasses progressive layers of complexity, all of which need to be disentangled before considering RA as a “curable” condition. As the synovial membrane represents the ultimate target of the pathological process of RA, a critical issue remains whether disease remission coincides with true suppression of inflammation and definitive tissue “healing.” In this short review, we will provide a critical summary of recent studies investigating the possibility of controlling RA synovitis at the clinical, imaging or pathological level. Potential advantages and limitations of these perspectives in the definition of remission are also discussed.
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Affiliation(s)
- Serena Bugatti
- Division of Rheumatology, Rheumatology and Translational Immunology Research Laboratories (LaRIT), IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Garifallia Sakellariou
- Division of Rheumatology, Rheumatology and Translational Immunology Research Laboratories (LaRIT), IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Terenzj Luvaro
- Division of Rheumatology, Rheumatology and Translational Immunology Research Laboratories (LaRIT), IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Maria Immacolata Greco
- Division of Rheumatology, Rheumatology and Translational Immunology Research Laboratories (LaRIT), IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Antonio Manzo
- Division of Rheumatology, Rheumatology and Translational Immunology Research Laboratories (LaRIT), IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
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24
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Jamar F, Versari A, Galli F, Lecouvet F, Signore A. Molecular Imaging of Inflammatory Arthritis and Related Disorders. Semin Nucl Med 2018; 48:277-290. [PMID: 29626944 DOI: 10.1053/j.semnuclmed.2017.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Rheumatic disorders comprise a number of diseases that range from benign, mildly symptomatic degenerative disease to severe systemic disorders such as giant-cell vasculitis with dramatic consequences such as acute blindness. The former is relatively common, whereas the latter is rare. In between, commonly encountered disorders such as rheumatoid arthritis and the various spondyloarthritides, with or without peripheral enthesitis, are daily challenges for the caring physician. Clinical evaluation is of utmost importance and is constantly described under the form of specialist guidelines in all parts of the world. Objective assessment of inflammatory arthritis and related disorders is of interest both for the care of the individual patient and for the assessment of the effects of the many novel experimental therapies proposed in this field, most of them being very expensive. High-resolution ultrasound, CT and spectral CT, MRI using various sequences, and molecular imaging using either gamma camera imaging (including SPECT-CT) or PET-CT are all proposed for a better assessment of these diseases. This review focuses on the several nuclear medicine techniques that are or may become useful to helping provide better patient care in this field and is mainly oriented to inflammatory rheumatic disorders, excluding mechanical degenerative diseases.
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Affiliation(s)
- François Jamar
- Nuclear Medicine Department, Cliniques Universitaires St-Luc and IREC, Université Catholique de Louvain, Brussels, Belgium.
| | - Annibale Versari
- Nuclear Medicine Unit, Oncology and High Technology Department, S. Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Filippo Galli
- Nuclear Medicine Unit, Faculty of Medicine and Psychology, Department of Medical-Surgical Sciences and Translational Medicine, "Sapienza" University, Roma, Italy
| | - Frédéric Lecouvet
- Department of Diagnostic Imaging, Cliniques Universitaires St-Luc and IREC, Université Catholique de Louvain, Brussels, Belgium
| | - Alberto Signore
- Nuclear Medicine Unit, Faculty of Medicine and Psychology, Department of Medical-Surgical Sciences and Translational Medicine, "Sapienza" University, Roma, Italy
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25
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Narayan N, Owen DR, Mandhair H, Smyth E, Carlucci F, Saleem A, Gunn RN, Rabiner EA, Wells L, Dakin SG, Sabokbar A, Taylor PC. Translocator Protein as an Imaging Marker of Macrophage and Stromal Activation in Rheumatoid Arthritis Pannus. J Nucl Med 2018; 59:1125-1132. [PMID: 29301931 DOI: 10.2967/jnumed.117.202200] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/30/2017] [Indexed: 02/06/2023] Open
Abstract
PET radioligands targeted to translocator protein (TSPO) offer a highly sensitive and specific means of imaging joint inflammation in rheumatoid arthritis (RA). Through high expression of TSPO on activated macrophages, TSPO PET has been widely reported in several studies of RA as a means of imaging synovial macrophages in vivo. However, this premise does not take into account the ubiquitous expression of TSPO. This study aimed to investigate TSPO expression in major cellular constituents of RA pannus-monocytes, macrophages, fibroblastlike synoviocytes (FLS cells), and CD4-positive (CD4+) T lymphocytes (T cells)-to more accurately interpret TSPO PET signal from RA synovium. Methods: Three RA patients and 3 healthy volunteers underwent PET of both knees using the TSPO radioligand 11C-PBR28. Through 3H-PBR28 autoradiography and immunostaining of synovial tissue in 6 RA patients and 6 healthy volunteers, cellular expression of TSPO in synovial tissue was evaluated. TSPO messenger RNA expression and 3H-PBR28 radioligand binding was assessed using in vitro monocytes, macrophages, FLS cells, and CD4+ T cells. Results:11C-PBR28 PET signal was significantly higher in RA joints than in healthy joints (average SUV, 0.82 ± 0.12 vs. 0.03 ± 0.004; P < 0.01). Further, 3H-PBR28-specific binding in synovial tissue was approximately 10-fold higher in RA patients than in healthy controls. Immunofluorescence revealed TSPO expression on macrophages, FLS cells, and CD4+ T cells. The in vitro study demonstrated the highest TSPO messenger RNA expression and 3H-PBR28-specific binding in activated FLS cells, nonactivated M0 macrophages, and activated M2 reparative macrophages, with the least TSPO expression being in activated and nonactivated CD4+ T cells. Conclusion: To our knowledge, this study was the first evaluation of cellular TSPO expression in synovium, with the highest TSPO expression and PBR28 binding being found on activated synovial FLS cells and M2 macrophages. TSPO-targeted PET may therefore have a unique sensitivity in detecting FLS cells and macrophage-predominant inflammation in RA, with potential utility for assessing treatment response in trials using novel FLS-cell-targeted therapies.
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Affiliation(s)
- Nehal Narayan
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - David R Owen
- Division of Brain Sciences, Imperial College, London, United Kingdom
| | - Harpreet Mandhair
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Erica Smyth
- Imanova Centre for Imaging Sciences, London, United Kingdom; and
| | - Francesco Carlucci
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Azeem Saleem
- Imanova Centre for Imaging Sciences, London, United Kingdom; and
| | - Roger N Gunn
- Imanova Centre for Imaging Sciences, London, United Kingdom; and
| | - Eugenii A Rabiner
- Imanova Centre for Imaging Sciences, London, United Kingdom; and.,Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom
| | - Lisa Wells
- Imanova Centre for Imaging Sciences, London, United Kingdom; and
| | - Stephanie G Dakin
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Afsie Sabokbar
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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26
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Hunt L, Eugénio G, Grainger AJ. Magnetic resonance imaging in individuals at risk of rheumatoid arthritis. Best Pract Res Clin Rheumatol 2017; 31:80-89. [PMID: 29221601 DOI: 10.1016/j.berh.2017.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 07/06/2017] [Accepted: 08/18/2017] [Indexed: 01/07/2023]
Abstract
Individuals with rheumatoid arthritis (RA) benefit from early diagnosis and initiation of therapy. There can be delays in both due to diagnostic uncertainties. Imaging modalities, including magnetic resonance imaging (MRI), can detect inflammation earlier than clinical examination alone in early RA patients. Furthermore, the predictive role of MRI for the future development of RA has recently been explored in 'at-risk' individuals. This review details the use of MRI in early and undifferentiated arthritis and summarises the studies to date in individuals at risk of RA.
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Affiliation(s)
- Laura Hunt
- Leeds Biomedical Research Centre, Chapel Allerton Hospital Leeds, LS7 4SA, UK.
| | - Gisela Eugénio
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Andrew J Grainger
- Leeds Biomedical Research Centre, Chapel Allerton Hospital Leeds, LS7 4SA, UK
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27
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Ng RSN. The Use of PET-CT in Rheumatology. HONG KONG BULLETIN ON RHEUMATIC DISEASES 2017. [DOI: 10.1515/hkbrd-2017-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Positron emission tomography (PET) is a sensitive imaging tool that gives quantitative measure of underlying inflammation. Computed tomography (CT) scan used in combination with PET further helps to delineate the anatomical structure. PET-CT can be helpful for the early diagnosis of rheumatic diseases by pattern recognition, but its role in disease monitoring still needs further evaluation. It is not a fast track solution for all because of different sensitivity and specificity to different diseases, relative high cost, and radiation exposure to the patients.
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Affiliation(s)
- Ray Sin-Ngai Ng
- Department of Medicine , Queen Elizabeth Hospital, 30 Gascoigne Road , Kowloon , Hong Kong
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28
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Narayan N, Owen DR, Taylor PC. Advances in positron emission tomography for the imaging of rheumatoid arthritis. Rheumatology (Oxford) 2017; 56:1837-1846. [DOI: 10.1093/rheumatology/kew484] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Indexed: 12/27/2022] Open
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29
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Bruijnen S, Tsang-A-Sjoe M, Raterman H, Ramwadhdoebe T, Vugts D, van Dongen G, Huisman M, Hoekstra O, Tak PP, Voskuyl A, van der Laken C. B-cell imaging with zirconium-89 labelled rituximab PET-CT at baseline is associated with therapeutic response 24 weeks after initiation of rituximab treatment in rheumatoid arthritis patients. Arthritis Res Ther 2016; 18:266. [PMID: 27863504 PMCID: PMC5116204 DOI: 10.1186/s13075-016-1166-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 10/25/2016] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND B cells are key players in the pathogenesis of rheumatoid arthritis (RA). Although successful in 50-60% of patients with RA, anti-B-cell therapy given as rituximab could be more efficient by identifying potential responders prior to treatment. Positron emission tomography (PET) using radiolabeled rituximab for B-cell imaging might provide the means to fulfil this unmet clinical need. The objective of this study was to investigate the association between biodistribution of zirconium-89 (89Zr)-rituximab on PET-computed tomography (CT) and clinical response in patients with RA. METHODS We included 20 patients with RA who were starting rituximab treatment. At the first intravenous (i.v.) therapeutic dose, patients were also injected with 89Zr-rituximab, followed by PET-CT. European League Against Rheumatism (EULAR) response criteria were applied to determine response at week 24. PET-CT was analyzed visually and quantitatively. Lymph node (LN) biopsies were performed at 0 and 4 weeks to correlate B-cell counts with imaging data. RESULTS PET-positive hand joints (range 1-20) were observed in 18/20 patients. Responders had significantly higher 89Zr-rituximab uptake in PET-positive hand joints than non-responders (median target-to-background (T/B)) ratios (IQR) were 6.2 (4.0-8.8) vs. 3.1 (2.2-3.9), p = 0.02). At T/B ≥4.0, positive and negative predictive values for clinical response were respectively 90% and 75%. Quantitative 89Zr-rituximab hand joint uptake on PET correlated inversely with CD22+ B-cell count in LN tissue at 4 weeks of treatment (r = 0.6, p = 0.05). In addition, the CD22+ B-cell count in LN correlated positively with quantitative LN PET data at baseline, supporting the specificity of B-cell imaging on PET. CONCLUSIONS Non-invasive B-cell imaging by 89Zr-rituximab PET-CT has promising clinical value to select RA responders to rituximab at baseline. 89Zr-rituximab PET-CT may also hold promise for monitoring anti-B-cell therapies in other B-cell driven autoimmune diseases, such as systemic lupus erythematosus and Sjögren's disease.
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Affiliation(s)
- Stefan Bruijnen
- Amsterdam Rheumatology and immunology Center (ARC), location VU University Medical Center, Amsterdam, The Netherlands
| | - Michel Tsang-A-Sjoe
- Amsterdam Rheumatology and immunology Center (ARC), location VU University Medical Center, Amsterdam, The Netherlands
| | - Hennie Raterman
- Amsterdam Rheumatology and immunology Center (ARC), location VU University Medical Center, Amsterdam, The Netherlands
| | - Tamara Ramwadhdoebe
- Amsterdam Rheumatology and immunology Center (ARC), location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniëlle Vugts
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Guus van Dongen
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Marc Huisman
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Otto Hoekstra
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Paul-Peter Tak
- Amsterdam Rheumatology and immunology Center (ARC), location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Alexandre Voskuyl
- Amsterdam Rheumatology and immunology Center (ARC), location VU University Medical Center, Amsterdam, The Netherlands
| | - Conny van der Laken
- Amsterdam Rheumatology and immunology Center (ARC), location VU University Medical Center, Amsterdam, The Netherlands
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30
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Hammoud DA. Molecular Imaging of Inflammation: Current Status. J Nucl Med 2016; 57:1161-5. [PMID: 27173159 DOI: 10.2967/jnumed.115.161182] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/11/2016] [Indexed: 11/16/2022] Open
Abstract
The ability to image inflammation in vivo can improve our understanding of the pathophysiology underlying various disease etiologies, including cancer, atherosclerosis, and neurodegeneration. A great wealth of preclinical and translational research has been and is currently being developed to decipher the involvement of the immune system in disease pathophysiology, quantify the course of a disease, and visualize the potential detrimental effects of excessive inflammation. Down the road, the ultimate goal is to have clinical noninvasive in vivo imaging biomarkers of inflammation that will help diagnose disease, establish prognosis, and gauge response to preventative and therapeutic strategies.
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Affiliation(s)
- Dima A Hammoud
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland
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31
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Akdemir G, Verheul MK, Heimans L, Wevers-de Boer KVC, Goekoop-Ruiterman YPM, van Oosterhout M, Harbers JB, Bijkerk C, Steup-Beekman GM, Lard LR, Huizinga TWJ, Trouw LA, Allaart CF. Predictive factors of radiological progression after 2 years of remission-steered treatment in early arthritis patients: a post hoc analysis of the IMPROVED study. RMD Open 2016; 2:e000172. [PMID: 26925251 PMCID: PMC4762208 DOI: 10.1136/rmdopen-2015-000172] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 01/08/2016] [Accepted: 01/17/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify predictive factors of radiological progression in early arthritis patients treated by remission-steered treatment. METHODS In the IMPROVED study, 610 patients with early rheumatoid arthritis (RA) or undifferentiated arthritis (UA) were treated with methotrexate (MTX) and a tapered high dose of prednisone. Patients in early remission (disease activity score (DAS) <1.6 after 4 months) tapered prednisone to zero. Patients not in early remission were randomised to arm 1: MTX plus hydroxychloroquine, sulfasalazine and prednisone, or to arm 2: MTX plus adalimumab. Predictors of radiological progression (≥0.5 Sharp/van der Heijde score; SHS) after 2 years were assessed using logistic regression analysis. RESULTS Median (IQR) SHS progression in 488 patients was 0 (0-0) point, without differences between RA or UA patients or between treatment arms. In only 50/488 patients, the SHS progression was ≥0.5: 33 (66%) were in the early DAS remission group, 9 (18%) in arm 1, 5 (10%) in arm 2, 3 (6%) in the outside of protocol group. Age (OR (95% CI): 1.03 (1.00 to 1.06)) and the combined presence of anticarbamylated protein antibodies (anti-CarP) and anticitrullinated protein antibodies (ACPA) (2.54 (1.16 to 5.58)) were independent predictors for SHS progression. Symptom duration <12 weeks showed a trend. CONCLUSIONS After 2 years of remission steered treatment in early arthritis patients, there was limited SHS progression in only a small group of patients. Numerically, patients who had achieved early DAS remission had more SHS progression than other patients. Positivity for both anti-CarP and ACPA and age were independently associated with SHS progression. TRIAL REGISTRATION NUMBERS ISRCTN Register number 11916566 and EudraCT number 2006 06186-16.
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Affiliation(s)
- Gülşah Akdemir
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - Marije K Verheul
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - Lotte Heimans
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | | | | | | | - Joop B Harbers
- Department of Rheumatology , Franciscus Hospital , Roosendaal , The Netherlands
| | - Casper Bijkerk
- Department of Rheumatology , Reinier de Graaf Gasthuis , Delft , The Netherlands
| | | | - Leroy R Lard
- Department of Rheumatology , Medical Center Haaglanden , Leidschendam , The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - Leendert A Trouw
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
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