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Wang X, Nai YH, Gan J, Lian CPL, Ryan FK, Tan FSL, Chan DYS, Ng JJ, Lo ZJ, Chong TT, Hausenloy DJ. Multi-Modality Imaging of Atheromatous Plaques in Peripheral Arterial Disease: Integrating Molecular and Imaging Markers. Int J Mol Sci 2023; 24:11123. [PMID: 37446302 DOI: 10.3390/ijms241311123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Peripheral artery disease (PAD) is a common and debilitating condition characterized by the narrowing of the limb arteries, primarily due to atherosclerosis. Non-invasive multi-modality imaging approaches using computed tomography (CT), magnetic resonance imaging (MRI), and nuclear imaging have emerged as valuable tools for assessing PAD atheromatous plaques and vessel walls. This review provides an overview of these different imaging techniques, their advantages, limitations, and recent advancements. In addition, this review highlights the importance of molecular markers, including those related to inflammation, endothelial dysfunction, and oxidative stress, in PAD pathophysiology. The potential of integrating molecular and imaging markers for an improved understanding of PAD is also discussed. Despite the promise of this integrative approach, there remain several challenges, including technical limitations in imaging modalities and the need for novel molecular marker discovery and validation. Addressing these challenges and embracing future directions in the field will be essential for maximizing the potential of molecular and imaging markers for improving PAD patient outcomes.
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Affiliation(s)
- Xiaomeng Wang
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
| | - Ying-Hwey Nai
- Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore
| | - Julian Gan
- Siemens Healthineers, Singapore 348615, Singapore
| | - Cheryl Pei Ling Lian
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Fraser Kirwan Ryan
- Infocomm Technology Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Forest Su Lim Tan
- Infocomm Technology Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Dexter Yak Seng Chan
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
| | - Jun Jie Ng
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore 119074, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore 258499, Singapore
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore 168752, Singapore
- Surgical Academic Clinical Programme, Singapore General Hospital, Singapore 169608, Singapore
- Vascular SingHealth Duke-NUS Disease Centre, Singapore 168752, Singapore
| | - Derek John Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore 169609, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore 117597, Singapore
- The Hatter Cardiovascular Institute, University College London, London WC1E 6HX, UK
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2
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Boswijk E, de Ligt M, Habets MFJ, Mingels AMA, van Marken Lichtenbelt WD, Mottaghy FM, Schrauwen P, Wildberger JE, Bucerius J. Resveratrol treatment does not reduce arterial inflammation in males at risk of type 2 diabetes: a randomized crossover trial. Nuklearmedizin 2021; 61:33-41. [PMID: 34918332 DOI: 10.1055/a-1585-7215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Resveratrol has shown promising anti-inflammatory effects in in vitro and animal studies. We aimed to investigate this effect on arterial inflammation in vivo. METHODS This was an additional analysis of a double-blind randomized crossover trial which included eight male subjects with decreased insulin sensitivity who underwent an 18F-fluoroxyglucose (18F-FDG) PET/CT after 34 days of placebo and resveratrol treatment (150 mg/day). 18F-FDG uptake was analyzed in the carotid arteries and the aorta, adipose tissue regions, spleen, and bone marrow as measures for arterial and systemic inflammation. Maximum target-to-background ratios (TBRmax) were compared between resveratrol and placebo treatment with the non-parametric Wilcoxon signed-rank test. Median values are shown with their interquartile range. RESULTS Arterial 18F-FDG uptake was non-significantly higher after resveratrol treatment (TBRmax all vessels 1.7 (1.6-1.7)) in comparison to placebo treatment (1.5 (1.4-1.6); p=0.050). Only in visceral adipose tissue, the increase in 18F-FDG uptake after resveratrol reached statistical significance (p=0.024). Furthermore, CRP-levels were not significantly affected by resveratrol treatment (p=0.091). CONCLUSIONS Resveratrol failed to attenuate arterial or systemic inflammation as measured with 18F-FDG PET in subjects at risk of developing type 2 diabetes. However, validation of these findings in larger human studies is needed.
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Affiliation(s)
- Ellen Boswijk
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Marlies de Ligt
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
| | - Marie-Fleur J Habets
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
| | - Alma M A Mingels
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht UMC+, Maastricht, Netherlands
| | - Wouter D van Marken Lichtenbelt
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
| | - Felix M Mottaghy
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, Netherlands.,Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany
| | - Patrick Schrauwen
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Jan Bucerius
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands.,Department of Nuclear Medicine, Universitätsmedizin Göttingen, Gottingen, Germany
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3
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Zhou W, Dey A, Manyak G, Teklu M, Patel N, Teague H, Mehta NN. The application of molecular imaging to advance translational research in chronic inflammation. J Nucl Cardiol 2021; 28:2033-2045. [PMID: 33244675 PMCID: PMC8149483 DOI: 10.1007/s12350-020-02439-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/17/2020] [Indexed: 01/23/2023]
Abstract
Over the past several decades, molecular imaging techniques to assess cellular processes in vivo have been integral in advancing our understanding of disease pathogenesis. 18F-fluorodeoxyglucose (18-FDG) positron emission tomography (PET) imaging in particular has shaped the field of atherosclerosis research by highlighting the importance of underlying inflammatory processes that are responsible for driving disease progression. The ability to assess physiology using molecular imaging, combining it with anatomic delineation using cardiac coronary angiography (CCTA) and magnetic resonance imaging (MRI) and lab-based techniques, provides a powerful combination to advance both research and ultimately clinical care. In this review, we demonstrate how molecular imaging studies, specifically using 18-FDG PET, have revealed that early vascular disease is a systemic process with multiple, concurrent biological mechanisms using inflammatory diseases as a basis to understand early atherosclerotic mechanisms in humans.
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Affiliation(s)
- Wunan Zhou
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
- Cardiovascular Branch, NHLBI, 10 Center Drive, CRC, Room 5-5140, Bethesda, MD, 20892, USA
| | - Amit Dey
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Grigory Manyak
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Meron Teklu
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Nidhi Patel
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Heather Teague
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Nehal N Mehta
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA.
- Cardiovascular Branch, NHLBI, 10 Center Drive, CRC, Room 5-5140, Bethesda, MD, 20892, USA.
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4
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Evans NR, Tarkin JM, Walsh J, Chowdhury MM, Patterson AJ, Graves MJ, Rudd JHF, Warburton EA. Carotid Atheroinflammation Is Associated With Cerebral Small Vessel Disease Severity. Front Neurol 2021; 12:690935. [PMID: 34531813 PMCID: PMC8438317 DOI: 10.3389/fneur.2021.690935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Atherosclerosis is a systemic inflammatory disease, with common inflammatory processes implicated in both atheroma vulnerability and blood-brain barrier disruption. This prospective multimodal imaging study aimed to measure directly the association between systemic atheroma inflammation (“atheroinflammation”) and downstream chronic cerebral small vessel disease severity. Methods: Twenty-six individuals with ischemic stroke with ipsilateral carotid artery stenosis of >50% underwent 18fluoride-fluorodeoxyglucose-positron emission tomography within 2 weeks of stroke. Small vessel disease severity and white matter hyperintensity volume were assessed using 3-tesla magnetic resonance imaging also within 2 weeks of stroke. Results: Fluorodeoxyglucose uptake was independently associated with more severe small vessel disease (odds ratio 6.18, 95% confidence interval 2.1–18.2, P < 0.01 for the non-culprit carotid artery) and larger white matter hyperintensity volumes (coefficient = 14.33 mL, P < 0.01 for the non-culprit carotid artery). Conclusion: These proof-of-concept results have important implications for our understanding of the neurovascular interface and potential therapeutic exploitation in the management of systemic atherosclerosis, particularly non-stenotic disease previously considered asymptomatic, in order to reduce the burden of chronic cerebrovascular disease.
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Affiliation(s)
- Nicholas R Evans
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Jason M Tarkin
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jessica Walsh
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | | | - Andrew J Patterson
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Martin J Graves
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Elizabeth A Warburton
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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5
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Cho SG, Kong EJ, Kang WJ, Paeng JC, Bom HSH, Cho I. KSNM60 in Cardiology: Regrowth After a Long Pause. Nucl Med Mol Imaging 2021; 55:151-161. [PMID: 34422125 PMCID: PMC8322215 DOI: 10.1007/s13139-021-00702-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/09/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022] Open
Abstract
The Korean Society of Nuclear Medicine (KSNM) is celebrating its 60th anniversary in honor of the nuclear medicine professionals who have dedicated their efforts towards research, academics, and the more comprehensive clinical applications and uses of nuclear imaging modalities. Nuclear cardiology in Korea was at its prime time in the 1990s, but its growth was interrupted by a long pause. Despite the academic and practical challenges, nuclear cardiology in Korea now meets the second leap, attributed to the growth in molecular imaging tailored for many non-coronary diseases and the genuine values of nuclear myocardial perfusion imaging. In this review, we describe the trends, achievements, challenges, and perspectives of nuclear cardiology throughout the 60-year history of the KSNM.
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Affiliation(s)
- Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Eun Jung Kong
- Department of Nuclear Medicine, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415 Republic of Korea
| | - Won Jun Kang
- Department of Nuclear Medicine, Yonsei University Severance Hospital, Seoul, Republic of Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee-Seung Henry Bom
- 5Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea
| | - Ihnho Cho
- Department of Nuclear Medicine, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415 Republic of Korea
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6
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Cho YS, Bae JH, Moon SH, Hyun SH, Choi JY, Kim BT, Lee KH. Serum uric acid in asymptomatic adults is weakly associated with carotid artery FDG uptake but not intima-media thickness. J Nucl Cardiol 2020; 27:1537-1546. [PMID: 30155781 DOI: 10.1007/s12350-018-1424-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/24/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study investigated the association of serum uric acid (UA) with carotid fluoro-2-deoxyglucose (FDG) uptake as a marker of inflammatory atherosclerosis. METHODS AND RESULTS In this cross-sectional retrospective study of 970 otherwise healthy adults, subjects in the greater serum UA quartiles had higher triglyceride (P < .001), lower high-density lipoprotein cholesterol (P < .05), and lower estimated GFR (P < .001). Mean and maximum Target-to-background ratios (TBRs) of carotid FDG uptake measured by positron emission tomography were significantly increased across greater serum UA quartiles (1.35 and 1.57 for Q1, 1.38 and 1.60 for Q2, 1.39 and 1.62 for Q3, and 1.39 and 1.61 for Q4; P = .001 and < .001). Carotid intima-media thickness was not different. Serum UA showed weak but significant correlations with estimated GFR (P < .001), and with mean (P < .001) and maximum carotid TBR (P = .004). Serum UA correlated with mean TBR in male (P = .008) and female subjects (P = .011), in high (≥ 70; P = .015) and low estimated GFR (< 70; P = .035), and in normotensive (P = .001) but not in hypertensive subjects. CONCLUSIONS Elevated serum UA in asymptomatic adults is associated with increased carotid FDG uptake, which suggests a potential role of UA in carotid inflammatory atherosclerosis.
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Affiliation(s)
- Young Seok Cho
- Department of Nuclear Medicine and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Ji Hoon Bae
- Department of Nuclear Medicine and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Seung Hwan Moon
- Department of Nuclear Medicine and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Seung Hyup Hyun
- Department of Nuclear Medicine and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Joon Young Choi
- Department of Nuclear Medicine and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Byung-Tae Kim
- Department of Nuclear Medicine and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Kyung-Han Lee
- Department of Nuclear Medicine and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea.
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7
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Gelfand JM, Shin DB, Duffin KC, Armstrong AW, Blauvelt A, Tyring SK, Menter A, Gottlieb S, Lockshin BN, Simpson EL, Kianifard F, Sarkar RP, Muscianisi E, Steadman J, Ahlman MA, Playford MP, Joshi AA, Dey AK, Werner TJ, Alavi A, Mehta NN. A Randomized Placebo-Controlled Trial of Secukinumab on Aortic Vascular Inflammation in Moderate-to-Severe Plaque Psoriasis (VIP-S). J Invest Dermatol 2020; 140:1784-1793.e2. [PMID: 32088207 PMCID: PMC7434644 DOI: 10.1016/j.jid.2020.01.025] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 02/08/2023]
Abstract
Psoriasis, a chronic immune-mediated disease, is associated with an increased risk of cardiovascular events and mortality. Secukinumab selectively neutralizes IL-17A and has reported high efficacy with a favorable safety profile in various psoriatic disease manifestations. Subsequent to the 12-week randomized, placebo-controlled, double-blind treatment period, patients with moderate-to-severe psoriasis received secukinumab for 40 weeks. Vascular inflammation using 18F-2-fluorodeoxyglucose-positron emission tomography/computed tomography imaging and blood-based cardiometabolic was assessed at week 0, 12, and 52. The difference in change in aortic inflammation from baseline to week 12 for secukinumab (n = 46) versus placebo (n = 45) was -0.053 (95% confidence interval = -0.169 to 0.064; P= 0.37). Small increases in total cholesterol, low-density lipoprotein, and low-density lipoprotein particles, but no changes in markers of inflammation, adiposity, insulin resistance, or predictors of diabetes, were observed with secukinumab treatment compared with placebo. At week 52, reductions in TNF-α (P= 0.0063) and ferritin (P= 0.0354), and an increase in fetuin-A (P= 0.0024), were observed with secukinumab treatment compared with baseline. No significant changes in aortic inflammation or markers of advanced lipoprotein characterization, adiposity, or insulin resistance were observed with secukinumab treatment compared with baseline. Secukinumab exhibited a neutral impact on aortic vascular inflammation and biomarkers of cardiometabolic disease after 52 weeks of treatment.
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Affiliation(s)
- Joel M Gelfand
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Daniel B Shin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - April W Armstrong
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | | | - Stephen K Tyring
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Alan Menter
- Division of Dermatology, Baylor Scott &White, Dallas, Texas, USA
| | - Scott Gottlieb
- Dermatology and Skin Surgery Center, Exton, Pennsylvania, USA
| | | | - Eric L Simpson
- OSHU Dermatology Clinic, South Waterfront, Portland, Oregon, USA
| | - Farid Kianifard
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | - Elisa Muscianisi
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | - Mark A Ahlman
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Martin P Playford
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Aditya A Joshi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amit K Dey
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Thomas J Werner
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abass Alavi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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8
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Gelfand JM, Shin DB, Alavi A, Torigian DA, Werner T, Papadopoulos M, Takeshita J, Noe MH, Dey AK, Playford MP, Mehta NN. A Phase IV, Randomized, Double-Blind, Placebo-Controlled Crossover Study of the Effects of Ustekinumab on Vascular Inflammation in Psoriasis (the VIP-U Trial). J Invest Dermatol 2020; 140:85-93.e2. [PMID: 31326395 PMCID: PMC6926160 DOI: 10.1016/j.jid.2019.07.679] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/06/2019] [Accepted: 07/03/2019] [Indexed: 02/08/2023]
Abstract
Psoriasis is a T helper type 17 autoimmune disease associated with an increased risk cardiovascular events and mortality. Ustekinumab, an antibody to p40, blocks cytokines IL-12 and IL-23, and is a highly effective and safe treatment for psoriasis. We conducted a randomized double-blinded placebo-controlled trial to determine the effect of ustekinumab on aortic vascular inflammation (AVI) measured by imaging, and key biomarkers of inflammation, lipid, and glucose metabolism in the blood of patients with moderate-to-severe psoriasis. A total of 43 patients were randomized, and at week 12, ustekinumab-treated patients had a -18.65% (95% confidence interval = -29.45% to -7.85%) reduction in AVI, a reduction in inflammatory biomarkers, and an increase in apolipoprotein B lipoproteins compared with placebo. At week 12, placebo patients were crossed over such that all patients received ustekinumab for 52 weeks. At the end of 52 weeks of ustekinumab treatment, there was no change in AVI compared with baseline, inflammatory markers were reduced, and there were increases in selected measures of lipids and leptin. These results show that blockade of IL-12 and/or IL-23 may transiently reduce AVI, with more durable reduction in inflammatory cytokines associated with cardiovascular disease.
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Affiliation(s)
- Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Daniel B Shin
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abass Alavi
- Department of Radiology (Nuclear Medicine), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Drew A Torigian
- Department of Radiology (Nuclear Medicine), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tom Werner
- Department of Radiology (Nuclear Medicine), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maryte Papadopoulos
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Junko Takeshita
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Megan H Noe
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amit K Dey
- Section of Inflammation and Cardiometabolic Diseases, National Heart Lung Blood Institute, Bethesda, Maryland, USA
| | - Martin P Playford
- Section of Inflammation and Cardiometabolic Diseases, National Heart Lung Blood Institute, Bethesda, Maryland, USA
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart Lung Blood Institute, Bethesda, Maryland, USA
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9
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Joshi AA, Lerman JB, Dey AK, Sajja AP, Belur AD, Elnabawi YA, Rodante JA, Aberra TM, Chung J, Salahuddin T, Natarajan B, Dave J, Goyal A, Groenendyk JW, Rivers JP, Baumer Y, Teague HL, Playford MP, Bluemke DA, Ahlman MA, Chen MY, Gelfand JM, Mehta NN. Association Between Aortic Vascular Inflammation and Coronary Artery Plaque Characteristics in Psoriasis. JAMA Cardiol 2019; 3:949-956. [PMID: 30208407 DOI: 10.1001/jamacardio.2018.2769] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Inflammation is critical to atherosclerosis. Psoriasis, a chronic inflammatory disease associated with early cardiovascular events and increased aortic vascular inflammation (VI), provides a model to study the process of early atherogenesis. Fludeoxyglucose F 18 positron emission tomography/computed tomography (18F-FDG PET/CT) helps quantify aortic VI, and coronary computed tomography angiography provides coronary artery disease (CAD) assessment through evaluation of total plaque burden (TB) and noncalcified coronary plaque burden (NCB), luminal stenosis, and high-risk plaques (HRP). To our knowledge, association between aortic VI and broad CAD indices has not yet been assessed in a chronic inflammatory disease state. Such a study may provide information regarding the utility of aortic VI in capturing early CAD. Objective To assess the association between aortic VI and CAD indices, including TB, NCB, luminal stenosis, and HRP prevalence, in psoriasis. Design, Setting, and Participants In a cross-sectional cohort study at the National Institutes of Health, 215 consecutive patients with psoriasis were recruited from surrounding outpatient dermatology practices. All patients underwent 18F-FDG PET/CT for aortic VI assessment, and 190 of 215 patients underwent coronary computed tomography angiography to characterize CAD. The study was conducted between January 1, 2013, and May 31, 2017. Data were analyzed in March 2018. Exposures Aortic VI assessed by 18F-FDG PET/CT. Main Outcomes and Measures Primary outcome: TB and NCB. Secondary outcomes: luminal stenosis and HRP. Results Among 215 patients with psoriasis (mean [SD] age, 50.4 [12.6] years; 126 men [59%]), patients with increased aortic VI had increased TB (standardized β = 0.48; P < .001), and higher prevalence of luminal stenosis (OR, 3.63; 95% CI, 1.71-7.70; P = .001) and HRP (OR, 3.05; 95% CI, 1.42-6.47; P = .004). The aortic VI and TB association was primarily driven by NCB (β = 0.49; P < .001), whereas the aortic VI and HRP association was driven by low-attenuation plaque (OR, 5.63; 95% CI, 1.96-16.19; P = .001). All associations of aortic VI remained significant after adjustment for cardiovascular risk factors: aortic VI and TB (β = 0.23; P < .001), NCB (β = 0.24; P < .001), luminal stenosis (OR, 3.40; 95% CI, 1.40-8.24; P = .007), and HRP (OR, 2.72; 95% CI, 1.08-6.83; P = .03). No association was found between aortic VI and dense-calcified coronary plaque burden. Conclusions and Relevance Aortic VI is associated with broad CAD indices, suggesting that aortic VI may be a surrogate for early CAD. Larger prospective studies need to assess these associations longitudinally and examine treatment effects on these outcomes.
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Affiliation(s)
- Aditya A Joshi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joseph B Lerman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amit K Dey
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Aparna P Sajja
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Agastya D Belur
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Youssef A Elnabawi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Justin A Rodante
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Tsion M Aberra
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Jonathan Chung
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Taufiq Salahuddin
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Balaji Natarajan
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Jenny Dave
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Aditya Goyal
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Jacob W Groenendyk
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joshua P Rivers
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Yvonne Baumer
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Heather L Teague
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Martin P Playford
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Mark A Ahlman
- Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Research Center, Bethesda, Maryland
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania, Philadelphia.,The Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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10
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Chou TH, Stacy MR. Clinical Applications for Radiotracer Imaging of Lower Extremity Peripheral Arterial Disease and Critical Limb Ischemia. Mol Imaging Biol 2019; 22:245-255. [PMID: 31482412 DOI: 10.1007/s11307-019-01425-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Peripheral arterial disease (PAD) is an atherosclerotic occlusive disease of the non-coronary vessels that is characterized by lower extremity tissue ischemia, claudication, increased prevalence of lower extremity wounds and amputations, and impaired quality of life. Critical limb ischemia (CLI) represents the severe stage of PAD and is associated with additional risk for wound formation, amputation, and premature death. Standard clinical tools utilized for assessing PAD and CLI primarily focus on anatomical evaluation of peripheral vascular lesions or hemodynamic assessment of the peripheral circulation. Evaluation of underlying pathophysiology has traditionally been achieved by radiotracer-based imaging, with many clinical investigations focusing on imaging of skeletal muscle perfusion and cases of foot infection/inflammation such as osteomyelitis and Charcot neuropathic osteoarthropathy. As advancements in hybrid imaging systems and radiotracers continue to evolve, opportunities for molecular imaging of PAD and CLI are also emerging that may offer novel insight into associated complications such as peripheral atherosclerosis, alterations in skeletal muscle metabolism, and peripheral neuropathy. This review summarizes the pros and cons of radiotracer-based techniques that have been utilized in the clinical environment for evaluating lower extremity ischemia and common pathologies associated with PAD and CLI.
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Affiliation(s)
- Ting-Heng Chou
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, WB4131, Columbus, OH, 43215, USA
| | - Mitchel R Stacy
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, WB4131, Columbus, OH, 43215, USA. .,Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.
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11
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Dey AK, Joshi AA, Chaturvedi A, Lerman JB, Aberra TM, Rodante JA, Teague HL, Harrington CL, Rivers JP, Chung JH, Kabbany MT, Natarajan B, Silverman JI, Ng Q, Sanda GE, Sorokin AV, Baumer Y, Gerson E, Prussick RB, Ehrlich A, Green LJ, Lockshin BN, Ahlman MA, Playford MP, Gelfand JM, Mehta NN. Association Between Skin and Aortic Vascular Inflammation in Patients With Psoriasis: A Case-Cohort Study Using Positron Emission Tomography/Computed Tomography. JAMA Cardiol 2019; 2:1013-1018. [PMID: 28564678 DOI: 10.1001/jamacardio.2017.1213] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Inflammation is critical in the development of atherosclerosis. Psoriasis is a chronic inflammatory skin disease that is associated with increased vascular inflammation by 18fluorodeoxyglucose positron emission tomography/computed tomography in vivo and future cardiovascular events. It provides a human model to understand the effect of treating inflammation in a target organ (eg, the skin) on vascular diseases. Objective To investigate the association between change in skin disease severity and change in vascular inflammation at 1 year and to characterize the impact of 1 year of anti-tumor necrosis factor therapy on vascular inflammation. Design, Setting, and Participants In this prospective cohort study, 220 participants from outpatient practices were recruited at the US National Institutes of Health. A total of 115 consecutively recruited patients with psoriasis were followed up at 1 year. The study was conducted from January 1, 2013, through October 31, 2016, with data analyzed in November 2016. Exposure Skin inflammation measured as Psoriasis Area and Severity Index (PASI) score. Main Outcomes and Measures Vascular inflammation assessed as target-to-background ratio by 18fluorodeoxyglucose positron emission tomography/computed tomography. Results Among the 115 patients, the mean (SD) age at 1-year follow-up was 50.8 (12.8) years and 68 were men (59%). The cohort had a low cardiovascular risk by Framingham risk score and mild-to-moderate psoriasis, with a median PASI score of 5.2 (interquartile range, 3.0-8.9). At follow-up, the total cohort had a median improvement in PASI score of 33%, with use of topical therapy (60%), biological therapy (66%, mostly anti-tumor necrosis factor) and phototherapy (15%) (P < .001). Moreover, improvement in PASI score was associated with improvement in target-to-background ratio of 6%, mainly driven by those with higher responses in PASI score (P < .001). This association persisted beyond traditional risk factors (β = 0.19; 95% CI, 0.012-0.375; P = .03) and was the strongest in those initiated with anti-tumor necrosis factor therapy (β = 0.79; 95% CI, 0.269-1.311; P = .03). Conclusions and Relevance Improvement in psoriasis skin disease severity was associated with improvement in aortic vascular inflammation by 18fluorodeoxyglucose positron emission tomography/computed tomography, with greater improvement in aortic vascular inflammation observed in those who had higher than 75% reduction in skin disease severity. These findings suggest that controlling remote target organ inflammation (eg, in the skin) may improve vascular diseases; however, randomized clinical trials are needed to confirm these findings.
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Affiliation(s)
- Amit K Dey
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Aditya A Joshi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Abhishek Chaturvedi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joseph B Lerman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Tsion M Aberra
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Justin A Rodante
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Heather L Teague
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Charlotte L Harrington
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joshua P Rivers
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Jonathan H Chung
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Mohammad Tarek Kabbany
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Balaji Natarajan
- University of Arizona College of Medicine at South Campus, Tucson
| | - Joanna I Silverman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Qimin Ng
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Gregory E Sanda
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Alexander V Sorokin
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Yvonne Baumer
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Emily Gerson
- Chevy Chase Dermatology Associates, Chevy Chase, Maryland
| | - Ronald B Prussick
- Department of Dermatology, George Washington Hospital, Washington, DC
| | - Alison Ehrlich
- Department of Dermatology, George Washington Hospital, Washington, DC
| | - Lawrence J Green
- Department of Dermatology, George Washington Hospital, Washington, DC
| | | | - Mark A Ahlman
- Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Research Center, Bethesda, Maryland
| | - Martin P Playford
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania, Philadelphia.,The Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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12
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Goyal A, Dey AK, Chaturvedi A, Elnabawi YA, Aberra TM, Chung JH, Belur AD, Groenendyk JW, Lerman JB, Rivers JP, Rodante JA, Harrington CL, Varghese NJ, Sanda GE, Baumer Y, Sorokin AV, Teague HL, Genovese LD, Natarajan B, Joshi AA, Playford MP, Bluemke DA, Chen MY, Alavi A, Pitman RK, Powell-Wiley TM, Tawakol A, Gelfand JM, Mehta NN. Chronic Stress-Related Neural Activity Associates With Subclinical Cardiovascular Disease in Psoriasis: A Prospective Cohort Study. JACC Cardiovasc Imaging 2018; 13:465-477. [PMID: 30448131 DOI: 10.1016/j.jcmg.2018.08.038] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/13/2018] [Accepted: 08/24/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study hypothesized that there is an association between chronic stress (as indexed by resting amygdalar activity [AmygA]), hematopoietic system activity (HMPA), and subclinical cardiovascular indexes (aortic vascular inflammation [VI] and noncalcified coronary plaque burden [NCB]) in psoriasis (PSO). The study also hypothesized that treatment of PSO would improve these parameters. BACKGROUND PSO is a stress-related chronic inflammatory condition that is associated with increased prevalence of subclinical cardiovascular disease (CVD). In individuals without PSO, stress has been linked to CVD through a serial biological pathway that involves the amygdala, hematopoietic tissues, and atherosclerotic plaques. METHODS A total of 164 consecutive patients with PSO and 47 healthy volunteers underwent 18-fluorodeoxyglucose positron emission tomography/computed tomography scans for assessment of AmygA, HMPA, and VI, as well as coronary computed tomography angiography scans for quantifying NCB. Furthermore, a consecutive subset of 30 patients with severe PSO (Psoriasis Area Severity Index Score >10) were followed at 1 year to assess the relationship between skin disease improvement and AmygA, HMPA, VI, and NCB. RESULTS The PSO cohort was middle-aged (mean age: 50 years), had low cardiovascular risk (Framingham risk score: median: 3) and had mild to moderate PSO activity (median Psoriasis Area Severity Index Score: 5.6). AmygA was higher in patients with PSO compared to volunteer participants. AmygA was associated with HMPA (bone marrow activity: β = 0.20, p = 0.01) and subclinical CVD (VI: β = 0.31, p < 0.001; NCB: β = 0.27, p < 0.001) The AmygA-CVD association was in part mediated by HMPA (VI: 20.9%, NCB: 36.7%). Following 1 year of PSO treatment in those with severe disease, improvement in skin disease was accompanied by a reduction in AmygA, bone marrow activity, and VI, with no progression of NCB. CONCLUSIONS In PSO, a chronic inflammatory disease state, AmygA, which is a manifestation of chronic stress, substantially contributes to the risk of subclinical CVD. Additional studies that use psychometric measures of stress are required to explore therapeutic impact.
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Affiliation(s)
- Aditya Goyal
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amit K Dey
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Abhishek Chaturvedi
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Youssef A Elnabawi
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Tsion M Aberra
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Jonathan H Chung
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Agastya D Belur
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Jacob W Groenendyk
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joseph B Lerman
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joshua P Rivers
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Justin A Rodante
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Charlotte L Harrington
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Nevin J Varghese
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Gregory E Sanda
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Yvonne Baumer
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Alexander V Sorokin
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Heather L Teague
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Leonard D Genovese
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Balaji Natarajan
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Aditya A Joshi
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Martin P Playford
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Marcus Y Chen
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roger K Pitman
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Ahmed Tawakol
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joel M Gelfand
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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13
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Lee YB, Choi KM. Diet-Modulated Lipoprotein Metabolism and Vascular Inflammation Evaluated by 18F-fluorodeoxyglucose Positron Emission Tomography. Nutrients 2018; 10:nu10101382. [PMID: 30274193 PMCID: PMC6212959 DOI: 10.3390/nu10101382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/17/2018] [Accepted: 09/23/2018] [Indexed: 02/06/2023] Open
Abstract
Vascular inflammation plays a central role in atherosclerosis, from initiation and progression to acute thrombotic complications. Modified low-density lipoproteins (LDLs) and apoB-containing particles stimulate plaque inflammation by interacting with macrophages. Loss of function of high-density lipoprotein (HDL) for preventing LDL particles from oxidative modification in dyslipidemic states may amplify modified LDL actions, accelerating plaque inflammation. Diets are one of the most important factors that can affect these processes of lipoprotein oxidation and vascular inflammation. Recently, 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has emerged as a reliable noninvasive imaging modality for identifying and quantifying vascular inflammation within atherosclerotic lesions based on the high glycolytic activity of macrophages infiltrating active atherosclerotic plaques. Vascular inflammation evaluated by FDG PET has been positively related to metabolic syndrome components and traditional risk factors of cardiovascular disease, including high-sensitivity C-reactive protein, body mass index, and insulin resistance. A positive association of vascular inflammation with endothelial dysfunction, resistin levels, pericardial adipose tissue, and visceral fat area has also been reported. In contrast, HDL cholesterol and adiponectin have been inversely related to vascular inflammation detected by FDG PET. Because of its reproducibility, serial FDG PET shows potential for tracking the effects of dietary interventions and other systemic and local antiatherosclerotic therapies for plaque inflammation.
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Affiliation(s)
- You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea.
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea.
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14
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Mehta NN. Positron Emission Tomography Assessment of Left Main Coronary Arterial Inflammation With Coronary Computed Tomographic Angiography Validation Before and After Statin Therapy: More Promise for Fluorodeoxyglucose Vascular Uptake? Circ Cardiovasc Imaging 2018; 9:CIRCIMAGING.116.005745. [PMID: 27956410 DOI: 10.1161/circimaging.116.005745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nehal N Mehta
- From the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
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15
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Malhotra S, Kaur S, Shafiq N, Dogra S, Mittal BR, Attri S, Bahl A, Narang T, Vinay K, Rajagopalan S. 18F-fluorodeoxyglucose positron emission tomography-based evaluation of systemic and vascular inflammation and assessment of the effect of systemic treatment on inflammation in patients with moderate-to-severe psoriasis: A randomized placebo-controlled pilot study. Indian J Dermatol Venereol Leprol 2018; 84:660-666. [DOI: 10.4103/ijdvl.ijdvl_717_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Liberale L, Dallegri F, Carbone F, Montecucco F. Pathophysiological relevance of macrophage subsets in atherogenesis. Thromb Haemost 2017; 117:7-18. [PMID: 27683760 DOI: 10.1160/th16-08-0593] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/12/2016] [Indexed: 12/14/2022]
Abstract
SummaryMacrophages are highly heterogeneous and plastic cells. They were shown to play a critical role in all stages of atherogenesis, from the initiation to the necrotic core formation and plaque rupture. Lesional macrophages primarily derive from blood monocyte, but local macrophage proliferation as well as differentiation from smooth muscle cells have also been described. Within atherosclerotic plaques, macrophages rapidly respond to changes in the microenvironment, shifting between pro- (M1) or anti-inflammatory (M2) functional phenotypes. Furthermore, different stimuli have been associated with differentiation of newly discovered M2 subtypes: IL-4/IL-13 (M2a), immunecomplex (M2b), IL-10/glucocorticoids (M2c), and adenosine receptor agonist (M2d). More recently, additional intraplaque macrophage phenotypes were also recognized in response to CXCL4 (M4), oxidized phospholipids (Mox), haemoglobin/haptoglobin complexes (HAmac/M(Hb)), and heme (Mhem). Such macrophage polarization was described as a progression among multiple phenotypes, which reflect the activity of different transcriptional factors and the cross-talk between intracellular signalling. Finally, the distribution of macrophage subsets within different plaque areas was markedly associated with cardiovascular (CV) vulnerability. The aim of this review is to update the current knowledge on the role of macrophage subsets in atherogenesis. In addition, the molecular mechanisms underlying macrophage phenotypic shift will be summarised and discussed. Finally, the role of intraplaque macrophages as predictors of CV events and the therapeutic potential of these cells will be discussed.
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17
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Variability in quantitative analysis of atherosclerotic plaque inflammation using 18F-FDG PET/CT. PLoS One 2017; 12:e0181847. [PMID: 28800625 PMCID: PMC5553940 DOI: 10.1371/journal.pone.0181847] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 07/08/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND 18F-FDG-PET(/CT) is increasingly used in studies aiming at quantifying atherosclerotic plaque inflammation. Considerable methodological variability exists. The effect of data acquisition and image analysis parameters on quantitative uptake measures, such as standardized uptake value (SUV) and target-to-background ratio (TBR) has not been investigated extensively. OBJECTIVE The goal of this study was to explore the effect of several data acquisition and image analysis parameters on quantification of vascular wall 18F-FDG uptake measures, in order to increase awareness of potential variability. METHODS Three whole-body emission scans and a low-dose CT scan were acquired 38, 60 and 90 minutes after injection of 18F-FDG in six rheumatoid arthritis patients with high cardiovascular risk profiles.Data acquisition (1 and 2) and image analysis (3, 4 and 5) parameters comprised:1. 18F-FDG uptake time, 2. SUV normalisation, 3. drawing regions/volumes of interest (ROI's/VOI's) according to: a. hot-spot (HS), b. whole-segment (WS) and c. most-diseased segment (MDS), 4. Background activity, 5. Image matrix/voxel size.Intraclass correlation coefficients (ICC's) and Bland Altman plots were used to assess agreement between these techniques and between observers. A linear mixed model was used to determine the association between uptake time and continuous outcome variables. RESULTS 1. Significantly higher TBRmax values were found at 90 minutes (1,57 95%CI 1,35-1,80) compared to 38 minutes (1,30 95%CI 1,21-1,39) (P = 0,024) 2. Normalising SUV for BW, LBM and BSA significantly influences average SUVmax (2,25 (±0,60) vs 1,67 (±0,37) vs 0,058 (±0,013)). 3. Intraclass correlation coefficients were high in all vascular segments when SUVmax HS was compared to SUVmax WS. SUVmax HS was consistently higher than SUVmax MDS in all vascular segments. 4. Blood pool activity significantly decreases in all (venous and arterial) segments over time, but does not differ between segments. 5. Image matrix/voxel size does not influence SUVmax. CONCLUSION Quantitative measures of vascular wall 18F-FDG uptake are affected mainly by changes in data acquisition parameters. Standardization of methodology needs to be considered when studying atherosclerosis and/or vasculitis.
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18
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Potential of α7 nicotinic acetylcholine receptor PET imaging in atherosclerosis. Methods 2017; 130:90-104. [PMID: 28602809 DOI: 10.1016/j.ymeth.2017.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/02/2017] [Accepted: 06/06/2017] [Indexed: 02/07/2023] Open
Abstract
Atherosclerotic events are usually acute and often strike otherwise asymptomatic patients. Although multiple clinical risk factors have been associated with atherosclerosis, as of yet no further individual prediction can be made as to who will suffer from its consequences based on biomarker analysis or traditional imaging methods like CT, MRI or angiography. Previously, non-invasive imaging with 18F-fluorodeoxyglucose (18F-FDG) PET was shown to potentially fill this niche as it offers high sensitive detection of metabolic processes associated with inflammatory changes in atherosclerotic plaques. However, 18F-FDG PET imaging of arterial vessels suffers from non-specificity and has still to be proven to reliably identify vulnerable plaques, carrying a high risk of rupture. Therefore, it may be regarded only as a secondary marker for monitoring treatment effects and it does not offer alternative treatment options or direct insight in treatment mechanisms. In this review, an overview is given of the current status and the potential of PET imaging of inflammation and angiogenesis in atherosclerosis in general and special emphasis is given to imaging of α7 nicotinic acetylcholine receptors (α7 nAChRs). Due to the gaps that still exist in our understanding of atherogenesis and the limitations of the available PET tracers, the search continues for a more specific radioligand, able to differentiate between stable atherosclerosis and plaques prone to rupture. The potential role of the α7 nAChR as imaging marker for plaque vulnerability is explored. Today, strong evidence exists that nAChRs are involved in the atherosclerotic disease process. They are suggested to mediate the deleterious effects of the major tobacco component, nicotine, a nAChR agonist. Mainly based on in vitro data, α7 nAChR stimulation might increase plaque burden via increased neovascularization. However, in animal studies, α7 nAChR manipulation appears to reduce plaque size due to its inhibitory effects on inflammatory cells. Thus, reliable identification of α7 nAChRs by in vivo imaging is crucial to investigate the exact role of α7 nAChR in atherosclerosis before any therapeutic approach in the human setting can be justified. In this review, we discuss the first experience with α7 nAChR PET tracers and developmental considerations regarding the "optimal" PET tracer to image vascular nAChRs.
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19
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Harrington CL, Dey AK, Yunus R, Joshi AA, Mehta NN. Psoriasis as a human model of disease to study inflammatory atherogenesis. Am J Physiol Heart Circ Physiol 2017; 312:H867-H873. [PMID: 28258057 DOI: 10.1152/ajpheart.00774.2016] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/24/2017] [Accepted: 02/24/2017] [Indexed: 02/08/2023]
Abstract
Inflammation is known to play a significant role in the process of atherogenesis and cardiovascular disease (CVD). Indeed, patients with chronic inflammatory diseases are at increased risk for cardiovascular events. However, the mechanisms linking chronic inflammation and CVD remain poorly understood. Psoriasis, a chronic inflammatory skin disease associated with a greater risk of early cardiovascular events, provides a suitable human model to study the pathophysiology of inflammatory atherogenesis in humans. Additionally, cytokines such as TNF-α, IL-17A, and other immune pathways are the common links between the pathogenesis of psoriasis and atherosclerosis, and hence the approved treatments for psoriasis, which include selective cytokine inhibition (e.g., anti-TNF, anti-IL-17A, and anti-IL-12/23) and immune modulation (e.g., methotrexate or cyclosporine), provide an opportunity to examine the effect of modulating these pathways on atherogenesis. We have been using this human model in a large, prospective cohort study, and this review summarizes our approach and results of using this human model to study inflammatory atherogenesis. Specifically, we review simultaneous multimodal imaging of several vascular beds using 18fludeoxyglucose positron emission tomography/computed tomography, 18fludeoxyglucose positron emission tomography/MRI, and coronary computed tomography angiography as well as cardiovascular biomarkers to better understand how modulation of inflammation may impact vascular diseases.
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Affiliation(s)
- Charlotte L Harrington
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; and
| | - Amit K Dey
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; and
| | - Raza Yunus
- Department of Medicine, The George Washington University, Washington, District of Columbia
| | - Aditya A Joshi
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; and
| | - Nehal N Mehta
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; and .,Department of Medicine, The George Washington University, Washington, District of Columbia
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Chaturvedi A, Dey AK, Joshi AA, Mehta NN. Vascular Inflammation Imaging in Psoriasis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9401-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Thresholds for Arterial Wall Inflammation Quantified by 18F-FDG PET Imaging: Implications for Vascular Interventional Studies. JACC Cardiovasc Imaging 2016; 9:1198-1207. [PMID: 27639759 PMCID: PMC5056585 DOI: 10.1016/j.jcmg.2016.04.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 03/22/2016] [Accepted: 04/21/2016] [Indexed: 11/26/2022]
Abstract
Objectives This study assessed 5 frequently applied arterial 18fluorodeoxyglucose (18F-FDG) uptake metrics in healthy control subjects, those with risk factors and patients with cardiovascular disease (CVD), to derive uptake thresholds in each subject group. Additionally, we tested the reproducibility of these measures and produced recommended sample sizes for interventional drug studies. Background 18F-FDG positron emission tomography (PET) can identify plaque inflammation as a surrogate endpoint for vascular interventional drug trials. However, an overview of 18F-FDG uptake metrics, threshold values, and reproducibility in healthy compared with diseased subjects is not available. Methods 18F-FDG PET/CT of the carotid arteries and ascending aorta was performed in 83 subjects (61 ± 8 years) comprising 3 groups: 25 healthy controls, 23 patients at increased CVD risk, and 35 patients with known CVD. We quantified 18F-FDG uptake across the whole artery, the most-diseased segment, and within all active segments over several pre-defined cutoffs. We report these data with and without background corrections. Finally, we determined measurement reproducibility and recommended sample sizes for future drug studies based on these results. Results All 18F-FDG uptake metrics were significantly different between healthy and diseased subjects for both the carotids and aorta. Thresholds of physiological 18F-FDG uptake were derived from healthy controls using the 90th percentile of their target to background ratio (TBR) value (TBRmax); whole artery TBRmax is 1.84 for the carotids and 2.68 in the aorta. These were exceeded by >52% of risk factor patients and >67% of CVD patients. Reproducibility was excellent in all study groups (intraclass correlation coefficient >0.95). Using carotid TBRmax as a primary endpoint resulted in sample size estimates approximately 20% lower than aorta. Conclusions We report thresholds for physiological 18F-FDG uptake in the arterial wall in healthy subjects, which are exceeded by the majority of CVD patients. This remains true, independent of readout vessel, signal quantification method, or the use of background correction. We also confirm the high reproducibility of 18F-FDG PET measures of inflammation. Nevertheless, because of overlap between subject categories and the relatively small population studied, these data have limited generalizability until substantiated in larger, prospective event-driven studies. (Vascular Inflammation in Patients at Risk for Atherosclerotic Disease; NTR5006)
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Abstract
Peripheral vascular disease (PVD) is a progressive atherosclerotic disease that leads to stenosis or occlusion of blood vessels supplying the lower extremities. Current diagnostic imaging techniques commonly focus on evaluation of anatomy or blood flow at the macrovascular level and do not permit assessment of the underlying pathophysiology associated with disease progression or treatment response. Molecular imaging with radionuclide-based approaches can offer novel insight into PVD by providing noninvasive assessment of biological processes such as angiogenesis and atherosclerosis. This article discusses emerging radionuclide-based imaging approaches that have potential clinical applications in the evaluation of PVD progression and treatment.
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Affiliation(s)
- Mitchel R Stacy
- Department of Internal Medicine, Yale University School of Medicine, PO Box 208017, Dana-3, New Haven, CT 06520, USA.
| | - Albert J Sinusas
- Department of Internal Medicine, Yale University School of Medicine, PO Box 208017, Dana-3, New Haven, CT 06520, USA; Department of Diagnostic Radiology, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520, USA
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Quirce R, Martínez-Rodríguez I, Banzo I, Jiménez-Bonilla J, Martínez-Amador N, Ibáñez-Bravo S, López-Defilló J, Jiménez-Alonso M, Revilla MA, Carril JM. New insight of functional molecular imaging into the atheroma biology: 18F-NaF and 18F-FDG in symptomatic and asymptomatic carotid plaques after recent CVA. Preliminary results. Clin Physiol Funct Imaging 2015; 36:499-503. [DOI: 10.1111/cpf.12254] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 03/17/2015] [Indexed: 02/02/2023]
Affiliation(s)
- R. Quirce
- Nuclear Medicine and Molecular Imaging Service; University Hospital “Marqués de Valdecilla”; University of Cantabria; Santander Spain
| | - I. Martínez-Rodríguez
- Nuclear Medicine and Molecular Imaging Service; University Hospital “Marqués de Valdecilla”; University of Cantabria; Santander Spain
| | - I. Banzo
- Nuclear Medicine and Molecular Imaging Service; University Hospital “Marqués de Valdecilla”; University of Cantabria; Santander Spain
| | - J. Jiménez-Bonilla
- Nuclear Medicine and Molecular Imaging Service; University Hospital “Marqués de Valdecilla”; University of Cantabria; Santander Spain
| | - N. Martínez-Amador
- Nuclear Medicine and Molecular Imaging Service; University Hospital “Marqués de Valdecilla”; University of Cantabria; Santander Spain
| | - S. Ibáñez-Bravo
- Nuclear Medicine and Molecular Imaging Service; University Hospital “Marqués de Valdecilla”; University of Cantabria; Santander Spain
| | - J. López-Defilló
- Nuclear Medicine and Molecular Imaging Service; University Hospital “Marqués de Valdecilla”; University of Cantabria; Santander Spain
| | - M. Jiménez-Alonso
- Nuclear Medicine and Molecular Imaging Service; University Hospital “Marqués de Valdecilla”; University of Cantabria; Santander Spain
| | - M. A. Revilla
- Neurology Service; University Hospital “Marqués de Valdecilla”; IDIVAL; Santander Spain
| | - J. M. Carril
- Nuclear Medicine and Molecular Imaging Service; University Hospital “Marqués de Valdecilla”; University of Cantabria; Santander Spain
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Thukkani AK, Jaffer FA. Molecular Imaging. Atherosclerosis 2015. [DOI: 10.1002/9781118828533.ch39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Huet P, Burg S, Le Guludec D, Hyafil F, Buvat I. Variability and uncertainty of 18F-FDG PET imaging protocols for assessing inflammation in atherosclerosis: suggestions for improvement. J Nucl Med 2015; 56:552-9. [PMID: 25722452 DOI: 10.2967/jnumed.114.142596] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/13/2015] [Indexed: 12/26/2022] Open
Abstract
UNLABELLED PET with (18)F-FDG shows promise for the evaluation of metabolic activities in atherosclerotic plaques. Although recommendations regarding the acquisition and measurement protocols to be used for (18)F-FDG PET imaging of atherosclerosis inflammation have been published, there is no consensus regarding the most appropriate protocols, and the image reconstruction approach has been especially overlooked. Given the small size of the targeted lesions, the reconstruction and measurement methods might strongly affect the results. We determined the differences in results due to the protocol variability and identified means of increasing the measurement reliability. METHODS An extensive literature search was performed to characterize the variability in atherosclerosis imaging and quantification protocols. Highly realistic simulations of atherosclerotic carotid lesions based on real patient data were designed to determine how the acquisition and processing protocol parameters affected the measured values. RESULTS In 49 articles, we identified 53 different acquisition protocols, 51 reconstruction protocols, and 46 quantification methods to characterize atherosclerotic lesions from (18)F-FDG PET images. The most important parameters affecting the measurement accuracy were the number of iterations used for reconstruction and the postfiltering applied to the reconstructed images, which could together make the measured standardized uptake values (SUVs) vary by a factor greater than 3. Image sampling, acquisition duration, and metrics used for the measurements also affected the results to a lesser extent (SUV varying by a factor of 1.3 at most). For an acceptable SUV variability, the lowest bias in SUV was observed using an 8-min acquisition per bed position; ordered-subset expectation maximization reconstruction with at least 120 maximum likelihood expectation maximization equivalent iterations, including a point spread function model using a 1 mm(3) voxel size; and no postfiltering. Because of the partial-volume effect, measurement bias remained greater than 60%. The use and limitations of the target-to-blood activity ratio metrics are also presented and discussed. CONCLUSION (18)F-FDG PET protocol harmonization is needed in atherosclerosis imaging. Optimized protocols can significantly reduce the measurement errors in wall activity estimates, but PET systems with higher spatial resolution and advanced partial-volume corrections will be required to accurately assess plaque inflammation from (18)F-FDG PET.
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Affiliation(s)
- Pauline Huet
- U1023 Inserm/CEA/Paris Sud University-ERL 9218 CNRS, CEA-SHFJ, Orsay, France IMNC UMR 8165 CNRS, Paris Sud University, Orsay, France; and
| | - Samuel Burg
- Department of Nuclear Medicine, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, UMR 1148, Inserm and Paris Diderot-Paris 7 University, Département Hospitalo-Universitaire Fire, Paris, France
| | - Dominique Le Guludec
- Department of Nuclear Medicine, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, UMR 1148, Inserm and Paris Diderot-Paris 7 University, Département Hospitalo-Universitaire Fire, Paris, France
| | - Fabien Hyafil
- Department of Nuclear Medicine, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, UMR 1148, Inserm and Paris Diderot-Paris 7 University, Département Hospitalo-Universitaire Fire, Paris, France
| | - Irène Buvat
- U1023 Inserm/CEA/Paris Sud University-ERL 9218 CNRS, CEA-SHFJ, Orsay, France
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Skagen K, Johnsrud K, Evensen K, Scott H, Krohg-Sørensen K, Reier-Nilsen F, Revheim ME, Fjeld JG, Skjelland M, Russell D. Carotid plaque inflammation assessed with (18)F-FDG PET/CT is higher in symptomatic compared with asymptomatic patients. Int J Stroke 2015; 10:730-6. [PMID: 25588553 DOI: 10.1111/ijs.12430] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/05/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Carotid artery plaque inflammation is thought to be an important marker of plaque vulnerability and increased stroke risk. AIM The main aim of this study was to assess the level of agreement between 2-deoxy-2-[(18)F] fluoro-D-glucose (18F-FDG) uptake on PET (positron emission tomography) scan in carotid plaques, with cerebrovascular symptoms, carotid plaque ultrasound echogenicity and histological assessments of plaque inflammation. METHODS Thirty-six patients with ≥70% carotid stenosis scheduled for carotid endarterectomy underwent a Colour Duplex ultrasound, (18)F-FDG PET/CT and blood tests less than 24 h prior to surgery. Plaques were defined as symptomatic when associated with ipsilateral cerebral ischemic symptoms within 30 days prior to inclusion. Plaques were assessed histologically following endarterectomy. The level of agreement between (18)F-FDG uptake (mean SUVmax and SUVmax ), and target-to-background ratio, symptoms, plaque echolucency, and histological evidence of inflammation was assessed. RESULTS The amount of (18)F-FDG uptake in plaques and the amount of inflammation on histological assessment were significantly correlated (r = 0·521, P = 0·003). (18)F-FDG uptake was significantly higher in symptomatic plaques with median SUVmax 1·75 (1·26-2·04) in symptomatic, and 1·43 (1·15-2·28) in asymptomatic patients (P = 0·03). (18)F-FDG uptake was also positively correlated with echolucency on Doppler ultrasound (P = 0·03). CONCLUSION (18)F-FDG uptake on PET/CT correlated with histological assessments of inflammation and was higher in patients with symptomatic compared with asymptomatic carotid artery plaques. These results support the use of (18)F-FDG PET/CT in the detection inflammation in carotid atherosclerosis, which may be of help in the detection of vulnerable plaques.
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Affiliation(s)
- Karolina Skagen
- Department of Neurology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Kjersti Johnsrud
- Department of Radiology and Nuclear Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Kristin Evensen
- Department of Neurology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Helge Scott
- Department of Pathology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Kirsten Krohg-Sørensen
- Department of Thoracic Surgery, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Frode Reier-Nilsen
- Department of Vascular and Thoracic surgery, Akershus University Hospital, Oslo, Norway
| | | | - Jan Gunnar Fjeld
- Department of Radiology and Nuclear Medicine, Oslo University Hospital and Akershus University College of Applied Sciences, Oslo, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - David Russell
- Department of Neurology, Oslo University Hospital and University of Oslo, Oslo, Norway
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Mateo J, Bilbao I, Vaquero JJ, Ruiz-Cabello J, España S. In Vivo ¹⁸F-FDG-PET Imaging in Mouse Atherosclerosis. Methods Mol Biol 2015; 1339:377-386. [PMID: 26445805 DOI: 10.1007/978-1-4939-2929-0_28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Positron emission tomography (PET) is an important technique in cardiovascular research. Vascular inflammation detected by fluorodeoxyglucose (FDG)-PET has been shown to predict cardiovascular (CV) events independent of traditional risk factors and is also highly associated with overall burden of atherosclerosis. The use of PET imaging in mouse models of atherosclerosis is challenged by the reduced size of the scanned organs. However, the last generation of dedicated PET scanners has an improved spatial resolution (<1 mm) and increased sensitivity allowing those studies to be performed. Here, we describe a procedure to perform FDG-PET experiments in atherosclerosis mouse models, the required equipment for animal handling and imaging, and the tools and procedures for image analysis and validation of the results.
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Affiliation(s)
- Jesús Mateo
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Izaskun Bilbao
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- Universidad Complutense de Madrid and CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Juan José Vaquero
- Departamento de Bioingeniería & Ingeniería Aeroespacial, Universidad Carlos III Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Jesús Ruiz-Cabello
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- Departamento de Bioingeniería & Ingeniería Aeroespacial, Universidad Carlos III Madrid, Madrid, Spain
| | - Samuel España
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
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Abstract
[(18)F]-fluorodeoxyglucose PET ((18)FDG PET) imaging has emerged as a promising tool for assessment of atherosclerosis. By targeting atherosclerotic plaque glycolysis, a marker for plaque inflammation and hypoxia, (18)FDG PET can assess plaque vulnerability and potentially predict risk of atherosclerosis-related disease, such as stroke and myocardial infarction. With excellent reproducibility, (18)FDG PET can be a surrogate end point in clinical drug trials, improving trial efficiency. This article summarizes key findings in the literature, discusses limitations of (18)FDG PET imaging of atherosclerosis, and reports recommendations to optimize imaging protocols.
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Affiliation(s)
- Björn A Blomberg
- Department of Nuclear Medicine, Odense University Hospital, Søndre Boulevard 29, 5000 Odense, Denmark; Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Molecular imaging of plaques in coronary arteries with PET and SPECT. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2014; 11:259-73. [PMID: 25278976 PMCID: PMC4178519 DOI: 10.11909/j.issn.1671-5411.2014.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 08/15/2014] [Accepted: 08/19/2014] [Indexed: 01/26/2023]
Abstract
Coronary artery disease remains a major cause of mortality. Presence of atherosclerotic plaques in the coronary artery is responsible for lumen stenosis which is often used as an indicator for determining the severity of coronary artery disease. However, the degree of coronary lumen stenosis is not often related to compromising myocardial blood flow, as most of the cardiac events that are caused by atherosclerotic plaques are the result of vulnerable plaques which are prone to rupture. Thus, identification of vulnerable plaques in coronary arteries has become increasingly important to assist identify patients with high cardiovascular risks. Molecular imaging with use of positron emission tomography (PET) and single photon emission computed tomography (SPECT) has fulfilled this goal by providing functional information about plaque activity which enables accurate assessment of plaque stability. This review article provides an overview of diagnostic applications of molecular imaging techniques in the detection of plaques in coronary arteries with PET and SPECT. New radiopharmaceuticals used in the molecular imaging of coronary plaques and diagnostic applications of integrated PET/CT and PET/MRI in coronary plaques are also discussed.
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Lee SJ, Thien Quach CH, Jung KH, Paik JY, Lee JH, Park JW, Lee KH. Oxidized low-density lipoprotein stimulates macrophage 18F-FDG uptake via hypoxia-inducible factor-1α activation through Nox2-dependent reactive oxygen species generation. J Nucl Med 2014; 55:1699-705. [PMID: 25214643 DOI: 10.2967/jnumed.114.139428] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
UNLABELLED For (18)F-FDG PET to be widely used to monitor atherosclerosis progression and therapeutic response, it is crucial to better understand how macrophage glucose metabolism is influenced by the atherosclerotic microenvironment and to elucidate the molecular mechanisms of this response. Oxidized low-density lipoprotein (oxLDL) is a key player in atherosclerotic inflammation that promotes macrophage recruitment, activation, and foam cell formation. We thus explored the effect of oxLDL on macrophage (18)F-FDG uptake and investigated the underlying molecular mechanism including the roles of hypoxia-inducible factor-1α (HIF-1α) and reactive oxygen species (ROS). METHODS RAW264.7 macrophages were stimulated with native LDL, oxLDL, or lipopolysaccharide. Cells were assessed for (18)F-FDG uptake, lactate production, membrane glucose transporter 1 (GLUT1) expression, and hexokinase activity. ROS generation, Nox expression, and HIF-1α activity were also measured. RESULTS oxLDL (20 μg/mL) induced a 17.5 ± 1.7-fold increase in macrophage (18)F-FDG uptake by 24 h, which was accompanied by increased lactate production, membrane GLUT1 expression, and hexokinase activity. oxLDL-stimulated (18)F-FDG uptake was completely blocked by inhibitors of Src or phosphoinositide 3-kinase. ROS generation was increased to 262.4% ± 17.9% of controls by oxLDL, and N-acetyl-l-cysteine completely abrogated both oxLDL-induced ROS production and (18)F-FDG uptake. oxLDL increased Nox2 expression, and nicotinamide adenine dinucleotide phosphate oxidase inhibition totally blocked increased ROS generation and (18)F-FDG uptake by oxLDL. Finally, there was a clear ROS-dependent increase of HIF-1α accumulation by oxLDL, and silencing of HIF-1α completely abolished the metabolic effect of oxLDL. CONCLUSION oxLDL is a strong stimulator of macrophage (18)F-FDG uptake and glycolysis through upregulation of GLUT1 and hexokinase. This metabolic response is mediated by Nox2-dependent ROS generation that promotes HIF-1α activation.
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Affiliation(s)
- Su Jin Lee
- Department of Nuclear Medicine, Ajou University School of Medicine, Suwon, Korea; and
| | - Cung Hoa Thien Quach
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Ho Jung
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Young Paik
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Hee Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Won Park
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Han Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sannino A, Brevetti L, Giugliano G, Scudiero F, Toscano E, Mainolfi C, Cuocolo A, Perrino C, Stabile E, Trimarco B, Esposito G. Non-invasive vulnerable plaque imaging: how do we know that treatment works? Eur Heart J Cardiovasc Imaging 2014; 15:1194-202. [PMID: 24876097 DOI: 10.1093/ehjci/jeu097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Atherosclerosis is an inflammatory disorder that can evolve into an acute clinical event by plaque development, rupture, and thrombosis. Plaque vulnerability represents the susceptibility of a plaque to rupture and to result in an acute cardiovascular event. Nevertheless, plaque vulnerability is not an established medical diagnosis, but rather an evolving concept that has gained attention to improve risk prediction. The availability of high-resolution imaging modalities has significantly facilitated the possibility of performing in vivo regression studies and documenting serial changes in plaque stability. This review summarizes the currently available non-invasive methods to identify vulnerable plaques and to evaluate the effects of the current cardiovascular treatments on plaque evolution.
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Affiliation(s)
- Anna Sannino
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Linda Brevetti
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Giuseppe Giugliano
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Fernando Scudiero
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Evelina Toscano
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Ciro Mainolfi
- Nuclear Medicine, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Alberto Cuocolo
- Nuclear Medicine, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Cinzia Perrino
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Eugenio Stabile
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Bruno Trimarco
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Giovanni Esposito
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
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Lee DH, Lee SJ, Lee DJ, Kwon SH, Jo KS, An YS, Yoon JK. Carotid Artery FDG Uptake May Serve as a Biomarker for Cardiovascular Risk Stratification in Asymptomatic Adults. Nucl Med Mol Imaging 2014; 48:196-202. [PMID: 25177376 DOI: 10.1007/s13139-014-0277-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 03/31/2014] [Accepted: 04/09/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE We investigated the relation between carotid artery FDG uptake and cardiovascular risk based on the Framingham risk score (FRS) and evaluated the possible role of FDG uptake in terms of risk stratification of asymptomatic adults. METHODS We evaluated 290 adults who underwent FDG PET/CT as part of general health screens. We calculated target-to-background ratios, corrected for pre-scan blood glucose levels, and obtained "TBRglu" values for both common carotid arteries. The FRS and the presence/absence of metabolic syndrome were recorded for each subject. Relationships among TBRglu values, metabolic syndrome status, and clinical parameters were assessed. RESULTS Carotid artery FDG uptake was significantly associated with clinical risk factors. Stepwise multiple regression analysis revealed that triglyceride levels, diabetes, and metabolic syndrome were independent determinants of high TBRglu. Of subjects with metabolic syndrome, those exhibiting high carotid artery FDG uptake had significantly higher levels of high sensitivity C-reactive protein (hsCRP). In subjects who did not have metabolic syndrome, FRSs were significantly elevated in those exhibiting high carotid artery FDG uptake compared to those with low uptake (13.1 ± 7.0 vs. 8.2 ± 7.4), as was also true of subjects with the syndrome (21.8 ± 16.0 vs. 13.5 ± 11.9). CONCLUSION High carotid FDG uptake is significantly associated with clinical risk factors and a greater FRS. Of subjects with metabolic syndrome, those with high carotid uptake had significantly higher hsCRP concentrations and FRSs. Therefore, carotid artery FDG activity may serve as a possible biomarker allowing cardiovascular risk stratification of asymptomatic populations.
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Affiliation(s)
- Dong Hyun Lee
- Departments of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 443-380 Republic of Korea
| | - Su Jin Lee
- Departments of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 443-380 Republic of Korea
| | - Duck-Joo Lee
- Family Practice and Community Health, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Soo Hyun Kwon
- Departments of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 443-380 Republic of Korea
| | - Kyung-Sook Jo
- Departments of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 443-380 Republic of Korea
| | - Young-Sil An
- Departments of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 443-380 Republic of Korea
| | - Joon-Kee Yoon
- Departments of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 443-380 Republic of Korea
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Kang S, Kyung C, Park JS, Kim S, Lee SP, Kim MK, Kim HK, Kim KR, Jeon TJ, Ahn CW. Subclinical vascular inflammation in subjects with normal weight obesity and its association with body fat: an 18 F-FDG-PET/CT study. Cardiovasc Diabetol 2014; 13:70. [PMID: 24708764 PMCID: PMC3994236 DOI: 10.1186/1475-2840-13-70] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 03/22/2014] [Indexed: 12/16/2022] Open
Abstract
Background Although body mass index (BMI) is the most widely accepted parameter for defining obesity, recent studies have indicated a unique set of patients who exhibit normal BMI and excess body fat (BF), which is termed as normal weight obesity (NWO). Increased BF is an established risk factor for atherosclerosis. However, it is unclear whether NWO subjects already have a higher degree of vascular inflammation compared to normal weight lean (NWL) subjects; moreover, the association of BF with vascular inflammation in normal weight subjects is largely unknown. Methods NWO and NWL subjects (n = 82 in each group) without any history of significant vascular disease were identified from a 3-year database of consecutively recruited patients undergoing 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG-PET/CT) at a self-referred Healthcare Promotion Program. The degree of subclinical vascular inflammation was evaluated using the mean and maximum target-to-background ratios (TBRmean and TBRmax) of the carotid artery, which were measured by 18 F-FDG-PET/CT (a noninvasive tool for assessing vascular inflammation). Results We found that metabolically dysregulation was greater in NWO subjects than in NWL subjects, with a significantly higher blood pressure, higher fasting glucose level, and worse lipid profile. Moreover, NWO subjects exhibited higher TBR than NWL subjects (TBRmean: 1.33 ± 0.16 versus 1.45 ± 0.19, p < 0.001; TBRmax: 1.52 ± 0.23 versus 1.67 ± 0.25, p < 0.001). TBR was significantly associated with total BF (TBRmean: r = 0.267, p = 0.001; TBRmax: r = 0.289, p < 0.001), age (TBRmean: r = 0.170, p = 0.029; TBRmax: r = 0.165, p = 0.035), BMI (TBRmean: r = 0.184, p = 0.018; TBRmax: r = 0.206, p = 0.008), and fasting glucose level (TBRmean: r = 0.157, p = 0.044; TBRmax: r = 0.182, p = 0.020). In multiple linear regression analysis, BF was an independent determinant of TBRmean and TBRmax, after adjusting for age, BMI, and fasting glucose level (TBRmean: regression coefficient = 0.020, p = 0.008; TBRmax: regression coefficient = 0.028, p = 0.005). Compared to NWL, NWO was also independently associated with elevated TBRmax values, after adjusting for confounding factors (odds ratio = 2.887, 95% confidence interval 1.206–6.914, p = 0.017). Conclusions NWO is associated with a higher degree of subclinical vascular inflammation, of which BF is a major contributing factor. These results warrant investigations for subclinical atherosclerosis in NWO patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Tae Joo Jeon
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, Korea.
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Delayed time-point 18F-FDG PET CT imaging enhances assessment of atherosclerotic plaque inflammation. Nucl Med Commun 2014; 34:860-7. [PMID: 23799532 DOI: 10.1097/mnm.0b013e3283637512] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the ideal circulation time of fluorine-18 fluorodeoxyglucose (F-FDG) in order to detect and quantify atherosclerotic plaque inflammation with PET computed tomography (CT) imaging. METHODS Fifteen patients underwent multiple time-point imaging at ∼60, 120, and 180 min after F-FDG administration. For each time point, global assessment of aortic and carotid F-FDG uptake was determined qualitatively by visual assessment and semiquantitatively by calculation of the mean and maximum standardized uptake values (SUV) and the corresponding target-to-background ratio (TBR). RESULTS Delayed imaging achieved significant improvement in visualization of atherosclerotic plaque inflammation [Friedman's χ statistic (d.f.=2, n=15)=24.13, P<0.001, Kendall's W=0.80]. This observation was confirmed by semiquantitative image analysis. At 1 h, the aortic and carotid SUVmean-calculated TBR was 1.05 [95% confidence interval (CI)=0.98, 1.11] and 0.88 (95% CI=0.81, 0.96), respectively. At 3 h, the TBR significantly increased to 1.57 (95% CI=1.28, 1.86; P=0.001) for the aorta and to 1.61 (95% CI=1.36, 1.87; P<0.001) for the carotid arteries. SUVmax-calculated TBRs showed a similar increase over time. CONCLUSION One- and 2-h F-FDG PET CT imaging is suboptimal for global assessment of atherosclerotic plaque inflammation compared with imaging at 3 h. Our data support the utilization of 3-h delayed imaging to obtain optimal data for the detection and quantification of atherosclerotic plaque inflammation in human arteries.
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Hess S, Blomberg BA, Zhu HJ, Høilund-Carlsen PF, Alavi A. The pivotal role of FDG-PET/CT in modern medicine. Acad Radiol 2014; 21:232-49. [PMID: 24439337 DOI: 10.1016/j.acra.2013.11.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/30/2013] [Accepted: 11/01/2013] [Indexed: 12/21/2022]
Abstract
The technology behind positron emission tomography (PET) and the most widely used tracer, 2-deoxy-2-[18F]fluoro-D-glucose (FDG), were both conceived in the 1970s, but the latest decade has witnessed a rapid emergence of FDG-PET as an effective imaging technique. This is not least due to the emergence of hybrid scanners combining PET with computed tomography (PET/CT). Molecular imaging has enormous potential for advancing biological research and patient care, and FDG-PET/CT is currently the most widely used technology in this domain. In this review, we discuss contemporary applications of FDG-PET and FDG-PET/CT as well as novel developments in quantification and potential future indications including the emerging new modality PET/magnetic resonance imaging.
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Jezovnik MK, Zidar N, Lezaic L, Gersak B, Poredos P. Identification of Inflamed Atherosclerotic Lesions In Vivo Using PET-CT. Inflammation 2013; 37:426-34. [DOI: 10.1007/s10753-013-9755-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Update on the use of PET radiopharmaceuticals in inflammatory disease. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Martínez-Rodríguez I, Carril JM. [Update on the use of PET radiopharmaceuticals in inflammatory disease]. Rev Esp Med Nucl Imagen Mol 2013; 32:378-86. [PMID: 24028819 DOI: 10.1016/j.remn.2013.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 07/04/2013] [Accepted: 07/06/2013] [Indexed: 10/26/2022]
Abstract
The use of molecular imaging with PET/CT technology using different radiotracers, especially the (18)F-FDG is currently spreading beyond the area of oncology, the most interest being placed on inflammatory and infectious diseases. This article presents a review of its contribution in different inflammatory conditions in the context of structural and conventional nuclear medicine imaging. Special emphasis is placed on the more significant diseases such as large-vessel vasculitis, sarcoidosis, rheumatoid arthritis and inflammatory bowel disease and the study of the atheroma plaque.
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Affiliation(s)
- I Martínez-Rodríguez
- Servicio de Medicina Nuclear, Hospital Universitario «Marqués de Valdecilla», Universidad de Cantabria, Santander, España.
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Marzola M, Saboury B, Chondrogiannis S, Rampin L, Grassetto G, Ferretti A, Alavi A, Rubello D. Role of FDG PET/CT in investigating the mechanisms underlying atherosclerotic plaque formation and evolution. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Marzola M, Saboury B, Chondrogiannis S, Rampin L, Grassetto G, Ferretti A, Alavi A, Rubello D. Role of FDG PET/CT in investigating the mechanisms underlying atherosclerotic plaque formation and evolution. Rev Esp Med Nucl Imagen Mol 2013; 32:246-52. [DOI: 10.1016/j.remn.2013.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/30/2013] [Accepted: 04/04/2013] [Indexed: 01/06/2023]
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Vijayakumar J, Subramanian S, Singh P, Corsini E, Fontanez S, Lawler M, Kaplan R, Brady TJ, Hoffmann U, Tawakol A. Arterial inflammation in bronchial asthma. J Nucl Cardiol 2013; 20:385-95. [PMID: 23526296 DOI: 10.1007/s12350-013-9697-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 02/13/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Bronchial asthma is a chronic inflammatory condition associated with increased cardiovascular (CV) events. Here, we assess arterial inflammation, using 18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging (FDG-PET/CT), in patients with bronchial asthma and low to intermediate Framingham risk scores (FRS). METHODS A total of 102 patients underwent FDG-PET/CT imaging for clinical indications. Thirty-four patients (mean age 54.9 ± 16.1) with mild asthma and no known atherosclerotic disease were compared to 2 non-asthmatic groups. The first control group (n = 34) were matched by age, gender, and FRS. The second control group (n = 34) had clinical atherosclerosis and were matched by gender. Thereafter, arterial FDG uptake on PET images was determined, while blinded to patient identifiers. RESULTS Target-to-background-ratio (TBR) in the aorta was higher in asthmatics vs non-asthmatic FRS-matched controls (1.96 ± 0.26 vs 1.76 ± 0.20; P < .001). The aortic TBR remained elevated in asthmatics vs non-asthmatic controls after adjusting traditional CV risk factors (P < .001). An inverse correlation was observed between FDG uptake and lung function, FEV1 (P = .02) and peak flow (P = .03). CONCLUSIONS Bronchial asthma is associated with increased arterial inflammation beyond that estimated by current risk stratification tools. Further studies are required to evaluate whether attenuation of systemic inflammation will decrease CV events.
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Affiliation(s)
- Jayanthi Vijayakumar
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
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Casciani E, De Vincentiis C, Colaiacomo MC, Gualdi GF. Multi-modal imaging technologies in cardiovascular risk assessment. Ther Apher Dial 2013; 17:138-49. [PMID: 23551670 DOI: 10.1111/j.1744-9987.2012.01132.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Atherosclerotic plaques can be responsible for life-threatening cardiovascular and cerebrovascular events. Some features of the plaque, such as a thin fibrous cap, large necrotic core, macrophage infiltration, neovascularization, and intraplaque hemorrhage, are associated with a major risk of such events and so their assessment is fundamental. Novel imaging techniques, each one with its own strength and drawbacks, can help in the evaluation and quantification of atherosclerosis. An analysis of the recent literature was carried out. The different techniques were compared by evaluating the accuracy of each one in the detection and assessment of the atherosclerotic plaque's features named above.
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Affiliation(s)
- Emanuele Casciani
- Emergency Department, Sant'andrea's Hospital, University of Rome La Sapienza, Rome, Italy.
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Hag AMF, Ripa RS, Pedersen SF, Bodholdt RP, Kjaer A. Small animal positron emission tomography imaging and in vivo studies of atherosclerosis. Clin Physiol Funct Imaging 2013; 33:173-85. [PMID: 23522010 DOI: 10.1111/cpf.12017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/30/2012] [Indexed: 12/31/2022]
Abstract
Atherosclerosis is a growing health challenge globally, and despite our knowledge of the disease has increased over the last couple of decades, many unanswered questions remain. As molecular imaging can be used to visualize, characterize and measure biological processes at the molecular and cellular levels in living systems, this technology represents an opportunity to investigate some of these questions in vivo. In addition, molecular imaging may be translated into clinical use and eventually pave the way for more personalized treatment regimes in patients. Here, we review the current knowledge obtained from in vivo positron emission tomography studies of atherosclerosis performed in small animals.
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Affiliation(s)
- Anne Mette Fisker Hag
- Cluster for Molecular Imaging, Faculty of Health and Medical Sciences, Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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Long-term changes of aortic 18F-FDG uptake and calcification in health-screening subjects. Ann Nucl Med 2012; 27:239-46. [DOI: 10.1007/s12149-012-0679-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 12/11/2012] [Indexed: 11/24/2022]
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Hyafil F, Feldman L, Le Guludec D, Fayad ZA. Evaluating Efficacy of Pharmaceutical Interventions in Atherosclerosis: Role of Magnetic Resonance Imaging and Positron Emission Tomography. ACTA ACUST UNITED AC 2012; 79:689-704. [DOI: 10.1002/msj.21349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Cocker MS, Mc Ardle B, Spence JD, Lum C, Hammond RR, Ongaro DC, McDonald MA, deKemp RA, Tardif JC, Beanlands RSB. Imaging atherosclerosis with hybrid [18F]fluorodeoxyglucose positron emission tomography/computed tomography imaging: what Leonardo da Vinci could not see. J Nucl Cardiol 2012; 19:1211-25. [PMID: 23073913 PMCID: PMC3510422 DOI: 10.1007/s12350-012-9631-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Prodigious efforts and landmark discoveries have led toward significant advances in our understanding of atherosclerosis. Despite significant efforts, atherosclerosis continues globally to be a leading cause of mortality and reduced quality of life. With surges in the prevalence of obesity and diabetes, atherosclerosis is expected to have an even more pronounced impact upon the global burden of disease. It is imperative to develop strategies for the early detection of disease. Positron emission tomography (PET) imaging utilizing [(18)F]fluorodeoxyglucose (FDG) may provide a non-invasive means of characterizing inflammatory activity within atherosclerotic plaque, thus serving as a surrogate biomarker for detecting vulnerable plaque. The aim of this review is to explore the rationale for performing FDG imaging, provide an overview into the mechanism of action, and summarize findings from the early application of FDG PET imaging in the clinical setting to evaluate vascular disease. Alternative imaging biomarkers and approaches are briefly discussed.
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Affiliation(s)
- Myra S. Cocker
- Molecular Function and Imaging Program, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
| | - Brian Mc Ardle
- Molecular Function and Imaging Program, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
| | - J. David Spence
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, University of Western Ontario, 1400 Western Road, London, ON Canada
| | - Cheemun Lum
- Interventional & Diagnostic Neuroradiology, Department of Radiology, The Ottawa
Hospital, University of Ottawa, Civic Campus, Diagnostic Imaging, K1Y 4E9 Ottawa, ON Canada
| | - Robert R. Hammond
- Departments of Pathology and Clinical Neurological Sciences, London Health Sciences Centre and University of Western Ontario, 339 Windermere Road, N6A 5A5 London, ON Canada
| | - Deidre C. Ongaro
- Molecular Function and Imaging Program, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
| | - Matthew A. McDonald
- Molecular Function and Imaging Program, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
| | - Robert A. deKemp
- Molecular Function and Imaging Program, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
| | | | - Rob S. B. Beanlands
- Molecular Function and Imaging Program, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
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Quillard T, Libby P. Molecular imaging of atherosclerosis for improving diagnostic and therapeutic development. Circ Res 2012; 111:231-44. [PMID: 22773426 DOI: 10.1161/circresaha.112.268144] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite recent progress, cardiovascular and allied metabolic disorders remain a worldwide health challenge. We must identify new targets for therapy, develop new agents for clinical use, and deploy them in a clinically effective and cost-effective manner. Molecular imaging of atherosclerotic lesions has become a major experimental tool in the last decade, notably by providing a direct gateway to the processes involved in atherogenesis and its complications. This review summarizes the current status of molecular imaging approaches that target the key processes implicated in plaque formation, development, and disruption and highlights how the refinement and application of such tools might aid the development and evaluation of novel therapeutics.
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Affiliation(s)
- Thibaut Quillard
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Elkhawad M, Rudd JHF, Sarov-Blat L, Cai G, Wells R, Davies LC, Collier DJ, Marber MS, Choudhury RP, Fayad ZA, Tawakol A, Gleeson FV, Lepore JJ, Davis B, Willette RN, Wilkinson IB, Sprecher DL, Cheriyan J. Effects of p38 mitogen-activated protein kinase inhibition on vascular and systemic inflammation in patients with atherosclerosis. JACC Cardiovasc Imaging 2012; 5:911-22. [PMID: 22974804 DOI: 10.1016/j.jcmg.2012.02.016] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 01/13/2012] [Accepted: 02/29/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study sought to determine the effects of a p38 mitogen-activated protein kinase inhibitor, losmapimod, on vascular inflammation, by (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography imaging. BACKGROUND The p38 mitogen-activated protein kinase cascade plays an important role in the initiation and progression of inflammatory diseases, including atherosclerosis. METHODS Patients with atherosclerosis on stable statin therapy (n = 99) were randomized to receive losmapimod 7.5 mg once daily (lower dose [LD]), twice daily (higher dose [HD]) or placebo for 84 days. Vascular inflammation was assessed by FDG positron emission tomography/computed tomography imaging of the carotid arteries and aorta; analyses focused on the index vessel (the artery with the highest average maximum tissue-to-background ratio [TBR] at baseline). Serum inflammatory biomarkers and FDG uptake in visceral and subcutaneous fat were also measured. RESULTS The primary endpoint, change from baseline in average TBR across all segments in the index vessel, was not significantly different between HD and placebo (ΔTBR: -0.04 [95% confidence interval [CI]: -0.14 to +0.06], p = 0.452) or LD and placebo (ΔTBR: -0.02 [95% CI: -0.11 to +0.06], p = 0.579). However, there was a statistically significant reduction in average TBR in active segments (TBR ≥1.6) (HD vs. placebo: ΔTBR: -0.10 [95% CI: -0.19 to -0.02], p = 0.0125; LD vs. placebo: ΔTBR: -0.10 [95% CI: -0.18 to -0.02], p = 0.0194). The probability of a segment being active was also significantly reduced for HD when compared with placebo (OR: 0.57 [95% CI: 0.41 to 0.81], p = 0.002). Within the HD group, reductions were observed in placebo-corrected inflammatory biomarkers including high-sensitivity C-reactive protein (% reduction: -28% [95% CI: -46 to -5], p = 0.023) as well as FDG uptake in visceral fat (ΔSUV: -0.05 [95% CI: -0.09 to -0.01], p = 0.018), but not subcutaneous fat. CONCLUSIONS Despite nonsignificant changes for the primary endpoint of average vessel TBR, HD losmapimod reduced vascular inflammation in the most inflamed regions, concurrent with a reduction in inflammatory biomarkers and FDG uptake in visceral fat. These results suggest a systemic anti-inflammatory effect. (A Study to Evaluate the Effects of 3 Months Dosing With GW856553, as Assessed FDG-PET/CT Imaging; NCT00633022).
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Affiliation(s)
- Maysoon Elkhawad
- Clinical Pharmacology Unit, University of Cambridge, Cambridge, United Kingdom
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Motegi H, Kuroda S, Nakayama N, Hirata K, Shiga T, Tamaki N. Fluorine-18-fluorodeoxyglucose positron emission tomography may predict the outcome in patients with asymptomatic mild stenosis of internal carotid artery--case report. Neurol Med Chir (Tokyo) 2012; 51:720-3. [PMID: 22027250 DOI: 10.2176/nmc.51.720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 47-year-old male presented with asymptomatic mild (45%) internal carotid artery (ICA) stenosis associated with familial hypercholesterolemia. Fluorine-18-fluorodeoxyglucose ([(18)F]FDG) positron emission tomography (PET) showed that the carotid plaque had high uptake of [(18)F]FDG on the initial scan. He was treated with antiplatelet agent, but subsequently developed retinal artery occlusion on the ipsilateral side. The patient safely underwent carotid endarterectomy (CEA). Histological examination revealed that the plaque was rich in lipids and activated macrophages. Previous large randomized clinical trials have clarified that CEA is an effective therapeutic option to reduce the risk for subsequent ischemic stroke in patients with severe (more than 70%) ICA stenosis. The case strongly suggests that [(18)F]FDG PET may be a useful modality to identify inflamed and/or vulnerable carotid plaque and may be useful to predict the risk for subsequent ischemic stroke even in patients with mild to moderate ICA stenosis (less than 70%).
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Affiliation(s)
- Hiroaki Motegi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, Japan
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