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He XY, Liang JT, Xiao JY, Li X, Zhang XB, Chen DY, Wu LJ. Dahuang Zhechong Pill Improves Pulmonary Fibrosis through miR-29b-2-5p/HK2 Mediated Glycolysis Pathway. Chin J Integr Med 2024:10.1007/s11655-024-3765-x. [PMID: 39231918 DOI: 10.1007/s11655-024-3765-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE To explore the preventive and therapeutic effects of Dahuang Zhechong Pill (DZP) on pulmonary fibrosis and the underlying mechanisms. METHODS The first key rate-limiting enzyme hexokinase 2 (HK2) of glycolysis was silenced and over-expressed through small interfering RNA and lentivirus using lung fibroblast MRC-5 cell line, respectively. The cell viability, migration, invasion and proliferation were detected by cell counting kit-8, wound healing assay, transwell assay, and flow cytometry. The mRNA and protein expression levels of HK2 were detected by RT-PCR and Western blotting, respectively. The contents of glucose, adenosine triphosphate (ATP) and lactate in MRC-5 cells were determined by enzyme-linked immunosorbnent assay (ELISA). Then, the relationship between miR-29b-2-5p and HK2 was explored by luciferase reporter gene assay. Pulmonary fibrosis cell model was induced by transforming growth factor-β 1 (TGF-β 1) in MRC-5 cells, and the medicated serum of DZP (DMS) was prepared in rats. MRC-5 cells were divided into control, TGF-β 1, TGF-β 1+10% DMS, TGF-β 1+10% DMS+miR-29b-2-5p inhibitor, TGF-β 1+10% DMS+inhibitor negative control, TGF-β 1+10% DMS+miR-29b-2-5p mimic and TGF-β 1+10% DMS+mimic negative control groups. After miR-29b-2-5p mimics and inhibitors were transfected into MRC-5 cells, all groups except control and model group were treated with DMS. The effect of DMS on MRC-5 cells were detected using aforementioned methods and immunofluorescence. Similarly, the contents of glucose, ATP and lactate in each group were measured by ELISA. RESULTS The mRNA and protein expressions of HK2 in MRC-5 cells were successfully silenced and overexpressed through si-HK2-3 and lentiviral transfection, respectively. After silencing HK2, the mRNA and protein expressions of HK2 were significantly decreased (P<0.01), and the concentrations of glucose, ATP and lactate were also significantly decreased (P<0.05). The proliferation, migration and invasion of MRC-5 cells were significantly declined (P<0.05 or P<0.01), while the apoptosis of MRC-5 cells was significantly increased (P<0.01). After overexpressing HK2, the mRNA and protein expressions of HK2 were significantly increased (P<0.05), and the concentrations of glucose, ATP and lactate were also significantly increased (P<0.05 or P<0.01). The proliferation, migration and invasion of MRC-5 cells were significantly increased (P<0.05 or P<0.01), while the apoptosis of MRC-5 cells was significantly decreased (P<0.05). The relative luciferase activity of 3'UTR-WT+hsa-miR-29b-2-5p transfected with HK2 was significantly decreased (P<0.01). After miR-29b-2-5p mimic and inhibitor were transfected into the MRC-5 cells, DMS intervention could significantly reduce the concentration of glucose, ATP and lactate, and the mRNA and proteins expressions of HK2, phosphofructokinase and pyruvate kinase isoform M2 (P<0.05 or P<0.01). The proliferation, migration and invasion of MRC-5 cells were alleviated (P<0.05 or P<0.01), and the deposition of fibronectin, α-smooth muscle actin, and collagen I were significantly decreased (P<0.05 or P<0.01). CONCLUSIONS Glycolysis is closely related to pulmonary fibrosis. DZP reduced glycolysis and inhibited fibroblasts' excessive differentiation and abnormal collagen deposition through the miR-29b-2-5p/HK2 pathway, which played a role in delaying the process of pulmonary fibrosis.
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Affiliation(s)
- Xiao-Yan He
- College of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Jing-Tao Liang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Jing-Yi Xiao
- College of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Xin Li
- College of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Xiao-Bo Zhang
- College of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Da-Yi Chen
- College of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Li-Juan Wu
- College of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
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Peng S, Liang Y, Zhu H, Wang Y, Li Y, Zhao Z, Li Y, Zhuang R, Huang L, Zhang X, Guo Z. A nitroreductase responsive probe for early diagnosis of pulmonary fibrosis disease. Redox Biol 2024; 75:103294. [PMID: 39096854 PMCID: PMC11345524 DOI: 10.1016/j.redox.2024.103294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/17/2024] [Accepted: 07/28/2024] [Indexed: 08/05/2024] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a serious interstitial lung disease. However, the definitive diagnosis of IPF is impeded by the limited capabilities of current diagnostic methods, which may fail to capture the optimal timing for treatment. The main goal of this study is to determine the feasibility of a nitroreductase (NTR) responsive probe, 18F-NCRP, for early detection and deterioration monitoring of IPF. 18F-NCRP was obtained with high radiochemical purity (>95 %). BLM-injured mice were established by intratracheal instillation with bleomycin (BLM) and characterized through histological analysis. Longitudinal PET/CT imaging, biodistribution study and in vitro autoradiography were performed. The correlations between the uptake of 18F-NCRP and mean lung density (tested by CT), as well as histopathological characteristics were analyzed. In PET imaging study, 18F-NCRP exhibited promising efficacy in monitoring the progression of IPF, which was earlier than CT. The ratio of uptake in BLM-injured lung to control lung increased from 1.4-fold on D15 to 2.2-fold on D22. Biodistribution data showed a significant lung uptake of 18F-NCRP in BLM-injured mice. There was a strong positive correlation between the 18F-NCRP uptake in the BLM-injured lungs and the histopathological characteristics. Given that, 18F-NCRP PET imaging of NTR, a promising biomarker for investigating the underlying pathogenic mechanism of IPF, is attainable as well as desirable, which might lay the foundation for establishing an NTR-targeted imaging evaluation system of IPF.
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Affiliation(s)
- Shilan Peng
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, 4221-116 Xiang'An South Rd, Xiamen, 361102, China
| | - Yuanyuan Liang
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, 4221-116 Xiang'An South Rd, Xiamen, 361102, China
| | - Haotian Zhu
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, 4221-116 Xiang'An South Rd, Xiamen, 361102, China
| | - Yike Wang
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, 4221-116 Xiang'An South Rd, Xiamen, 361102, China
| | - Yun Li
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, 4221-116 Xiang'An South Rd, Xiamen, 361102, China
| | - Zuoquan Zhao
- Theranostics and Translational Research Center, Institute of Clinical Medicine, Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yesen Li
- Department of Nuclear Medicine & Minnan PET Center, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Rongqiang Zhuang
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, 4221-116 Xiang'An South Rd, Xiamen, 361102, China
| | - Lumei Huang
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, 4221-116 Xiang'An South Rd, Xiamen, 361102, China.
| | - Xianzhong Zhang
- Theranostics and Translational Research Center, Institute of Clinical Medicine, Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Zhide Guo
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, 4221-116 Xiang'An South Rd, Xiamen, 361102, China.
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Liu Y, Tang P, Peng S, Zhong J, Xu Z, Zhong J, Su J, Zhong Y, Hu K. [ 18F]AlF-CBP imaging of type I collagen for non-invasive monitoring of pulmonary fibrosis in preclinical models. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06888-3. [PMID: 39172179 DOI: 10.1007/s00259-024-06888-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 08/14/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE Pulmonary fibrosis is an irreversible scar-forming condition for which there is a lack of non-invasive and specific methods for monitoring its progression and therapy efficacy. However, the disease is known to be accompanied by collagen accumulation. Here, we developed a novel positron emission tomography (PET) probe targeting type I collagen to evaluate its utility for the non-invasive assessment of pulmonary fibrosis. METHODS We designed a 18F-labeled PET probe ([18F]AlF-CBP) to target type I collagen and evaluated its binding affinity, specificity and stability in vitro. PET with [18F]AlF-CBP, CT, histopathology, immunofluorescence, and biochemical indice were performed to assess and quantify type I collagen levels and pulmonary fibrosis progression and treatment in murine models. Dynamic PET/CT studies of [18F]AlF-CBP were conducted to assess lung fibrosis in non-human primate models. RESULTS [18F]AlF-CBP was successfully prepared, and in vitro and in vivo tests showed high stability (> 95%) and type I collagen specificity (IC50 = 0.36 µM). The lungs of the fibrotic murine model showed more elevated probe uptake and retention compared to the control group, and there was a positive correlation between the radioactivity uptake signals and the degree of fibrosis (CT: R2 = 0.89, P < 0.0001; hydroxyproline levels: R2 = 0.89, P < 0.0001). PET signals also correlated well with mean lung density in non-human primate models of pulmonary fibrosis (R2 = 0.84, P < 0.0001). CONCLUSION [18F]AlF-CBP PET imaging is a promising non-invasive method for specific monitoring of lung fibrosis progression and therapy efficacy.
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Affiliation(s)
- Yang Liu
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Peipei Tang
- Department of Rehabilitation Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Simin Peng
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Jinmei Zhong
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zexin Xu
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Jiawei Zhong
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jin Su
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Yuhua Zhong
- Department of Rehabilitation Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Kongzhen Hu
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China.
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Ji H, Song X, Lv X, Shao F, Long Y, Song Y, Song W, Qiao P, Gai Y, Jiang D, Lan X. [ 68Ga]FAPI PET for Imaging and Treatment Monitoring in a Preclinical Model of Pulmonary Fibrosis: Comparison to [ 18F]FDG PET and CT. Pharmaceuticals (Basel) 2024; 17:726. [PMID: 38931393 PMCID: PMC11206307 DOI: 10.3390/ph17060726] [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: 04/14/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE This study aimed to evaluate the feasibility of using [68Ga]-fibroblast-activating protein inhibitor (FAPI) positron emission tomography (PET) imaging for diagnosing pulmonary fibrosis in a mouse model. We also examined its value in monitoring treatment response and compared it with traditional [18F]-fluorodeoxyglucose (FDG) PET and computed tomography (CT) imaging. METHODS A model of idiopathic pulmonary fibrosis was established using intratracheal injection of bleomycin (BLM, 2 mg/kg) into C57BL/6 male mice. For the treatment of IPF, a daily oral dose of 400 mg/kg/day of pirfenidone was administered from 9 to 28 days after the establishment of the model. Disease progression and treatment efficacy were assessed at different stages of the disease every week for four weeks using CT, [18F]FDG PET, and [68Ga]FAPI PET (baseline imaging performed at week 0). Mice were sacrificed and lung tissues were harvested for hematoxylin-eosin staining, picrosirius red staining, and immunohistochemical staining for glucose transporter 1 (GLUT1) and FAP. Expression levels of GLUT1 and FAP in pathological sections were quantified. Correlations between imaging parameters and pathological quantitative values were analyzed. RESULTS CT, [18F]FDG PET and [68Ga]FAPI PET revealed anatomical and functional changes in the lung that reflected progression of pulmonary fibrosis. In untreated mice with pulmonary fibrosis, lung uptake of [18F]FDG peaked on day 14, while [68Ga]FAPI uptake and mean lung density peaked on day 21. In mice treated with pirfenidone, mean lung density and lung uptake of both PET tracers decreased. Mean lung density, [18F]FDG uptake, and [68Ga]FAPI uptake correlated well with quantitative values of picrosirius red staining, GLUT1 expression, and FAP expression, respectively. Conclusions: Although traditional CT and [18F]FDG PET reflect anatomical and metabolic status in fibrotic lung, [68Ga]FAPI PET provides a means of evaluating fibrosis progression and monitoring treatment response.
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Affiliation(s)
- Hao Ji
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xiangming Song
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xiaoying Lv
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Fuqiang Shao
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yu Long
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yangmeihui Song
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenyu Song
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Pengxin Qiao
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yongkang Gai
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Key Laboratory of Biological Targeted Therapy of the Ministry of Education, Wuhan 430022, China
| | - Dawei Jiang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Key Laboratory of Biological Targeted Therapy of the Ministry of Education, Wuhan 430022, China
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Key Laboratory of Biological Targeted Therapy of the Ministry of Education, Wuhan 430022, China
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Leek F, Anderson C, Robinson AP, Moss RM, Porter JC, Garthwaite HS, Groves AM, Hutton BF, Thielemans K. Optimisation of the air fraction correction for lung PET/CT: addressing resolution mismatch. EJNMMI Phys 2023; 10:77. [PMID: 38049611 PMCID: PMC10695904 DOI: 10.1186/s40658-023-00595-y] [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: 09/07/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Increased pulmonary [Formula: see text]F-FDG metabolism in patients with idiopathic pulmonary fibrosis, and other forms of diffuse parenchymal lung disease, can predict measurements of health and lung physiology. To improve PET quantification, voxel-wise air fractions (AF) determined from CT can be used to correct for variable air content in lung PET/CT. However, resolution mismatches between PET and CT can cause artefacts in the AF-corrected image. METHODS Three methodologies for determining the optimal kernel to smooth the CT are compared with noiseless simulations and non-TOF MLEM reconstructions of a patient-realistic digital phantom: (i) the point source insertion-and-subtraction method, [Formula: see text]; (ii) AF-correcting with varyingly smoothed CT to achieve the lowest RMSE with respect to the ground truth (GT) AF-corrected volume of interest (VOI), [Formula: see text]; iii) smoothing the GT image to match the reconstruction within the VOI, [Formula: see text]. The methods were evaluated both using VOI-specific kernels, and a single global kernel optimised for the six VOIs combined. Furthermore, [Formula: see text] was implemented on thorax phantom data measured on two clinical PET/CT scanners with various reconstruction protocols. RESULTS The simulations demonstrated that at [Formula: see text] iterations (200 i), the kernel width was dependent on iteration number and VOI position in the lung. The [Formula: see text] method estimated a lower, more uniform, kernel width in all parts of the lung investigated. However, all three methods resulted in approximately equivalent AF-corrected VOI RMSEs (<10%) at [Formula: see text]200i. The insensitivity of AF-corrected quantification to kernel width suggests that a single global kernel could be used. For all three methodologies, the computed global kernel resulted in an AF-corrected lung RMSE <10% at [Formula: see text]200i, while larger lung RMSEs were observed for the VOI-specific kernels. The global kernel approach was then employed with the [Formula: see text] method on measured data. The optimally smoothed GT emission matched the reconstructed image well, both within the VOI and the lung background. VOI RMSE was <10%, pre-AFC, for all reconstructions investigated. CONCLUSIONS Simulations for non-TOF PET indicated that around 200i were needed to approach image resolution stability in the lung. In addition, at this iteration number, a single global kernel, determined from several VOIs, for AFC, performed well over the whole lung. The [Formula: see text] method has the potential to be used to determine the kernel for AFC from scans of phantoms on clinical scanners.
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Affiliation(s)
- Francesca Leek
- Institute of Nuclear Medicine, University College London Hospitals NHS Trust, London, UK.
- Nuclear Medicine Metrology, National Physical Laboratory, Teddington, UK.
| | - Cameron Anderson
- Institute of Nuclear Medicine, University College London Hospitals NHS Trust, London, UK
| | - Andrew P Robinson
- Nuclear Medicine Metrology, National Physical Laboratory, Teddington, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
- Schuster Laboratory, School of Physics and Astronomy, University of Manchester, Manchester, UK
| | - Robert M Moss
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Joanna C Porter
- UCL Respiratory, University College London and Interstitial Lung Disease Service, University College London Hospitals NHS Trust, London, UK
| | - Helen S Garthwaite
- UCL Respiratory, University College London and Interstitial Lung Disease Service, University College London Hospitals NHS Trust, London, UK
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London Hospitals NHS Trust, London, UK
| | - Brian F Hutton
- Institute of Nuclear Medicine, University College London Hospitals NHS Trust, London, UK
| | - Kris Thielemans
- Institute of Nuclear Medicine, University College London Hospitals NHS Trust, London, UK
- Centre for Medical Image Computing, University College London, London, UK
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Song CY, Liu ZF, Wang P, Su XH, Lu YQ. Assessment of pulmonary fibrosis induced by paraquat using Al 18F-NODA-FAPI-04 PET/CT. Intern Emerg Med 2023; 18:1673-1679. [PMID: 37284931 DOI: 10.1007/s11739-023-03327-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/25/2023] [Indexed: 06/08/2023]
Abstract
The lack of a highly sensitive method to evaluate paraquat (PQ)-induced pulmonary fibrosis and predict disease progression remains an unresolved clinic issue. Fibroblast activation protein (FAP) may play an important role in the pathogenesis of PQ-induced pulmonary fibrosis. We aimed to evaluate the role of FAP in the PQ-induced pulmonary fibrosis and the utility of fibroblast activation protein inhibitor (FAPI) for positron emission tomography (PET) imaging in PQ-induced pulmonary fibrosis. In our study, two cases of PQ poisoning were presented and FAPI PET/CT was performed as a novel imaging technique. The uptake of FAPI increased in both cases of PQ poisoning. Animal experiments were then performed to validate the findings in the patients. Physiological FAPI lung uptake was higher in mice of the PQ group than in the control group. The results of histological analysis and Western blot were consistent with the findings of PET/CT imaging. The pulmonary fibrosis animal model was developed by intragastric gavage of PQ. PET/CT imaging was performed after injection of FAPI. Lung tissues of mice were collected for fibrosis assessment after imaging. Immunohistochemistry for FAP, histology and Western blot for collagen were performed to further validate the imaging findings. In conclusion, FAPI was involved in the pathogenesis of fibrosis induced by PQ, and PET/CT with FAPI could detect lung fibrogenesis, making it a promising tool to assess early disease activity and predict disease progression.
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Affiliation(s)
- Cong-Ying Song
- Department of Emergency Medicine, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310003, China
- Key Laboratory for Diagnosis and Treatment of Aging and Physic-Chemical Injury Diseases of Zhejiang Province, Hangzhou, 310003, China
| | - Zhen-Feng Liu
- Department of Nuclear Medicine, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Ping Wang
- Department of Emergency Medicine, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310003, China
- Key Laboratory for Diagnosis and Treatment of Aging and Physic-Chemical Injury Diseases of Zhejiang Province, Hangzhou, 310003, China
| | - Xin-Hui Su
- Department of Nuclear Medicine, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Yuan-Qiang Lu
- Department of Emergency Medicine, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310003, China.
- Key Laboratory for Diagnosis and Treatment of Aging and Physic-Chemical Injury Diseases of Zhejiang Province, Hangzhou, 310003, China.
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Sviridenko A, di Santo G, Virgolini I. Imaging Fibrosis. PET Clin 2023:S1556-8598(23)00017-2. [PMID: 36990946 DOI: 10.1016/j.cpet.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Tissue injury in nonmalignant human disease can develop from either disproportionate inflammation or exaggerated fibrotic responses. The molecular and cellular fundamental of these 2 processes, their impact on disease prognosis and the treatment concept deviates fundamentally. Consequently, the synchronous assessment and quantification of these 2 processes in vivo is extremely desirable. Although noninvasive molecular techniques such as 18F-fluorodeoxyglucose PET offer insights into the degree of inflammatory activity, the assessment of the molecular dynamics of fibrosis remains challenging. The 68Ga-fibroblast activation protein inhibitor-46 may improve noninvasive clinical diagnostic performance in patients with both fibroinflammatory pathology and long-term CT-abnormalities after severe COVID-19.
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Jablonski R. Lung Cancer and Lung Transplantation. CURRENT PULMONOLOGY REPORTS 2023. [DOI: 10.1007/s13665-023-00301-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Increased Lung Immune Metabolic Activity in COVID-19 Survivors. Clin Nucl Med 2022; 47:1019-1025. [PMID: 36026599 PMCID: PMC9653065 DOI: 10.1097/rlu.0000000000004376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE We quantified lung glycolytic metabolic activity, clinical symptoms and inflammation, coagulation, and endothelial activation biomarkers in 2019 coronavirus disease (COVID-19) pneumonia survivors. METHODS Adults previously hospitalized with moderate to severe COVID-19 pneumonia were prospectively included. Subjects filled out a questionnaire on clinical consequences, underwent chest CT and 18 F-FDG PET/CT, and provided blood samples on the same day. Forty-five volunteers served as control subjects. Analysis of CT images and quantitative voxel-based analysis of PET/CT images were performed for both groups. 18 F-FDG uptake in the whole-lung volume and in high- and low-attenuation areas was calculated and normalized to liver values. Quantification of plasma markers of inflammation (interleukin 6), d -dimer, and endothelial cell activation (angiopoietins 1 and 2, vascular cell adhesion molecule 1, and intercellular adhesion molecule 1) was also performed. RESULTS We enrolled 53 COVID-19 survivors (62.3% were male; median age, 50 years). All survivors reported at least 1 persistent symptom, and 41.5% reported more than 6 symptoms. The mean lung density was greater in survivors than in control subjects, and more metabolic activity was observed in normal and dense lung areas, even months after symptom onset. Plasma proinflammatory, coagulation, and endothelial activation biomarker concentrations were also significantly higher in survivors. CONCLUSION We observed more metabolic activity in areas of high and normal lung attenuation several months after moderate to severe COVID-19 pneumonia. In addition, plasma markers of thromboinflammation and endothelial activation persisted. These findings may have implications for our understanding of the in vivo pathogenesis and long-lasting effects of COVID-19 pneumonia.
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Broens B, Duitman JW, Zwezerijnen GJC, Nossent EJ, van der Laken CJ, Voskuyl AE. Novel tracers for molecular imaging of interstitial lung disease: A state of the art review. Autoimmun Rev 2022; 21:103202. [PMID: 36150433 DOI: 10.1016/j.autrev.2022.103202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Abstract
Interstitial lung disease is an overarching term for a wide range of disorders characterized by inflammation and/or fibrosis in the lungs. Most prevalent forms, among others, include idiopathic pulmonary fibrosis (IPF) and connective tissue disease associated interstitial lung disease (CTD-ILD). Currently, only disease modifying treatment options are available for IPF and progressive fibrotic CTD-ILD, leading to reduction or stabilization in the rate of lung function decline at best. Management of these patients would greatly advance if we identify new strategies to improve (1) early detection of ILD, (2) predicting ILD progression, (3) predicting response to therapy and (4) understanding pathophysiology. Over the last years, positron emission tomography (PET) and single photon emission computed tomography (SPECT) have emerged as promising molecular imaging techniques to improve ILD management. Both are non-invasive diagnostic tools to assess molecular characteristics of an individual patient with the potential to apply personalized treatment. In this review, we encompass the currently available pre-clinical and clinical studies on molecular imaging with PET and SPECT in IPF and CTD-ILD. We provide recommendations for potential future clinical applications of these tracers and directions for future research.
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Affiliation(s)
- Bo Broens
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rheumatology and Clinical Immunology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Infection & Immunity, Inflammatory diseases, Amsterdam, the Netherlands.
| | - Jan-Willem Duitman
- Amsterdam Infection & Immunity, Inflammatory diseases, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Pulmonary Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Experimental Immunology (EXIM), Meibergdreef 9, Amsterdam, the Netherlands.
| | - Gerben J C Zwezerijnen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Esther J Nossent
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands..
| | - Conny J van der Laken
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rheumatology and Clinical Immunology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Infection & Immunity, Inflammatory diseases, Amsterdam, the Netherlands.
| | - Alexandre E Voskuyl
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rheumatology and Clinical Immunology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Infection & Immunity, Inflammatory diseases, Amsterdam, the Netherlands.
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11
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Ohira H, deKemp R, Kadoya Y, Renaud J, Stewart DJ, Davies RA, Chandy G, Contreras-Dominguez V, Pugliese C, Dunne R, Beanlands R, Mielniczuk L. Evaluation of Lung Glucose Uptake with Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/CT in Patients with Pulmonary Arterial Hypertension and Pulmonary Hypertension Due to Left Heart Disease. ANNALS OF NUCLEAR CARDIOLOGY 2022; 8:21-29. [PMID: 36540173 PMCID: PMC9749761 DOI: 10.17996/anc.22-00151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/01/2022] [Accepted: 04/05/2022] [Indexed: 06/17/2023]
Abstract
Aim: Previous studies have demonstrated increased glucose uptake by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in lung parenchyma in animal models or small pulmonary arterial hypertension (PAH) cohorts. However, it is not well known whether increased FDG uptake in the lung is a unique phenomenon in PAH or whether elevated pulmonary artery pressure (PAP) induces FDG uptake. Methods and results: Nineteen patients with PAH, 8 patients with pulmonary hypertension due to left heart disease (PH-LHD), and 14 age matched control subjects were included. All PH patients underwent right heart catheterization and FDG-PET. The mean standard uptake value (SUV g/mL) of FDG in each lung was obtained and average values of both lungs were calculated as mean lung FDG SUV. The correlation between hemodynamics and mean lung FDG SUV was also analyzed in PH patients. Mean PAP (mPAP) was not significantly different between PAH and PH-LHD (45±11 vs 43±5 mmHg, p=0.51). PAH patients demonstrated significantly increased mean lung FDG SUV compared with PH-LHD and controls (PAH: 0.76±0.26 vs PH-LHD: 0.51±0.12 vs controls: 0.53±0.16, p=0.0025). The mean lung FDG SUV did not correlate with mPAP either in PAH or PH-LHD. Conclusion: PAH is associated with increased lung FDG uptake indicating increased glucose utilization in the lung. This may represent metabolic shift to glycolysis and/or active inflammation in the remodeled pulmonary vasculature, and is observed to a greater extent in PAH than in patients with PH secondary to LHD and control subjects without PH.
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Affiliation(s)
- Hiroshi Ohira
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Robert deKemp
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Yoshito Kadoya
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jennifer Renaud
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Duncan J. Stewart
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Respirology and Division of General Internal Medicine, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ross A. Davies
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - George Chandy
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Medicine and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Vladimir Contreras-Dominguez
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Carolyn Pugliese
- Department of Medical Imaging, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Rosemary Dunne
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rob Beanlands
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Lisa Mielniczuk
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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12
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Broens B, van der Laken CJ, Zwezerijnen GJ, Nossent EJ, Meijboom LJ, Spierings J, de Vries-Bouwstra JK, van Laar JM, Voskuyl AE. Positron Emission Tomography to Improve Assessment of Interstitial Lung Disease in Patients With Systemic Sclerosis Eligible for Autologous Stem Cell Transplantation. Front Immunol 2022; 13:923869. [PMID: 35865521 PMCID: PMC9294594 DOI: 10.3389/fimmu.2022.923869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Positron emission tomography (PET) is a promising technique to improve the assessment of systemic sclerosis associated interstitial lung disease (SSc-ILD). This technique could be of particular value in patients with severe diffuse cutaneous SSc (dcSSc) that are possibly eligible for autologous hematopoietic stem cell transplantation (aHSCT). aHSCT is a potentially effective therapy for patients with severe dcSSc and ILD, leading to stabilization or improvement of lung function. However, there is a high need to improve patient selection, which includes (1) the selection of patients with rapidly progressive ILD for early rather than last-resort aHSCT (2) the prediction of treatment response on ILD and (3) the understanding of the mechanism(s) of action of aHSCT in the lungs. As previous studies with 18F-FDG PET in SSc-ILD and other forms of ILD have demonstrated its potential value in predicting disease progression and reactivity to anti-inflammatory treatment, we discuss the potential benefit of using this technique in patients with early severe dcSSc and ILD in the context of aHSCT. In addition, we discuss the potential value of other PET tracers in the assessment of ILD and understanding the mechanisms of action of aHSCT in the lung. Finally, we provide several suggestions for future research.
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Affiliation(s)
- Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam, Netherlands
| | - Conny J. van der Laken
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Esther J. Nossent
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, Netherlands
| | - Lilian J. Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, Netherlands
| | - Julia Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | - Jacob M. van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Alexandre E. Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam, Netherlands
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13
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18F-FDG PET/CT and HRCT: a combined tool for risk stratification in idiopathic inflammatory myopathy-associated interstitial lung disease. Clin Rheumatol 2022; 41:3095-3105. [PMID: 35759126 DOI: 10.1007/s10067-022-06239-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Rapidly progressive interstitial lung disease (RP-ILD) is a life-threatening form of idiopathic inflammatory myopathy (IIM)-associated interstitial lung disease (ILD). We aimed to assess the combination of 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) and high-resolution computed tomography (HRCT) for the quantification of IIM-ILD activity and risk stratification for RP-ILD. METHOD Patients with IIM and undergoing 18F-FDG PET/CT were included in this retrospective study. Pulmonary FDG uptake was assessed using the maximum standardized uptake value (SUVlung) and visual score (PET score). HRCT was evaluated using visual analysis (HRCT score). Multivariable logistic regression was used to identify risk factors for RP-ILD. RESULTS Seventy-three patients with IIM (17 with RP-ILD, 38 with non-RP-ILD, and 18 without ILD) were included. SUVlung, PET score, and HRCT score were significantly higher in RP-ILD than in non-RP-ILD. Strong positive correlations were observed between SUVlung, PET score, and the HRCT parameters. The area under the curve (AUC) of the PET score to differentiate between RP-ILD and non-RP-ILD (AUC = 0.860) was higher than that of the SUVlung (AUC = 0.802) and HRCT scores (AUC = 0.806). We developed a risk score based on the number of positive risk factors (PET score > 18, HRCT score > 140, and positive anti-melanoma differentiation-associated gene 5 (MDA5) antibody) to differentiate between RP-ILD and non-RP-ILD (AUC = 0.955). Patients with higher risk scores had significantly worse prognoses. CONCLUSIONS 18F-FDG PET/CT is useful for assessing disease activity in patients with IIM-ILD. The combination of PET score, HRCT score, and anti-MDA5 antibody can be used to identify patients at increased risk of RP-ILD and with poor prognoses.
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14
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Porter JC, Win T, Erlandsson K, Thielemans K, Groves AM. Reply: Measurement of hypoxia in the lung in idiopathic pulmonary fibrosis: a matter of control. Eur Respir J 2022; 59:13993003.03124-2021. [PMID: 35086831 PMCID: PMC8907934 DOI: 10.1183/13993003.03124-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/10/2022] [Indexed: 01/26/2023]
Abstract
We thank P-S. Bellaye and co-workers for their considered and insightful response. Given their finding of [18F]fluoromisonidazole ([18F]F-MISO) uptake in the bleomycin mouse model of fibrosis [1], we too were surprised not to demonstrate a similar signal in patients with idiopathic pulmonary fibrosis (IPF). However, as acknowledged, there are other examples of positron emission tomography (PET) tracers, such as cis-4-[18F]-fluoro-l-proline, yielding PET signals in animal lung fibrosis models that have not been replicated in humans with fibrotic lung disease [2, 3]. In vivo PET imaging in IPF patients shows no significant evidence of lung tissue hypoxiahttps://bit.ly/3fywY7K
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Affiliation(s)
- Joanna C. Porter
- Centre for Inflammation and Tissue Repair, UCL and the UCLH Interstitial Lung Disease Service, London, UK,Joanna C. Porter ()
| | - Thida Win
- Respiratory Medicine, Lister Hospital, Stevenage, UK
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15
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Röhrich M, Leitz D, Glatting FM, Wefers AK, Weinheimer O, Flechsig P, Kahn N, Mall MA, Giesel FL, Kratochwil C, Huber PE, Deimling AV, Heußel CP, Kauczor HU, Kreuter M, Haberkorn U. Fibroblast Activation Protein-Specific PET/CT Imaging in Fibrotic Interstitial Lung Diseases and Lung Cancer: A Translational Exploratory Study. J Nucl Med 2022; 63:127-133. [PMID: 34272325 PMCID: PMC8717194 DOI: 10.2967/jnumed.121.261925] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/27/2021] [Indexed: 11/16/2022] Open
Abstract
Interstitial lung diseases (ILDs) comprise over 200 parenchymal lung disorders. Among them, fibrosing ILDs, especially idiopathic pulmonary fibrosis, are associated with a poor prognosis, whereas some other ILDs, such as sarcoidosis, have a much better prognosis. A high proportion manifests as fibrotic ILD (fILD). Lung cancer (LC) is a frequent complication of fILD. Activated fibroblasts are crucial for fibrotic processes in fILD. The aim of this exploratory study was to evaluate the imaging properties of static and dynamic fibroblast activation protein (FAP) inhibitor (FAPI) PET/CT in various types of fILD and to confirm FAP expression in fILD lesions by FAP immunohistochemistry of human fILD biopsy samples and of lung sections of genetically engineered (Nedd4-2-/- ) mice with an idiopathic pulmonary fibrosislike lung disease. Methods: PET scans of 15 patients with fILD and suspected LC were acquired 10, 60, and 180 min after the administration of 150-250 MBq of a 68Ga-labeled FAPI tracer (FAPI-46). In 3 patients, dynamic scans over 40 min were performed instead of imaging after 10 min. The SUVmax and SUVmean of fibrotic lesions and LC were measured and CT-density-corrected. Target-to-background ratios (TBRs) were calculated. PET imaging was correlated with CT-based fibrosis scores. Time-activity curves derived from dynamic imaging were analyzed. FAP immunohistochemistry of 4 human fILD biopsy samples and of fibrotic lungs of Nedd4-2-/- mice was performed. Results: fILD lesions as well as LC showed markedly elevated 68Ga-FAPI uptake (density-corrected SUVmax and SUVmean 60 min after injection: 11.12 ± 6.71 and 4.29 ± 1.61, respectively, for fILD lesions and 16.69 ± 9.35 and 6.44 ± 3.29, respectively, for LC) and high TBR (TBR of density-corrected SUVmax and SUVmean 60 min after injection: 2.30 ± 1.47 and 1.67 ± 0.79, respectively, for fILD and 3.90 ± 2.36 and 2.37 ± 1.14, respectively, for LC). SUVmax and SUVmean decreased over time, with a stable TBR for fILD and a trend toward an increasing TBR in LC. Dynamic imaging showed differing time-activity curves for fILD and LC. 68Ga-FAPI uptake showed a positive correlation with the CT-based fibrosis index. Immunohistochemistry of human biopsy samples and the lungs of Nedd4-2-/- mice showed a patchy expression of FAP in fibrotic lesions, preferentially in the transition zone to healthy lung parenchyma. Conclusion:68Ga-FAPI PET/CT imaging is a promising new imaging modality for fILD and LC. Its potential clinical value for monitoring and therapy evaluation of fILD should be investigated in future studies.
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Affiliation(s)
- Manuel Röhrich
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany;
| | - Dominik Leitz
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Frederik M Glatting
- Clinical Cooperation Unit Molecular and Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Annika K Wefers
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Oliver Weinheimer
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Paul Flechsig
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Nicolas Kahn
- Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thorax Clinic, University of Heidelberg, Heidelberg, Germany; and
| | - Marcus A Mall
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter E Huber
- Clinical Cooperation Unit Molecular and Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Claus Peter Heußel
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Hans Ulrich Kauczor
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Michael Kreuter
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
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16
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Kuzniewski CT, Kizhner O, Donnelly EF, Henry TS, Amin AN, Kandathil A, Kelly AM, Laroia AT, Lee E, Martin MD, Morris MF, Raptis CA, Sirajuddin A, Wu CC, Kanne JP. ACR Appropriateness Criteria® Chronic Cough. J Am Coll Radiol 2021; 18:S305-S319. [PMID: 34794590 DOI: 10.1016/j.jacr.2021.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/26/2021] [Indexed: 11/20/2022]
Abstract
Chronic cough is defined by a duration lasting at least 8 weeks. The most common causes of chronic cough include smoking-related lung disease, upper airway cough syndrome, asthma, gastroesophageal reflux disease, and nonasthmatic eosinophilic bronchitis. The etiology of chronic cough in some patients may be difficult to localize to an isolated source and is often multifactorial. The complex pathophysiology, clinical presentation, and variable manifestations of chronic cough underscore the challenges faced by clinicians in the evaluation and management of these patients. Imaging plays a role in the initial evaluation, although there is a lack of high-quality evidence guiding which modalities are useful and at what point in time the clinical evaluation should be performed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Edwin F Donnelly
- Panel Chair and Chief, Thoracic Imaging, The Ohio State University Wexner Medical Center, Columbus, Ohio; and Co-Chair, Physics Module Committee, RSBA
| | - Travis S Henry
- Panel Vice-Chair, University of California San Francisco, San Francisco, California; Course Co-Director, HRCT Course, ACR Education Center, Reston Virginia; and Division Chief, Cardiothoracic Radiology, Duke University Hospital
| | - Alpesh N Amin
- University of California Irvine, Irvine, California; American College of Physicians
| | | | | | | | - Elizabeth Lee
- University of Michigan Health System, Ann Arbor, Michigan
| | - Maria D Martin
- Director of Diversity and Inclusion, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | | | - Carol C Wu
- Deputy Chair Ad Interim, The University of Texas MD Anderson Cancer Center, Houston, Texas; Chair, Society of Thoracic Radiology Big Data Committee; and Chair, Thoracic Use Cases Panel - ACR DSI
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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17
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Hobbs SB, Chung JH, Walker CM, Bang TJ, Carter BW, Christensen JD, Danoff SK, Kandathil A, Madan R, Moore WH, Shah SD, Kanne JP. ACR Appropriateness Criteria® Diffuse Lung Disease. J Am Coll Radiol 2021; 18:S320-S329. [PMID: 34794591 DOI: 10.1016/j.jacr.2021.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022]
Abstract
Diffuse lung disease, frequently referred to as interstitial lung disease, encompasses numerous disorders affecting the lung parenchyma. The potential etiologies of diffuse lung disease are broad with several hundred established clinical syndromes and pathologies currently identified. Imaging plays a critical role in diagnosis and follow-up of many of these diseases, although multidisciplinary discussion is the current standard for diagnosis of several DLDs. This document aims to establish guidelines for evaluation of diffuse lung diseases for 1) initial imaging of suspected diffuse lung disease, 2) initial imaging of suspected acute exacerbation or acute deterioration in cases of confirmed diffuse lung disease, and 3) clinically indicated routine follow-up of confirmed diffuse lung disease without acute deterioration. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Stephen B Hobbs
- Vice-Chair, Informatics and Integrated Clinical Operations and Division Chief, Cardiovascular and Thoracic Radiology, University of Kentucky, Lexington, Kentucky.
| | - Jonathan H Chung
- Panel Chair; and Vice-Chair of Quality, and Section Chief, Chest Imaging, Department of Radiology, University of Chicago, Chicago, Illinois
| | | | - Tami J Bang
- Co-Director, Cardiothoracic Imaging Fellowship Committee, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado; Co-Chair, membership committee, NASCI; and Membership committee, ad-hoc online content committee, STR
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jared D Christensen
- Vice-Chair, Department of Radiology, Duke University Medical Center, Durham, North Carolina; and Chair, ACR Lungs-RADS
| | - Sonye K Danoff
- Johns Hopkins Medicine, Baltimore, Maryland; Board of Directors, American Thoracic Society; Senior Medical Advisor, Pulmonary Fibrosis Foundation; and Medical Advisory Board Member, The Myositis Association
| | | | - Rachna Madan
- Associate Fellowship Director, Division of Thoracic Imaging, Brigham & Women's Hospital, Boston, Massachusetts
| | - William H Moore
- Associate Chair, Clinical Informatics and Chief, Thoracic Imaging, New York University Langone Medical Center, New York, New York
| | - Sachin D Shah
- Associate Chief and Medical Information Officer, University of Chicago, Chicago, Illinois; and Primary care physician
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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18
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Selvarajah B, Azuelos I, Anastasiou D, Chambers RC. Fibrometabolism-An emerging therapeutic frontier in pulmonary fibrosis. Sci Signal 2021; 14:14/697/eaay1027. [PMID: 34429381 DOI: 10.1126/scisignal.aay1027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fibrosis is the final pathological outcome and major cause of morbidity and mortality in many common and chronic inflammatory, immune-mediated, and metabolic diseases. Despite the growing incidence of fibrotic diseases and extensive research efforts, there remains a lack of effective therapies that improve survival. The application of omics technologies has revolutionized our approach to identifying previously unknown therapeutic targets and potential disease biomarkers. The application of metabolomics, in particular, has improved our understanding of disease pathomechanisms and garnered a wave of scientific interest in the role of metabolism in the biology of myofibroblasts, the key effector cells of the fibrogenic response. Emerging evidence suggests that alterations in metabolism not only are a feature of but also may play an influential role in the pathogenesis of fibrosis, most notably in idiopathic pulmonary fibrosis (IPF), the most rapidly progressive and fatal of all fibrotic conditions. This review will detail the role of key metabolic pathways, their alterations in myofibroblasts, and the potential this new knowledge offers for the development of antifibrotic therapeutic strategies.
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Affiliation(s)
- Brintha Selvarajah
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Ilan Azuelos
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London WC1E 6JF, UK
| | | | - Rachel C Chambers
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London WC1E 6JF, UK.
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19
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Han S, Chandel NS. Lessons from Cancer Metabolism for Pulmonary Arterial Hypertension and Fibrosis. Am J Respir Cell Mol Biol 2021; 65:134-145. [PMID: 33844936 DOI: 10.1165/rcmb.2020-0550tr] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Metabolism is essential for a living organism to sustain life. It provides energy to a cell by breaking down compounds (catabolism) and supplies building blocks for the synthesis of macromolecules (anabolism). Signal transduction pathways tightly regulate mammalian cellular metabolism. Simultaneously, metabolism itself serves as a signaling pathway to control many cellular processes, such as proliferation, differentiation, cell death, gene expression, and adaptation to stress. Considerable progress in the metabolism field has come from understanding how cancer cells co-opt metabolic pathways for growth and survival. Recent data also show that several metabolic pathways may participate in the pathogenesis of lung diseases, some of which could be promising therapeutic targets. In this translational review, we will outline the basic metabolic principles learned from the cancer metabolism field as they apply to the pathogenesis of pulmonary arterial hypertension and fibrosis and will place an emphasis on therapeutic potential.
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Affiliation(s)
- SeungHye Han
- Division of Pulmonary and Critical Care, Department of Medicine, and
| | - Navdeep S Chandel
- Division of Pulmonary and Critical Care, Department of Medicine, and.,Department Biochemistry and Molecular Genetics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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20
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Ledoult E, Morelle M, Soussan M, Mékinian A, Béhal H, Sobanski V, Hachulla E, Huglo D, Le Gouellec N, Remy-Jardin M, Baillet C, Launay D. 18F-FDG positron emission tomography scanning in systemic sclerosis-associated interstitial lung disease: a pilot study. Arthritis Res Ther 2021; 23:76. [PMID: 33673861 PMCID: PMC7936499 DOI: 10.1186/s13075-021-02460-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background Interstitial lung disease is a common complication of systemic sclerosis (SSc-ILD), and it remains difficult to accurately predict its course. Progressing ILD could be more metabolically active, suggesting that the 18F-FDG tracer could be a tool in the managing of SSc-ILD. Methods In our center, SSc patients and controls (non-Hodgkin lymphoma cured after first-line regimen) who had received a PET/CT were screened retrospectively. The FDG uptake (visual intensity, pattern, SUVmax) was systematically recorded in > 30 regions of interest (ROIs) linked to SSc in a blind reviewing by 2 independent nuclear medicine physicians using a standardized form. Results Among the 545 SSc patients followed up in our center, 36, including 22 SSc-ILDs, had a PET/CT, whose indication was cancer screening in most cases. The mean ± SD age was 57.9 ± 13.0 years with 20/36 females. Fourteen patients had a disease duration of less than 2 years. A third had anti-centromere antibodies and 27.8% had anti-topoisomerase antibodies. Pulmonary FDG uptakes were higher in SSc patients than in controls (n = 89), especially in those with ILD compared with those without ILD. Pulmonary FDG uptakes were positively correlated with the ILD severity (fibrosis extent, %FVC, and %DLCO). No significant difference was found in the FDG uptakes from extrathoracic ROIs. Progressing SSc-ILDs within the 2 years after PET/CT (n = 9) had significant higher pulmonary FDG uptakes at baseline than stable SSc-ILDs (n = 13). Conclusion PET/CT could be a useful tool in the assessment of the severity and the prediction of pulmonary function outcome of SSc-ILD. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02460-8.
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Affiliation(s)
- Emmanuel Ledoult
- Univ. Lille, INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France. .,Univ. Lille, CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000, Lille, France. .,Inserm, U1286, F-59000, Lille, France. .,Hôpital Claude Huriez, Service de Médecine Interne, Rue Michel Polonovski, F59037, Lille Cedex, France.
| | - Maxime Morelle
- CHU Lille, Service de Médecine Nucléaire, F-59000, Lille, France
| | - Michael Soussan
- CH Avicenne - APHP, Service de Médecine Nucléaire, F-93000, Bobigny, France
| | - Arsène Mékinian
- Hôpital Saint-Antoine - APHP, Service de Médecine Interne, F-75012, Paris, France.,Sorbonne Université, F-75571, Paris Cedex 12, France
| | - Hélène Béhal
- Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
| | - Vincent Sobanski
- Univ. Lille, INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France.,Univ. Lille, CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000, Lille, France.,Inserm, U1286, F-59000, Lille, France
| | - Eric Hachulla
- Univ. Lille, INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France.,Univ. Lille, CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000, Lille, France.,Inserm, U1286, F-59000, Lille, France
| | - Damien Huglo
- CHU Lille, Service de Médecine Nucléaire, F-59000, Lille, France.,Univ. Lille, Inserm, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000, Lille, France
| | - Noémie Le Gouellec
- Univ. Lille, CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000, Lille, France.,CH Valenciennes, Service de Médecine Interne, Centre de Compétences adultes pour les maladies auto-immunes et systémiques rares, F-59300, Valenciennes, France
| | - Martine Remy-Jardin
- Univ. Lille, CHU Lille, Service d'imagerie Thoracique, F-59000, Lille, France
| | - Clio Baillet
- CHU Lille, Service de Médecine Nucléaire, F-59000, Lille, France.,Univ. Lille, CHU Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000, Lille, France
| | - David Launay
- Univ. Lille, INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France.,Univ. Lille, CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000, Lille, France.,Inserm, U1286, F-59000, Lille, France
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Ogger PP, Silva JD, Aghapour M, Mahmutovic Persson I, Tulen C, Jurkowska R, Ubags ND. Early Career Members at the ERS Lung Science Conference 2020: metabolic alterations in lung ageing and disease. Breathe (Sheff) 2021; 16:200063. [PMID: 33447269 PMCID: PMC7792764 DOI: 10.1183/20734735.0063-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Every year, the European Respiratory Society (ERS) organises the Lung Science Conference (LSC) in Estoril, Portugal, to discuss basic and translational science. The topic of the LSC 2020 was “Metabolic alterations in lung ageing and disease”. In addition to an outstanding scientific programme, the LSC provides excellent opportunities for career development and inclusion of Early Career Members (ECMs). All scientific and poster sessions are chaired by an ECM who is paired with a senior faculty member to allow ECMs to become acquainted with session chairing. In addition, 40 travel bursaries are made available to abstract authors and all bursary recipients are invited to take part in a mentorship lunch. Moreover, there is a session organised by the Early Career Members Committee (ECMC) dedicated to career development. Here, we describe the scientific highlights of LSC 2020 for those who could not attend. The Lung Science Conference 2020 brought together leading experts in the field to discuss the latest cutting-edge science, as well as various career development opportunities for early career membershttps://bit.ly/2XZ5YGQ
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Affiliation(s)
- Patricia P Ogger
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Johnatas Dutra Silva
- Wellcome-Wolfson Centre for Experimental Medicine, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Mahyar Aghapour
- Infection Immunology Group, Institute of Medical Microbiology, Infection Control and Prevention, Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke University, Magdeburg, Germany.,Immune Regulation Group, Helmholtz Center for Infection Research, Braunschweig, Germany
| | - Irma Mahmutovic Persson
- Institution of Medical Radiation Physics, Dept of Translational Medicine, Lund University, Malmö, Sweden
| | - Christy Tulen
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Dept of Pharmacology and Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | - Niki D Ubags
- Faculty of Biology and Medicine, University of Lausanne, Service de Pneumologie, CHUV, Epalinges, Switzerland
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22
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Zhou IY, Montesi SB, Akam EA, Caravan P. Molecular Imaging of Fibrosis. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00077-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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23
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Increased 18F-FDG accumulation in less-affected lung area in patients with non-small cell lung cancer and postoperative acute exacerbation of interstitial lung disease. Eur J Radiol 2020; 135:109477. [PMID: 33401111 DOI: 10.1016/j.ejrad.2020.109477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/25/2020] [Accepted: 12/09/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate whether or not 18F-FDG accumulation in normal or less-affected lung fields increased in non-small cell lung cancer (NSCLC) patients with postoperative acute exacerbation (PAE) of interstitial lung disease (ILD) MATERIAL AND METHODS: Thirty-six NSCLC patients with ILD and 50 patients without ILD (non-ILD patients) underwent pre-operative 18F-FDG-PET/CT at 2 institutions. Volume-of-interest (VOI) was placed to measure the mean standardized uptake value (SUVmean) in normal or less-affected lung fields at pre-defined 12 areas on ventral and dorsal locations of both lungs. SUVtissue fraction (TF) was defined as corrected SUVmean by using TF and mean computed tomography density on PET/CT. Harmonized SUVmean (hSUVmean) and SUVTF (hSUVTF) were calculated based on results of phantom study, which was performed to optimize the measured SUV difference among 2 institutions. Both the h-SUVmean and the h-SUVTF were compared between 8 patients with PAE of ILD (PAE group) or remaining 28 patients without PAE of ILD (non-PAE group) and non-ILD patients in each of the 12 areas. RESULTS The hSUVmean in PAE group was higher in 9 out of 12 locations as compared with non-ILD patients, whereas the hSUVmean was mostly similar between non-PAE group and non-ILD patients. In contrast, the hSUVTF in non-PAE group was similar to that in PAE group, and higher than in non-ILD patients in most locations. CONCLUSION 18F-FDG-PET/CT demonstrated increased SUVmean along with elevated SUVTF in normal or less-affected lung fields for NSCLC patients with PAE of ILD, which may reflect regional invisible fibrosis and inflammatory change.
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Türkkan G, Willems Y, Hendriks LEL, Mostard R, Conemans L, Gietema HA, Mitea C, Peeters S, De Ruysscher D. Idiopathic pulmonary fibrosis: Current knowledge, future perspectives and its importance in radiation oncology. Radiother Oncol 2020; 155:269-277. [PMID: 33245945 DOI: 10.1016/j.radonc.2020.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/01/2020] [Accepted: 11/17/2020] [Indexed: 02/06/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive, fibrotic lung disease with an unknown cause. Uncertainties still remain regarding the pathogenesis of IPF, and the prognosis of this disease is poor despite some recent improvements in treatment. Radiation induced lung injury (RILI) is a common complication and a dose-limiting toxicity of thoracic radiotherapy. Importantly, IPF is a crucial risk factor for pulmonary toxicity after thoracic radiotherapy. Although IPF is not universally accepted as a definite contraindication for thoracic radiotherapy at present, it has been shown that IPF can increase the risk of severe and fatal complications after thoracic radiotherapy. Proton beam therapy has shown promising results in reducing the incidence of thoracic radiotherapy related life-threatening complications in IPF patients, but the current evidence is not sufficient to recommend the standard use of it. Many similarities are noticeable between IPF and RILI in terms of pathogenesis and underlying mechanisms. Better understanding of the mechanisms of IPF and RILI may enable clinicians to provide safer and more effective thoracic radiotherapy treatments in cancer patients with IPF. In this review, we summarize the current knowledge of IPF, present the importance of IPF in radiation oncology practice, and highlight the similarities and relationship between IPF and RILI.
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Affiliation(s)
- Görkem Türkkan
- Department of Radiation Oncology, MAASTRO Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - Yves Willems
- Department of Radiation Oncology, MAASTRO Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Rémy Mostard
- Department of Respiratory Medicine, Zuyderland Medical Center Heerlen-Sittard, The Netherlands
| | - Lennart Conemans
- Department of Pulmonary Diseases, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Hester A Gietema
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Cristina Mitea
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Stéphanie Peeters
- Department of Radiation Oncology, MAASTRO Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology, MAASTRO Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
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25
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Platé M, Guillotin D, Chambers RC. The promise of mTOR as a therapeutic target pathway in idiopathic pulmonary fibrosis. Eur Respir Rev 2020; 29:29/157/200269. [PMID: 33060168 PMCID: PMC9488186 DOI: 10.1183/16000617.0269-2020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/18/2020] [Indexed: 12/11/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is characterised by the progressive deposition of excessive extracellular matrix proteins within the lung parenchyma and represents the most rapidly progressive and fatal of all fibrotic conditions. Current anti-fibrotic drugs approved for the treatment of IPF fail to halt disease progression and have significant side-effect profiles. Therefore, there remains a pressing need to develop novel therapeutic strategies for IPF. Mammalian target of rapamycin (mTOR) forms the catalytic subunit of two complexes, mTORC1 and mTORC2. mTORC1 acts as critical cellular sensor which integrates intracellular and extracellular signals to reciprocally regulate a variety of anabolic and catabolic processes. The emerging evidence for a critical role for mTORC1 in influencing extracellular matrix production, metabolism, autophagy and senescence in the setting of IPF highlights this axis as a novel therapeutic target with the potential to impact multiple IPF pathomechanisms. Current evidence supports the scientific rationale for targeting the mTOR pathway in idiopathic pulmonary fibrosishttps://bit.ly/33OQiYf
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Affiliation(s)
- Manuela Platé
- Centre for Inflammation and Tissue Repair, Dept of Respiratory Medicine, Division of Medicine, University College London, London, UK
| | - Delphine Guillotin
- Centre for Inflammation and Tissue Repair, Dept of Respiratory Medicine, Division of Medicine, University College London, London, UK
| | - Rachel C Chambers
- Centre for Inflammation and Tissue Repair, Dept of Respiratory Medicine, Division of Medicine, University College London, London, UK
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26
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Vass L, Fisk M, Lee S, Wilson FJ, Cheriyan J, Wilkinson I. Advances in PET to assess pulmonary inflammation: A systematic review. Eur J Radiol 2020; 130:109182. [DOI: 10.1016/j.ejrad.2020.109182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/27/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022]
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27
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Peelen DM, Zwezerijnen BGJC, Nossent EJ, Meijboom LJ, Hoekstra OS, Van der Laken CJ, Voskuyl AE. The quantitative assessment of interstitial lung disease with positron emission tomography scanning in systemic sclerosis patients. Rheumatology (Oxford) 2020; 59:1407-1415. [PMID: 31642912 PMCID: PMC7244784 DOI: 10.1093/rheumatology/kez483] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/25/2019] [Indexed: 02/06/2023] Open
Abstract
Objectives The reversibility of interstitial lung disease (ILD) in SSc is difficult to assess by current diagnostic modalities and there is clinical need for imaging techniques that allow for treatment stratification and monitoring. 18F-Fluorodeoxyglucose (FDG) PET/CT scanning may be of interest for this purpose by detection of metabolic activity in lung tissue. This study aimed to investigate the potential role of 18F-FDG PET/CT scanning for the quantitative assessment of SSc-related active ILD. Methods 18F-FDG PET/CT scans and high resolution CT scans of eight SSc patients, including five with ILD, were analysed. For comparison, reference groups were included: eight SLE patients and four primary Sjögren’s syndrome (pSS) patients, all without ILD. A total of 22 regions of interest were drawn in each patient at apical, medial and dorsobasal lung levels. 18F-FDG uptake was measured as mean standardized uptake value (SUVmean) in each region of interest. Subsequently, basal/apical (B/A) and medial/apical (M/A) ratios were calculated at patient level (B/A-p and M/A-p) and at tissue level (B/A-t and M/A-t). Results SUVmean values in dorsobasal ROIs and B/A-p ratios were increased in SSc with ILD compared with SSc without ILD (P = 0.04 and P = 0.07, respectively), SLE (P = 0.003 and P = 0.002, respectively) and pSS (P = 0.03 and P = 0.02, respectively). Increased uptake in the dorsobasal lungs and increased B/A-t ratios corresponded to both ground glass and reticulation on high resolution CT. Conclusion Semi-quantitative assessment of 18F-FDG PET/CT is able to distinguish ILD from non-affected lung tissue in SSc, suggesting that it may be used as a new biomarker for SSc-ILD disease activity.
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Affiliation(s)
- Daphne M Peelen
- Department of Rheumatology, Amsterdam Rheumatology & Immunology Center
| | | | - Esther J Nossent
- Department of Pulmonary Medicine and Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Montesi SB, Izquierdo-Garcia D, Désogère P, Abston E, Liang LL, Digumarthy S, Seethamraju R, Lanuti M, Caravan P, Catana C. Type I Collagen-targeted Positron Emission Tomography Imaging in Idiopathic Pulmonary Fibrosis: First-in-Human Studies. Am J Respir Crit Care Med 2020; 200:258-261. [PMID: 31161770 DOI: 10.1164/rccm.201903-0503le] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Sydney B Montesi
- 1 Massachusetts General Hospital Boston, Massachusetts.,2 Harvard Medical School Boston, Massachusetts and
| | - David Izquierdo-Garcia
- 1 Massachusetts General Hospital Boston, Massachusetts.,2 Harvard Medical School Boston, Massachusetts and
| | | | - Eric Abston
- 1 Massachusetts General Hospital Boston, Massachusetts
| | - Lloyd L Liang
- 1 Massachusetts General Hospital Boston, Massachusetts
| | - Subba Digumarthy
- 1 Massachusetts General Hospital Boston, Massachusetts.,2 Harvard Medical School Boston, Massachusetts and
| | | | - Michael Lanuti
- 1 Massachusetts General Hospital Boston, Massachusetts.,2 Harvard Medical School Boston, Massachusetts and
| | - Peter Caravan
- 1 Massachusetts General Hospital Boston, Massachusetts.,2 Harvard Medical School Boston, Massachusetts and
| | - Ciprian Catana
- 1 Massachusetts General Hospital Boston, Massachusetts.,2 Harvard Medical School Boston, Massachusetts and
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Lillington J, Brusaferri L, Kläser K, Shmueli K, Neji R, Hutton BF, Fraioli F, Arridge S, Cardoso MJ, Ourselin S, Thielemans K, Atkinson D. PET/MRI attenuation estimation in the lung: A review of past, present, and potential techniques. Med Phys 2020; 47:790-811. [PMID: 31794071 PMCID: PMC7027532 DOI: 10.1002/mp.13943] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 07/23/2019] [Accepted: 11/20/2019] [Indexed: 12/16/2022] Open
Abstract
Positron emission tomography/magnetic resonance imaging (PET/MRI) potentially offers several advantages over positron emission tomography/computed tomography (PET/CT), for example, no CT radiation dose and soft tissue images from MR acquired at the same time as the PET. However, obtaining accurate linear attenuation correction (LAC) factors for the lung remains difficult in PET/MRI. LACs depend on electron density and in the lung, these vary significantly both within an individual and from person to person. Current commercial practice is to use a single‐valued population‐based lung LAC, and better estimation is needed to improve quantification. Given the under‐appreciation of lung attenuation estimation as an issue, the inaccuracy of PET quantification due to the use of single‐valued lung LACs, the unique challenges of lung estimation, and the emerging status of PET/MRI scanners in lung disease, a review is timely. This paper highlights past and present methods, categorizing them into segmentation, atlas/mapping, and emission‐based schemes. Potential strategies for future developments are also presented.
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Affiliation(s)
- Joseph Lillington
- Centre for Medical Imaging, University College London, London, W1W 7TS, UK
| | - Ludovica Brusaferri
- Institute of Nuclear Medicine, University College London, London, NW1 2BU, UK
| | - Kerstin Kläser
- Centre for Medical Image Computing, University College London, London, WC1E 7JE, UK
| | - Karin Shmueli
- Magnetic Resonance Imaging Group, Department of Medical Physics & Biomedical Engineering, University College London, London, WC1E 6BT, UK
| | - Radhouene Neji
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, GU16 8QD, UK
| | - Brian F Hutton
- Institute of Nuclear Medicine, University College London, London, NW1 2BU, UK
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College London, London, NW1 2BU, UK
| | - Simon Arridge
- Centre for Medical Image Computing, University College London, London, WC1E 7JE, UK
| | - Manuel Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Kris Thielemans
- Institute of Nuclear Medicine, University College London, London, NW1 2BU, UK
| | - David Atkinson
- Centre for Medical Imaging, University College London, London, W1W 7TS, UK
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30
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Schniering J, Benešová M, Brunner M, Haller S, Cohrs S, Frauenfelder T, Vrugt B, Feghali-Bostwick C, Schibli R, Distler O, Müller C, Maurer B. 18F-AzaFol for Detection of Folate Receptor-β Positive Macrophages in Experimental Interstitial Lung Disease-A Proof-of-Concept Study. Front Immunol 2019; 10:2724. [PMID: 31824505 PMCID: PMC6883947 DOI: 10.3389/fimmu.2019.02724] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/06/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Interstitial lung disease (ILD) is a common and severe complication in rheumatic diseases. Folate receptor-β is expressed on activated, but not resting macrophages which play a key role in dysregulated tissue repair including ILD. We therefore aimed to pre-clinically evaluate the potential of 18F-AzaFol-based PET/CT (positron emission computed tomography/computed tomography) for the specific detection of macrophage-driven pathophysiologic processes in experimental ILD. Methods: The pulmonary expression of folate receptor-β was analyzed in patients with different subtypes of ILD as well as in bleomycin (BLM)-treated mice and respective controls using immunohistochemistry. PET/CT was performed at days 3, 7, and 14 after BLM instillation using the 18F-based folate radiotracer 18F-AzaFol. The specific pulmonary accumulation of the radiotracer was assessed by ex vivo PET/CT scans and quantified by ex vivo biodistribution studies. Results: Folate receptor-β expression was 3- to 4-fold increased in patients with fibrotic ILD, including idiopathic pulmonary fibrosis and connective tissue disease-related ILD, and significantly correlated with the degree of lung remodeling. A similar increase in the expression of folate receptor-β was observed in experimental lung fibrosis, where it also correlated with disease extent. In the mouse model of BLM-induced ILD, pulmonary accumulation of 18F-AzaFol reflected macrophage-related disease development with good correlation of folate receptor-β positivity with radiotracer uptake. In the ex vivo imaging and biodistribution studies, the maximum lung accumulation was observed at day 7 with a mean accumulation of 1.01 ± 0.30% injected activity/lung in BLM-treated vs. control animals (0.31 ± 0.06% % injected activity/lung; p < 0.01). Conclusion: Our preclinical proof-of-concept study demonstrated the potential of 18F-AzaFol as a novel imaging tool for the visualization of macrophage-driven fibrotic lung diseases.
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Affiliation(s)
- Janine Schniering
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Martina Benešová
- Center for Radiopharmaceutical Sciences, Paul Scherrer Institute, Villigen, Switzerland
- Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Matthias Brunner
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Stephanie Haller
- Center for Radiopharmaceutical Sciences, Paul Scherrer Institute, Villigen, Switzerland
| | - Susan Cohrs
- Center for Radiopharmaceutical Sciences, Paul Scherrer Institute, Villigen, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Bart Vrugt
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Carol Feghali-Bostwick
- Division of Rheumatology & Immunology, Medical University of South Carolina, Charleston, SC, United States
| | - Roger Schibli
- Center for Radiopharmaceutical Sciences, Paul Scherrer Institute, Villigen, Switzerland
- Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Oliver Distler
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Cristina Müller
- Center for Radiopharmaceutical Sciences, Paul Scherrer Institute, Villigen, Switzerland
- Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Britta Maurer
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
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Abstract
Fibrosis is the abnormal deposition of extracellular matrix, which can lead to organ dysfunction, morbidity, and death. The disease burden caused by fibrosis is substantial, and there are currently no therapies that can prevent or reverse fibrosis. Metabolic alterations are increasingly recognized as an important pathogenic process that underlies fibrosis across many organ types. As a result, metabolically targeted therapies could become important strategies for fibrosis reduction. Indeed, some of the pathways targeted by antifibrotic drugs in development - such as the activation of transforming growth factor-β and the deposition of extracellular matrix - have metabolic implications. This Review summarizes the evidence to date and describes novel opportunities for the discovery and development of drugs for metabolic reprogramming, their associated challenges, and their utility in reducing fibrosis. Fibrotic therapies are potentially relevant to numerous common diseases such as cirrhosis, non-alcoholic steatohepatitis, chronic renal disease, heart failure, diabetes, idiopathic pulmonary fibrosis, and scleroderma.
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32
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Selvarajah B, Azuelos I, Platé M, Guillotin D, Forty EJ, Contento G, Woodcock HV, Redding M, Taylor A, Brunori G, Durrenberger PF, Ronzoni R, Blanchard AD, Mercer PF, Anastasiou D, Chambers RC. mTORC1 amplifies the ATF4-dependent de novo serine-glycine pathway to supply glycine during TGF-β 1-induced collagen biosynthesis. Sci Signal 2019; 12:eaav3048. [PMID: 31113850 PMCID: PMC6584619 DOI: 10.1126/scisignal.aav3048] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The differentiation of fibroblasts into a transient population of highly activated, extracellular matrix (ECM)-producing myofibroblasts at sites of tissue injury is critical for normal tissue repair. Excessive myofibroblast accumulation and persistence, often as a result of a failure to undergo apoptosis when tissue repair is complete, lead to pathological fibrosis and are also features of the stromal response in cancer. Myofibroblast differentiation is accompanied by changes in cellular metabolism, including increased glycolysis, to meet the biosynthetic demands of enhanced ECM production. Here, we showed that transforming growth factor-β1 (TGF-β1), the key pro-fibrotic cytokine implicated in multiple fibrotic conditions, increased the production of activating transcription factor 4 (ATF4), the transcriptional master regulator of amino acid metabolism, to supply glucose-derived glycine to meet the amino acid requirements associated with enhanced collagen production in response to myofibroblast differentiation. We further delineated the signaling pathways involved and showed that TGF-β1-induced ATF4 production depended on cooperation between canonical TGF-β1 signaling through Smad3 and activation of mechanistic target of rapamycin complex 1 (mTORC1) and its downstream target eukaryotic translation initiation factor 4E-binding protein 1 (4E-BP1). ATF4, in turn, promoted the transcription of genes encoding enzymes of the de novo serine-glycine biosynthetic pathway and glucose transporter 1 (GLUT1). Our findings suggest that targeting the TGF-β1-mTORC1-ATF4 axis may represent a novel therapeutic strategy for interfering with myofibroblast function in fibrosis and potentially in other conditions, including cancer.
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Affiliation(s)
- Brintha Selvarajah
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Rayne Building, University College London, London WC1E 6JF, UK
| | - Ilan Azuelos
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Rayne Building, University College London, London WC1E 6JF, UK
| | - Manuela Platé
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Rayne Building, University College London, London WC1E 6JF, UK
| | - Delphine Guillotin
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Rayne Building, University College London, London WC1E 6JF, UK
| | - Ellen J Forty
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Rayne Building, University College London, London WC1E 6JF, UK
| | - Greg Contento
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Rayne Building, University College London, London WC1E 6JF, UK
| | - Hannah V Woodcock
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Rayne Building, University College London, London WC1E 6JF, UK
| | - Matthew Redding
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Rayne Building, University College London, London WC1E 6JF, UK
| | - Adam Taylor
- Fibrosis Discovery Performance Unit, Respiratory Therapy Area, Medicines Research Centre, GlaxoSmithKline R&D, Stevenage SG1 2NY, UK
| | - Gino Brunori
- GlaxoSmithKline, David Jack Centre for R&D, Park Road, Ware, Hertfordshire, SG12 0DP, UK
| | - Pascal F Durrenberger
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Rayne Building, University College London, London WC1E 6JF, UK
| | - Riccardo Ronzoni
- Centre for Respiratory Biology, UCL Respiratory, Rayne Building, University College London, London WC1E 6JF, UK
| | - Andy D Blanchard
- Fibrosis Discovery Performance Unit, Respiratory Therapy Area, Medicines Research Centre, GlaxoSmithKline R&D, Stevenage SG1 2NY, UK
| | - Paul F Mercer
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Rayne Building, University College London, London WC1E 6JF, UK
| | | | - Rachel C Chambers
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Rayne Building, University College London, London WC1E 6JF, UK.
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33
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Role of 18F-FDG PET/CT in Restrictive Allograft Syndrome After Lung Transplantation. Transplantation 2019; 103:823-831. [DOI: 10.1097/tp.0000000000002393] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Weatherley ND, Eaden JA, Stewart NJ, Bartholmai BJ, Swift AJ, Bianchi SM, Wild JM. Experimental and quantitative imaging techniques in interstitial lung disease. Thorax 2019; 74:611-619. [PMID: 30886067 PMCID: PMC6585263 DOI: 10.1136/thoraxjnl-2018-211779] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 01/05/2019] [Accepted: 01/14/2019] [Indexed: 01/19/2023]
Abstract
Interstitial lung diseases (ILDs) are a heterogeneous group of conditions, with a wide and complex variety of imaging features. Difficulty in monitoring, treating and exploring novel therapies for these conditions is in part due to the lack of robust, readily available biomarkers. Radiological studies are vital in the assessment and follow-up of ILD, but currently CT analysis in clinical practice is qualitative and therefore somewhat subjective. In this article, we report on the role of novel and quantitative imaging techniques across a range of imaging modalities in ILD and consider how they may be applied in the assessment and understanding of ILD. We critically appraised evidence found from searches of Ovid online, PubMed and the TRIP database for novel and quantitative imaging studies in ILD. Recent studies have explored the capability of texture-based lung parenchymal analysis in accurately quantifying several ILD features. Newer techniques are helping to overcome the challenges inherent to such approaches, in particular distinguishing peripheral reticulation of lung parenchyma from pleura and accurately identifying the complex density patterns that accompany honeycombing. Robust and validated texture-based analysis may remove the subjectivity that is inherent to qualitative reporting and allow greater objective measurements of change over time. In addition to lung parenchymal feature quantification, pulmonary vessel volume analysis on CT has demonstrated prognostic value in two retrospective analyses and may be a sign of vascular changes in ILD which, to date, have been difficult to quantify in the absence of overt pulmonary hypertension. Novel applications of existing imaging techniques, such as hyperpolarised gas MRI and positron emission tomography (PET), show promise in combining structural and functional information. Although structural imaging of lung tissue is inherently challenging in terms of conventional proton MRI techniques, inroads are being made with ultrashort echo time, and dynamic contrast-enhanced MRI may be used for lung perfusion assessment. In addition, inhaled hyperpolarised 129Xenon gas MRI may provide multifunctional imaging metrics, including assessment of ventilation, intra-acinar gas diffusion and alveolar-capillary diffusion. PET has demonstrated high standard uptake values (SUVs) of 18F-fluorodeoxyglucose in fibrosed lung tissue, challenging the assumption that these are ‘burned out’ and metabolically inactive regions. Regions that appear structurally normal also appear to have higher SUV, warranting further exploration with future longitudinal studies to assess if this precedes future regions of macroscopic structural change. Given the subtleties involved in diagnosing, assessing and predicting future deterioration in many forms of ILD, multimodal quantitative lung structure-function imaging may provide the means of identifying novel, sensitive and clinically applicable imaging markers of disease. Such imaging metrics may provide mechanistic and phenotypic information that can help direct appropriate personalised therapy, can be used to predict outcomes and could potentially be more sensitive and specific than global pulmonary function testing. Quantitative assessment may objectively assess subtle change in character or extent of disease that can assist in efficacy of antifibrotic therapy or detecting early changes of potentially pneumotoxic drugs involved in early intervention studies.
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Affiliation(s)
| | - James A Eaden
- Academic Unit of Academic Radiology, University of Sheffield, Sheffield, UK
| | - Neil J Stewart
- Academic Unit of Academic Radiology, University of Sheffield, Sheffield, UK
| | - Brian J Bartholmai
- Department of Radiology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Andrew J Swift
- Academic Unit of Academic Radiology, University of Sheffield, Sheffield, UK
| | - Stephen Mark Bianchi
- Department of Respiratory Medicine, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - Jim M Wild
- Academic Unit of Academic Radiology, University of Sheffield, Sheffield, UK
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Flechsig P, Hural O, Kreuter M, Eichhorn M, HEUßEL G, Sachpekidis C, Kauczor HU, Haberkorn U, Heussel CP, Eichinger M. Impact of FDG-PET on the Detection of Patients with Lung Cancer at High Risk for ILD. In Vivo 2019; 32:1457-1462. [PMID: 30348701 DOI: 10.21873/invivo.11399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND/AIM Idiopathic pulmonary fibrosis IPF is a type of interstitial lung disease (ILD) with poor prognosis. Lung cancer (LC) is a frequent complication in IPF, where all therapeutic options are potential triggers for acute exacerbation of IPF. PATIENTS AND METHODS Patients with 2-deoxy-2-fluoro-D-glucose-positron emission tomography/computer tomography (FDG-PET/CT) results before lobectomy for LC with and without (n=10 each) signs of ILD in initial imaging and after-care CT were retrospectively analyzed. FDG uptake was calculated as the maximum standardized uptake value (SUVmax) in the lung periphery divided by the SUVmax of the mediastinal blood pool (rSUVmax). Regional increase of fibrosis and ground-glass features in lobe-based CT analysis was used as standard reference. RESULTS Patients with LC with ILD presented a significantly higher rSUVmax of 0.57 compared to patients without ILD with rSUVmax 0.47 (p<0.001). CONCLUSION rSUVmax seems to be a valuable imaging surrogate in predicting patients with LC with increased risk for progressive ILD associated with thoracic surgery.
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Affiliation(s)
- Paul Flechsig
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany .,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany.,Division of Diagnostic and Interventional Radiology with Nuclear Medicine, Thorax Clinic, University of Heidelberg, Heidelberg, Germany
| | - Olena Hural
- Division of Diagnostic and Interventional Radiology with Nuclear Medicine, Thorax Clinic, University of Heidelberg, Heidelberg, Germany
| | - Michael Kreuter
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany.,Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thorax Clinic, University of Heidelberg, Heidelberg, Germany
| | - Martin Eichhorn
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany.,Department of Thoracic Surgery, Thorax Clinic, University of Heidelberg, Heidelberg, Germany
| | - Gudula HEUßEL
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany.,Division of Diagnostic and Interventional Radiology with Nuclear Medicine, Thorax Clinic, University of Heidelberg, Heidelberg, Germany.,Department of Thoracic Surgery, Thorax Clinic, University of Heidelberg, Heidelberg, Germany
| | - Christos Sachpekidis
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit, Department of Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany.,Clinical Cooperation Unit, Department of Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Claus Peter Heussel
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany.,Division of Diagnostic and Interventional Radiology with Nuclear Medicine, Thorax Clinic, University of Heidelberg, Heidelberg, Germany
| | - Monika Eichinger
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany.,Division of Diagnostic and Interventional Radiology with Nuclear Medicine, Thorax Clinic, University of Heidelberg, Heidelberg, Germany
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Bondue B, Castiaux A, Van Simaeys G, Mathey C, Sherer F, Egrise D, Lacroix S, Huaux F, Doumont G, Goldman S. Absence of early metabolic response assessed by 18F-FDG PET/CT after initiation of antifibrotic drugs in IPF patients. Respir Res 2019; 20:10. [PMID: 30646908 PMCID: PMC6334423 DOI: 10.1186/s12931-019-0974-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/02/2019] [Indexed: 02/08/2023] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is characterized by a progressive and irreversible respiratory failure. Non-invasive markers of disease activity are essential for prognosis and evaluation of early response to anti-fibrotic treatments. Objectives The aims of this study were to determine whether fluorodeoxyglucose ([18F]-FDG) lung uptake is reduced after initiation of pirfenidone or nintedanib and to assess its possible use as a prognostic factor. Methods [18F]-FDG PET/CT was performed in IPF patients and in a murine model of pulmonary fibrosis. PET/CTs were performed at day 8 and day 15 post-instillation of bleomycin in pirfenidone- or vehicule-treated mice. In IPF patients, PET-CT was performed before and 3 months after the initiation of pirfenidone or nintedanib. Results In bleomycin-treated mice, pirfenidone significantly reduced the [18F]-FDG uptake compared to vehicule-treated mice at day 15 (p < 0.001), whereas no difference was observed at day 8 after bleomycin administration. In IPF patients, [18F]-FDG lung uptake before and after 3 months of treatment by nintedanib (n = 11) or pirfenidone (n = 14) showed no significant difference regardless the antifibrotic treatment. Moreover, no difference was noticed between patients with progressive or non-progressive disease at one year of follow up. Conclusions Pirfenidone significantly reduces the lung [18F]-FDG uptake during the fibrotic phase in a mouse model of IPF. However, these preclinical data were not confirmed in IPF patients 3 months after the initiation of antifibrotic therapy. [18F]-FDG seems therefore not useful in clinical practice to assess the early response of IPF patients to nintedanib or pirfenidone. Electronic supplementary material The online version of this article (10.1186/s12931-019-0974-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin Bondue
- Department of Respiratory Medicine, Erasme University Hospital, Université libre de Bruxelles (ULB), route de Lennik 808, 1070, Brussels, Belgium.
| | - Amélie Castiaux
- Department of Nuclear Medicine, Erasme University Hospital, Université libre de Bruxelles (ULB), route de Lennik 808, 1070, Brussels, Belgium
| | - Gaetan Van Simaeys
- Department of Nuclear Medicine, Erasme University Hospital, Université libre de Bruxelles (ULB), route de Lennik 808, 1070, Brussels, Belgium.,Center for Microscopy and Molecular Imaging, Université libre de Bruxelles (ULB), rue Adrienne Bolland 8, 6041, Charleroi, Belgium
| | - Céline Mathey
- Department of Nuclear Medicine, Erasme University Hospital, Université libre de Bruxelles (ULB), route de Lennik 808, 1070, Brussels, Belgium
| | - Félicie Sherer
- Department of Nuclear Medicine, Erasme University Hospital, Université libre de Bruxelles (ULB), route de Lennik 808, 1070, Brussels, Belgium.,Center for Microscopy and Molecular Imaging, Université libre de Bruxelles (ULB), rue Adrienne Bolland 8, 6041, Charleroi, Belgium
| | - Dominique Egrise
- Department of Nuclear Medicine, Erasme University Hospital, Université libre de Bruxelles (ULB), route de Lennik 808, 1070, Brussels, Belgium.,Center for Microscopy and Molecular Imaging, Université libre de Bruxelles (ULB), rue Adrienne Bolland 8, 6041, Charleroi, Belgium
| | - Simon Lacroix
- Department of Nuclear Medicine, Erasme University Hospital, Université libre de Bruxelles (ULB), route de Lennik 808, 1070, Brussels, Belgium.,Center for Microscopy and Molecular Imaging, Université libre de Bruxelles (ULB), rue Adrienne Bolland 8, 6041, Charleroi, Belgium
| | - François Huaux
- Louvain Centre for Toxicology and Applied Pharmacology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Avenue Hippocrate, 57 bte B1.57.06, 1200, Woluwe-Saint-Lambert, Belgium
| | - Gilles Doumont
- Center for Microscopy and Molecular Imaging, Université libre de Bruxelles (ULB), rue Adrienne Bolland 8, 6041, Charleroi, Belgium
| | - Serge Goldman
- Department of Nuclear Medicine, Erasme University Hospital, Université libre de Bruxelles (ULB), route de Lennik 808, 1070, Brussels, Belgium.,Center for Microscopy and Molecular Imaging, Université libre de Bruxelles (ULB), rue Adrienne Bolland 8, 6041, Charleroi, Belgium
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Fraioli F, Lyasheva M, Porter JC, Bomanji J, Shortman RI, Endozo R, Wan S, Bertoletti L, Machado M, Ganeshan B, Win T, Groves AM. Synergistic application of pulmonary 18F-FDG PET/HRCT and computer-based CT analysis with conventional severity measures to refine current risk stratification in idiopathic pulmonary fibrosis (IPF). Eur J Nucl Med Mol Imaging 2019; 46:2023-2031. [PMID: 31286201 PMCID: PMC6667685 DOI: 10.1007/s00259-019-04386-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/30/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION To investigate the combined performance of quantitative CT (qCT) following a computer algorithm analysis (IMBIO) and 18F-FDG PET/CT to assess survival in patients with idiopathic pulmonary fibrosis (IPF). METHODS A total of 113 IPF patients (age 70 ± 9 years) prospectively and consecutively underwent 18F-FDG PET/CT and high-resolution CT (HRCT) at our institution. During a mean follow-up of 29.6 ± 26 months, 44 (48%) patients died. As part of the qCT analysis, pattern evaluation of HRCT (using IMBIO software) included the total extent (percentage) of the following features: normal-appearing lung, hyperlucent lung, parenchymal damage (comprising ground-glass opacification, reticular pattern and honeycombing), and the pulmonary vessels. The maximum (SUVmax) and minimum (SUVmin) standardized uptake value (SUV) for 18F-FDG uptake in the lungs, and the target-to-background (SUVmax/SUVmin) ratio (TBR) were quantified using routine region-of-interest (ROI) analysis. Pulmonary functional tests (PFTs) were acquired within 14 days of the PET/CT/HRCT scan. Kaplan-Meier (KM) survival analysis was used to identify associations with mortality. RESULTS Data from 91 patients were available for comparative analysis. The average ± SD GAP [gender, age, physiology] score was 4.2 ± 1.7 (range 0-8). The average ± SD SUVmax, SUVmin, and TBR were 3.4 ± 1.4, 0.7 ± 0.2, and 5.6 ± 2.8, respectively. In all patients, qCT analysis demonstrated a predominantly reticular lung pattern (14.9 ± 12.4%). KM analysis showed that TBR (p = 0.018) and parenchymal damage assessed by qCT (p = 0.0002) were the best predictors of survival. Adding TBR and qCT to the GAP score significantly increased the ability to differentiate between high and low risk (p < 0.0001). CONCLUSION 18F-FDG PET and qCT are independent and synergistic in predicting mortality in patients with IPF.
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Affiliation(s)
- Francesco Fraioli
- Institute of Nuclear Medicine, UCL(H) and University College London Hospital, 235 Euston Rd, London, NW1 2BU UK
| | - Maria Lyasheva
- Department of Oncology, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Joanna C. Porter
- CITR, UCL and Interstitial Lung Disease Centre, UCLH, London, UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, UCL(H) and University College London Hospital, 235 Euston Rd, London, NW1 2BU UK
| | - Robert I. Shortman
- Institute of Nuclear Medicine, UCL(H) and University College London Hospital, 235 Euston Rd, London, NW1 2BU UK
| | - Raymond Endozo
- Institute of Nuclear Medicine, UCL(H) and University College London Hospital, 235 Euston Rd, London, NW1 2BU UK
| | - Simon Wan
- Institute of Nuclear Medicine, UCL(H) and University College London Hospital, 235 Euston Rd, London, NW1 2BU UK
| | | | - Maria Machado
- Institute of Nuclear Medicine, UCL(H) and University College London Hospital, 235 Euston Rd, London, NW1 2BU UK
| | - Balaji Ganeshan
- Institute of Nuclear Medicine, UCL(H) and University College London Hospital, 235 Euston Rd, London, NW1 2BU UK
| | - Thida Win
- Respiratory Medicine, Lister Hospital, Stevenage, UK
| | - Ashley M. Groves
- Institute of Nuclear Medicine, UCL(H) and University College London Hospital, 235 Euston Rd, London, NW1 2BU UK
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38
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Castiaux A, Van Simaeys G, Goldman S, Bondue B. Assessment of 18F-FDG uptake in idiopathic pulmonary fibrosis: influence of lung density changes. Eur J Hybrid Imaging 2018. [DOI: 10.1186/s41824-018-0045-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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39
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Aliyu SA, Avery G, Cawthorne C, Archibald SJ, Kadir T, Willaime JMY, Morice AH, Hart SP, Crooks MG. Textural analysis demonstrates heterogeneous [ 18F]-fluorodeoxyglucose uptake in radiologically normal lung in patients with idiopathic pulmonary fibrosis. Eur Respir J 2018; 52:13993003.01138-2018. [PMID: 30262576 DOI: 10.1183/13993003.01138-2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/24/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Shamsuddeen A Aliyu
- Respiratory Research Group, Hull York Medical School, Castle Hill Hospital, Cottingham, UK.,PET Research Centre, University of Hull, Hull, UK
| | - Ged Avery
- Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Cottingham, UK
| | | | | | - Timor Kadir
- Optellum Ltd, Oxford Centre for Innovation, Oxford, UK
| | | | - Alyn H Morice
- Respiratory Research Group, Hull York Medical School, Castle Hill Hospital, Cottingham, UK
| | - Simon P Hart
- Respiratory Research Group, Hull York Medical School, Castle Hill Hospital, Cottingham, UK
| | - Michael G Crooks
- Respiratory Research Group, Hull York Medical School, Castle Hill Hospital, Cottingham, UK
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40
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Pulmonary 18F-FDG uptake helps refine current risk stratification in idiopathic pulmonary fibrosis (IPF). Eur J Nucl Med Mol Imaging 2018; 45:806-815. [PMID: 29335764 PMCID: PMC5978900 DOI: 10.1007/s00259-017-3917-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/14/2017] [Indexed: 12/11/2022]
Abstract
Purpose There is a lack of prognostic biomarkers in idiopathic pulmonary fibrosis (IPF) patients. The objective of this study is to investigate the potential of 18F-FDG-PET/ CT to predict mortality in IPF. Methods A total of 113 IPF patients (93 males, 20 females, mean age ± SD: 70 ± 9 years) were prospectively recruited for 18F-FDG-PET/CT. The overall maximum pulmonary uptake of 18F-FDG (SUVmax), the minimum pulmonary uptake or background lung activity (SUVmin), and target-to-background (SUVmax/ SUVmin) ratio (TBR) were quantified using routine region-of-interest analysis. Kaplan–Meier analysis was used to identify associations of PET measurements with mortality. We also compared PET associations with IPF mortality with the established GAP (gender age and physiology) scoring system. Cox analysis assessed the independence of the significant PET measurement(s) from GAP score. We investigated synergisms between pulmonary 18F-FDG-PET measurements and GAP score for risk stratification in IPF patients. Results During a mean follow-up of 29 months, there were 54 deaths. The mean TBR ± SD was 5.6 ± 2.7. Mortality was associated with high pulmonary TBR (p = 0.009), low forced vital capacity (FVC; p = 0.001), low transfer factor (TLCO; p < 0.001), high GAP index (p = 0.003), and high GAP stage (p = 0.003). Stepwise forward-Wald–Cox analysis revealed that the pulmonary TBR was independent of GAP classification (p = 0.010). The median survival in IPF patients with a TBR < 4.9 was 71 months, whilst in those with TBR > 4.9 was 24 months. Combining PET data with GAP data (“PET modified GAP score”) refined the ability to predict mortality. Conclusions A high pulmonary TBR is independently associated with increased risk of mortality in IPF patients. Electronic supplementary material The online version of this article (10.1007/s00259-017-3917-8) contains supplementary material, which is available to authorized users.
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Cuplov V, Holman BF, McClelland J, Modat M, Hutton BF, Thielemans K. Issues in quantification of registered respiratory gated PET/CT in the lung. ACTA ACUST UNITED AC 2017; 63:015007. [DOI: 10.1088/1361-6560/aa950b] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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42
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Molina-Molina M, Agusti A, Crestani B, Schwartz DA, Königshoff M, Chambers RC, Maher TM, Faner R, Mora AL, Rojas M, Antoniou KM, Sellares J. Towards a global initiative for fibrosis treatment (GIFT). ERJ Open Res 2017; 3:00106-2017. [PMID: 29214157 PMCID: PMC5710382 DOI: 10.1183/23120541.00106-2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/06/2017] [Indexed: 12/13/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease characterised by increased scarring of lung tissue. Despite the recent introduction of novel drugs that slow disease progression, IPF remains a deadly disease, and the benefits of these new drugs differ markedly between patients. Human diseases arise due to alterations in an almost limitless network of interconnected genes, proteins, metabolites, cells and tissues, in direct relationship with a continuously changing macro- or microenvironment. Systems biology is a novel research strategy that seeks to understand the structure and behaviour of the so-called “emergent properties” of complex systems, such as those involved in disease pathogenesis, which are most often overlooked when just one element of disease pathogenesis is observed in isolation. This article summarises the debate that took place during a European Respiratory Society research seminar in Barcelona, Spain on December 15–16, 2016, which focused on how systems biology could generate new data by integrating the different IPF pathogenic levels of complexity. The main conclusion of the seminar was to create a global initiative to improve IPF outcomes by integrating cutting-edge international research that leverages systems biology to develop a precision medicine approach to tackle this devastating disease. A novel call to action for implementing systems biology in IPF researchhttp://ow.ly/Is0A30gpnVb
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Affiliation(s)
- Maria Molina-Molina
- Servei de Pneumologia, Laboratori de Pneumologia Experimental, IDIBELL, Campus de Bellvitge, Universitat de Barcelona, Barcelona, Spain.,CIBER of Respiratory Diseases, ISCIII, Barcelona, Spain
| | - Alvar Agusti
- CIBER of Respiratory Diseases, ISCIII, Barcelona, Spain.,Servei de Pneumologia, Institut Respiratori, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Bruno Crestani
- Service de Pneumologie A, Hospital Bichat, University Paris Diderot, Paris, France
| | | | - Melanie Königshoff
- Division of Pulmonary Sciences and Critical Care Medicine, Dept of Medicine, University of Colorado, Aurora, CO, USA
| | - Rachel C Chambers
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
| | - Toby M Maher
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Fibrosis Research Group, National Heart and Lung Institute, Imperial College, London, UK
| | - Rosa Faner
- CIBER of Respiratory Diseases, ISCIII, Barcelona, Spain.,Servei de Pneumologia, Institut Respiratori, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Ana Lucia Mora
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mauricio Rojas
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, University of Pittsburgh, Pittsburgh, PA, USA
| | - Katerina M Antoniou
- Dept of Respiratory Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Greece
| | - Jacobo Sellares
- CIBER of Respiratory Diseases, ISCIII, Barcelona, Spain.,Servei de Pneumologia, Institut Respiratori, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
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43
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Cho SJ, Moon JS, Lee CM, Choi AMK, Stout-Delgado HW. Glucose Transporter 1-Dependent Glycolysis Is Increased during Aging-Related Lung Fibrosis, and Phloretin Inhibits Lung Fibrosis. Am J Respir Cell Mol Biol 2017; 56:521-531. [PMID: 27997810 DOI: 10.1165/rcmb.2016-0225oc] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aging is associated with metabolic diseases such as type 2 diabetes mellitus, cardiovascular disease, cancer, and neurodegeneration. Aging contributes to common processes including metabolic dysfunction, DNA damage, and reactive oxygen species generation. Although glycolysis has been linked to cell growth and proliferation, the mechanisms by which the activation of glycolysis by aging regulates fibrogenesis in the lung remain unclear. The objective of this study was to determine if glucose transporter 1 (GLUT1)-induced glycolysis regulates age-dependent fibrogenesis of the lung. Mouse and human lung tissues were analyzed for GLUT1 and glycolytic markers using immunoblotting. Glycolytic function was measured using a Seahorse apparatus. To study the effect of GLUT1, genetic inhibition of GLUT1 was performed by short hairpin RNA transduction, and phloretin was used for pharmacologic inhibition of GLUT1. GLUT1-dependent glycolysis is activated in aged lung. Genetic and pharmacologic inhibition of GLUT1 suppressed the protein expression of α-smooth muscle actin, a key cytoskeletal component of activated fibroblasts, in mouse primary lung fibroblast cells. Moreover, we demonstrated that the activation of AMP-activated protein kinase, which is regulated by GLUT1-dependent glycolysis, represents a critical metabolic pathway for fibroblast activation. Furthermore, we demonstrated that phloretin, a potent inhibitor of GLUT1, significantly inhibited bleomycin-induced lung fibrosis in vivo. These results suggest that GLUT1-dependent glycolysis regulates fibrogenesis in aged lung and that inhibition of GLUT1 provides a potential target of therapy of age-related lung fibrosis.
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Affiliation(s)
- Soo Jung Cho
- 1 Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, New York.,2 Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York; and
| | - Jong-Seok Moon
- 1 Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, New York.,2 Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York; and
| | - Chang-Min Lee
- 3 Department of Molecular Microbiology and Immunology, Brown University, Providence, Rhode Island
| | - Augustine M K Choi
- 1 Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, New York.,2 Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York; and
| | - Heather W Stout-Delgado
- 1 Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, New York.,2 Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York; and
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44
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Coello C, Fisk M, Mohan D, Wilson FJ, Brown AP, Polkey MI, Wilkinson I, Tal-Singer R, Murphy PS, Cheriyan J, Gunn RN. Quantitative analysis of dynamic 18F-FDG PET/CT for measurement of lung inflammation. EJNMMI Res 2017; 7:47. [PMID: 28547129 PMCID: PMC5445063 DOI: 10.1186/s13550-017-0291-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/09/2017] [Indexed: 11/23/2022] Open
Abstract
Background An inflammatory reaction in the airways and lung parenchyma, comprised mainly of neutrophils and alveolar macrophages, is present in some patients with chronic obstructive pulmonary disease (COPD). Thoracic fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) has been proposed as a promising imaging biomarker to assess this inflammation. We sought to introduce a fully quantitative analysis method and compare this with previously published studies based on the Patlak approach using a dataset comprising 18F-FDG PET scans from COPD subjects with elevated circulating inflammatory markers (fibrinogen) and matched healthy volunteers (HV). Dynamic 18F-FDG PET scans were obtained for high-fibrinogen (>2.8 g/l) COPD subjects (N = 10) and never smoking HV (N = 10). Lungs were segmented using co-registered computed tomography images and subregions (upper, middle and lower) were semi-automatically defined. A quantitative analysis approach was developed, which corrects for the presence of air and blood in the lung (qABL method), enabling direct estimation of the metabolic rate of FDG in lung tissue. A normalised Patlak analysis approach was also performed to enable comparison with previously published results. Effect sizes (Hedge’s g) were used to compare HV and COPD groups. Results The qABL method detected no difference (Hedge’s g = 0.15 [−0.76 1.04]) in the tissue metabolic rate of FDG in the whole lung between HV (μ = 6.0 ± 1.9 × 10−3 ml cm−3 min−1) and COPD (μ = 5.7 ± 1.7 × 10−3 ml cm−3 min−1). However, analysis with the normalised Patlak approach detected a significant difference (Hedge’s g = −1.59 [−2.57 −0.48]) in whole lung between HV (μ = 2.9 ± 0.5 × 10−3 ml cm−3 min−1) and COPD (μ = 3.9 ± 0.7 × 10−3 ml cm−3 min−1). The normalised Patlak endpoint was shown to be a composite measure influenced by air volume, blood volume and actual uptake of 18F-FDG in lung tissue. Conclusions We have introduced a quantitative analysis method that provides a direct estimate of the metabolic rate of FDG in lung tissue. This work provides further understanding of the underlying origin of the 18F-FDG signal in the lung in disease groups and helps interpreting changes following standard or novel therapies. Electronic supplementary material The online version of this article (doi:10.1186/s13550-017-0291-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christopher Coello
- Imanova Ltd., Centre for Imaging Sciences, Hammersmith Hospital, London, UK. .,Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK.
| | - Marie Fisk
- Experimental Medicine and Immunotherapeutics (EMIT) Division, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Divya Mohan
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK.,GSK R&D, King of Prussia, PA, USA
| | | | - Andrew P Brown
- Imanova Ltd., Centre for Imaging Sciences, Hammersmith Hospital, London, UK
| | - Michael I Polkey
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Ian Wilkinson
- Experimental Medicine and Immunotherapeutics (EMIT) Division, Department of Medicine, University of Cambridge, Cambridge, UK.,Cambridge Clinical Trials Unit, Addenbrooke's Hospital, Cambridge, UK
| | | | | | - Joseph Cheriyan
- Experimental Medicine and Immunotherapeutics (EMIT) Division, Department of Medicine, University of Cambridge, Cambridge, UK.,GSK R&D, Cambridge, UK.,Cambridge Clinical Trials Unit, Addenbrooke's Hospital, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, UK
| | - Roger N Gunn
- Imanova Ltd., Centre for Imaging Sciences, Hammersmith Hospital, London, UK.,Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK.,Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
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45
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Désogère P, Tapias LF, Hariri LP, Rotile NJ, Rietz TA, Probst CK, Blasi F, Day H, Mino-Kenudson M, Weinreb P, Violette SM, Fuchs BC, Tager AM, Lanuti M, Caravan P. Type I collagen-targeted PET probe for pulmonary fibrosis detection and staging in preclinical models. Sci Transl Med 2017; 9:eaaf4696. [PMID: 28381537 PMCID: PMC5568793 DOI: 10.1126/scitranslmed.aaf4696] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 10/20/2016] [Accepted: 03/16/2017] [Indexed: 12/26/2022]
Abstract
Pulmonary fibrosis is scarring of the lungs that can arise from radiation injury, drug toxicity, environmental or genetic causes, and for unknown reasons [idiopathic pulmonary fibrosis (IPF)]. Overexpression of collagen is a hallmark of organ fibrosis. We describe a peptide-based positron emission tomography (PET) probe (68Ga-CBP8) that targets collagen type I. We evaluated 68Ga-CBP8 in vivo in the bleomycin-induced mouse model of pulmonary fibrosis. 68Ga-CBP8 showed high specificity for pulmonary fibrosis and high target/background ratios in diseased animals. The lung PET signal and lung 68Ga-CBP8 uptake (quantified ex vivo) correlated linearly (r2 = 0.80) with the amount of lung collagen in mice with fibrosis. We further demonstrated that the 68Ga-CBP8 probe could be used to monitor response to treatment in a second mouse model of pulmonary fibrosis associated with vascular leak. Ex vivo analysis of lung tissue from patients with IPF supported the animal findings. These studies indicate that 68Ga-CBP8 is a promising candidate for noninvasive imaging of human pulmonary fibrosis.
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Affiliation(s)
- Pauline Désogère
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Luis F Tapias
- Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Lida P Hariri
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Nicholas J Rotile
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Tyson A Rietz
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Clemens K Probst
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Francesco Blasi
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Helen Day
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | | | | | - Bryan C Fuchs
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Andrew M Tager
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Michael Lanuti
- Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
| | - Peter Caravan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA.
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46
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Abstract
The field of interstitial lung disease (ILD) has undergone significant evolution in recent years, with an increasing incidence and more complex, ever expanding disease classification. In their most severe forms, these diseases lead to progressive loss of lung function, respiratory failure and eventually death. Despite notable advances, progress has been challenged by a poor understanding of pathological mechanisms and patient heterogeneity, including variable progression. The diagnostic pathway is thus being continually refined, with the introduction of tools such as transbronchial cryo lung biopsy and a move towards genetically aided, precision medicine. In this review, we focus on how to approach a patient with ILD and the diagnostic process.
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Affiliation(s)
- Theresia A Mikolasch
- UCL Respiratory, Univeristy College London and Interstitial Lung Disease Service, University College London NHS Foundation Trust, London, UK
| | - Helen S Garthwaite
- UCL Respiratory, Univeristy College London and Interstitial Lung Disease Service, University College London NHS Foundation Trust, London, UK
| | - Joanna C Porter
- UCL Respiratory, University College London and Interstitial Lung Disease Service, University College London NHS Foundation Trust, London, UK
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47
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Dournes G, Macey J, Blanchard E, Berger P, Laurent F. [MRI of the pulmonary parenchyma: Towards clinical applicability?]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:40-49. [PMID: 28159433 DOI: 10.1016/j.pneumo.2016.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 12/27/2016] [Indexed: 06/06/2023]
Abstract
Lung parenchyma has long been considered out of the scope of magnetic resonance imaging (MRI) clinical applicability. However, technological advances have emerged to soluce the technical difficulties and thus, applications in clinical practice have become realistic. Nevertheless, various approaches have been proposed and there is a need to synthetize the most recent literature data in order to envision a rationale to build lung MR protocols for clinical use. In addition, these technological innovations may modify the usual paradigms of lung MRI, which are still not consensual. Thus, lung MR protocols appear to be heterogeneous across expert centers in the current context. In this literature review, we ought to describe a rationale on the need to get an alternative to ionizing imaging modalities, in particular in the follow-up of patients with chronic lung diseases. We will describe the most recent technical advances regarding both morphological and functional MRI. Finally, we will conclude on the clinical applicability of MRI of the pulmonary parenchyma, as a routine or research tool.
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Affiliation(s)
- G Dournes
- Centre de recherche cardio-thoracique de Bordeaux, Inserm U1045, université Bordeaux-Segalen, CIC1401, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France; Service de radiologie, service de pneumologie, service d'exploration fonctionnelle respiratoire, CHU de Bordeaux, CIC1401, 33064 Pessac, France.
| | - J Macey
- Centre de recherche cardio-thoracique de Bordeaux, Inserm U1045, université Bordeaux-Segalen, CIC1401, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France; Service de radiologie, service de pneumologie, service d'exploration fonctionnelle respiratoire, CHU de Bordeaux, CIC1401, 33064 Pessac, France
| | - E Blanchard
- Service de radiologie, service de pneumologie, service d'exploration fonctionnelle respiratoire, CHU de Bordeaux, CIC1401, 33064 Pessac, France
| | - P Berger
- Centre de recherche cardio-thoracique de Bordeaux, Inserm U1045, université Bordeaux-Segalen, CIC1401, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France; Service de radiologie, service de pneumologie, service d'exploration fonctionnelle respiratoire, CHU de Bordeaux, CIC1401, 33064 Pessac, France
| | - F Laurent
- Centre de recherche cardio-thoracique de Bordeaux, Inserm U1045, université Bordeaux-Segalen, CIC1401, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France; Service de radiologie, service de pneumologie, service d'exploration fonctionnelle respiratoire, CHU de Bordeaux, CIC1401, 33064 Pessac, France
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48
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Chen DL, Cheriyan J, Chilvers ER, Choudhury G, Coello C, Connell M, Fisk M, Groves AM, Gunn RN, Holman BF, Hutton BF, Lee S, MacNee W, Mohan D, Parr D, Subramanian D, Tal-Singer R, Thielemans K, van Beek EJR, Vass L, Wellen JW, Wilkinson I, Wilson FJ. Quantification of Lung PET Images: Challenges and Opportunities. J Nucl Med 2017; 58:201-207. [PMID: 28082432 DOI: 10.2967/jnumed.116.184796] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/10/2017] [Indexed: 01/03/2023] Open
Abstract
Millions of people are affected by respiratory diseases, leading to a significant health burden globally. Because of the current insufficient knowledge of the underlying mechanisms that lead to the development and progression of respiratory diseases, treatment options remain limited. To overcome this limitation and understand the associated molecular changes, noninvasive imaging techniques such as PET and SPECT have been explored for biomarker development, with 18F-FDG PET imaging being the most studied. The quantification of pulmonary molecular imaging data remains challenging because of variations in tissue, air, blood, and water fractions within the lungs. The proportions of these components further differ depending on the lung disease. Therefore, different quantification approaches have been proposed to address these variabilities. However, no standardized approach has been developed to date. This article reviews the data evaluating 18F-FDG PET quantification approaches in lung diseases, focusing on methods to account for variations in lung components and the interpretation of the derived parameters. The diseases reviewed include acute respiratory distress syndrome, chronic obstructive pulmonary disease, and interstitial lung diseases such as idiopathic pulmonary fibrosis. Based on review of prior literature, ongoing research, and discussions among the authors, suggested considerations are presented to assist with the interpretation of the derived parameters from these approaches and the design of future studies.
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Affiliation(s)
- Delphine L Chen
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Joseph Cheriyan
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Edwin R Chilvers
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Gourab Choudhury
- Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Martin Connell
- Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Marie Fisk
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Roger N Gunn
- Imanova Ltd., London, United Kingdom.,Department of Medicine, Imperial College London, London, United Kingdom
| | - Beverley F Holman
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Brian F Hutton
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Sarah Lee
- Medical Image Analysis Consultant, London, United Kingdom
| | - William MacNee
- Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Divya Mohan
- Clinical Discovery, Respiratory Therapy Area Unit, GlaxoSmithKline R&D, King of Prussia, Pennsylvania
| | - David Parr
- University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | | | - Ruth Tal-Singer
- Clinical Discovery, Respiratory Therapy Area Unit, GlaxoSmithKline R&D, King of Prussia, Pennsylvania
| | - Kris Thielemans
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Edwin J R van Beek
- Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Laurence Vass
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jeremy W Wellen
- Worldwide Research and Development, Pfizer, Inc., Cambridge, Massachusetts; and
| | - Ian Wilkinson
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Frederick J Wilson
- Experimental Medicine Imaging, GlaxoSmithKline, Stevenage, United Kingdom
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49
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Abstract
The field of interstitial lung disease (ILD) has undergone significant evolution in recent years, with an increasing incidence and more complex, ever expanding disease classification. In their most severe forms, these diseases lead to progressive loss of lung function, respiratory failure and eventually death. Despite notable advances, progress has been challenged by a poor understanding of pathological mechanisms and patient heterogeneity, including variable progression. The diagnostic pathway is thus being continually refined, with the introduction of tools such as transbronchial cryo lung biopsy and a move towards genetically aided, precision medicine. In this review, we focus on how to approach a patient with ILD and the diagnostic process.
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Affiliation(s)
- Theresia A Mikolasch
- UCL Respiratory, Univeristy College London and Interstitial Lung Disease Service, University College London NHS Foundation Trust, London, UK
| | - Helen S Garthwaite
- UCL Respiratory, Univeristy College London and Interstitial Lung Disease Service, University College London NHS Foundation Trust, London, UK
| | - Joanna C Porter
- UCL Respiratory, University College London and Interstitial Lung Disease Service, University College London NHS Foundation Trust, London, UK
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50
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FDG-PET/CT in the prediction of pulmonary function improvement in nonspecific interstitial pneumonia. A Pilot Study. Eur J Radiol 2016; 85:2200-2205. [DOI: 10.1016/j.ejrad.2016.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/30/2016] [Accepted: 10/02/2016] [Indexed: 11/20/2022]
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