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A recently developed molecular imaging method, 18F-FAPI PET, is capable of spotting the initial indicators of tissue remodeling in individuals with pulmonary arterial hypertension (PAH). This advancement provides healthcare providers with an early signal regarding the advancement of the disease. It holds the promise for more tailored approaches to manage PAH, allowing for timely interventions that could enhance patient outcomes.
PAH is a progressive and potentially fatal condition characterized by elevated blood pressure in the pulmonary arteries, which transport blood from the heart to the lungs. This increase in pressure is frequently due to narrowing or damage to the artery structures caused by tissue remodeling.
“We understand that fibroblasts become activated during the remodeling phase,” explained Cheng Hong, MD, PhD, a specialist in pulmonary vascular medicine at the First Affiliated Hospital of Guangzhou Medical University, part of the National Center for Respiratory Medicine and State Key Laboratory of Respiratory Disease in Guangzhou, China. “Traditionally, PAH has been assessed using hemodynamic studies and echocardiography, but my colleagues and I aimed to see if imaging the fibroblast activation protein could help predict the progression of PAH.”
The research incorporated both preclinical and clinical elements. The preclinical study involved a small group of 15 rats developed with PAH, alongside a control group of five. On days seven, 14, and 21, these rats underwent 18F-FAPI PET imaging, with corresponding hemodynamic data being collected. Changes in 18F-FAPI uptake and hemodynamic parameters were analyzed over this period.
In the clinical part of the study, 38 PAH patients had 18F-FAPI PET scans along with right heart catheterization and echocardiography, all conducted within a week to evaluate pulmonary blood flow and heart functionality. The response to treatment was also monitored for those who were undergoing PAH-specific therapy.
Results indicated that increased 18F-FAPI uptake in the right heart and pulmonary arteries correlated with hemodynamic metrics and heart function. Among the five patients receiving PAH-targeted treatments, three showed a decrease in 18F-FAPI uptake after a second scan, which matched improvements in their clinical status.
“The capability to identify fibroblast activation in PAH patients is crucial since it could act as an early indicator of disease progression, potentially even ahead of irreversible structural changes,” remarked Xinlu Wang, MD, PhD, a nuclear medicine expert at the First Affiliated Hospital of Guangzhou Medical University in Guangzhou, China.
“Furthermore, we observed that following PAH-directed therapy, 18F-FAPI uptake in the right heart and pulmonary arteries of patients declined, hinting at the possible reversibility of fibroblast activation in PAH. The 18F-FAPI PET technique could support healthcare professionals in evaluating the effectiveness of PAH-targeted therapies, presenting a new avenue for personalized medicine.”
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