bioRxiv · 10.1101/2020.03.04.960179
Chemokine receptor 2-targeted molecular imaging in pulmonary fibrosis
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive, inflammatory lung disease that is monitored clinically by measures of lung function, without effective molecular markers of disease activity or therapeutic efficacy. Lung immune cells active in the pro-fibrotic process include inflammatory monocyte and interstitial macrophages that express the C-C motif chemokine receptor 2 (CCR2). CCR2+ monocyte lung influx is essential for disease phenotypes in models of fibrosis and identified in lungs from subjects with IPF. Here, we show that our peptide-based radiotracer 64Cu-DOTA-ECL1i identifies CCR2+ inflammatory monocytes and interstitial macrophages in multiple preclinical mouse models of lung fibrosis, using positron emission tomography (PET) imaging. Mice with bleomycin-induced fibrosis treated with blocking antibodies to interleukin-1{beta}, a mediator of fibrosis associated with CCR2+ cell inflammation, or with pirfenidone, an approved anti-fibrotic agent, demonstrated decreased CCR2-dependent interstitial macrophage accumulation and reduced 64Cu-DOTA-ECL1i PET uptake, compared to controls. Lung tissues from patients with fibrotic lung disease demonstrated abundant CCR2+ cells surrounding regions of fibrosis, and an ex vivo tissue-binding assay showed correlation between radiotracer localization and CCR2+ cells. In a phase 0/1 clinical study of 64Cu-DOTA-ECL1i PET, healthy volunteers showed little lung uptake, while subjects with pulmonary fibrosis exhibited increased uptake, notably in zones of subpleural fibrosis, reflecting the distribution of CCR2+ cells in the profibrotic niche. These findings support a pathologic role of inflammatory lung monocytes/macrophages in fibrotic lung disease and the translational use of 64Cu-DOTA-ECL1i PET to track CCR2-specific inflammation for image-guided therapy. One Sentence SummaryPET imaging of CCR2+ cells in lung fibrosis identifies a therapeutic response in mouse models and displays a perifibrotic signal in subjects with IPF.
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Brody, S. L., Gunsten, S. P., Luehmann, H. P., Sultan, D. H., Hoelscher, M., Heo, G. S., Pan, J., Koenitzer, J. R., Lee, E. C., Huang, T., Mpoy, C., Guo, S., Laforest, R., Salter, A., Russell, T. D., Shifren, A., Combadiere, C., Lavine, K. J., Kreisel, D., Humphreys, B. D., Rogers, B. E., Grierada, D. S., Byers, D. E., Gropler, R. J., Chen, D. L., Atkinson, J. J., Liu, Y.. 2020-03-05. Chemokine receptor 2-targeted molecular imaging in pulmonary fibrosis. https://doi.org/10.1101/2020.03.04.960179
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