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MHH study: Examination of inflammatory response using PET/CT imaging enables individual prognosis and personalised treatment strategies
Every year, more than 300,000 people in Germany suffer a heart attack, known in medical terms as acute myocardial infarction (AMI). This causes part of the heart muscle tissue in the left ventricle, which pumps oxygen-rich blood into the body, to die. This injury triggers the immune system: specialised white blood cells (leukocytes) trigger an inflammatory response in the heart muscle, breaking down the damaged tissue and thus initiating the healing process. However, if the inflammatory response is too strong, the risk of chronic heart failure (cardiac insufficiency) increases for patients. A research team led by Professor Frank Bengel, Director of the Department for Nuclear Medicine at Hannover Medical School (MHH), and Professor Johann Bauersachs, Director of the Department for Cardiology and Angiology, has now investigated this inflammatory response in more detail. Using high-resolution molecular imaging technology, they were able to not only predict the individual course of the disease, but also tailor the necessary treatment to each individual patient. The results have been published in the Journal of Nuclear Medicine. The scientific study was also featured as the cover story of the November issue of the magazine.
CXCR4 binding sites control inflammatory cells
The research focused on specific proteins in the surface membrane of white blood cells. These receptors, called CXCR4, serve as binding sites for small signalling proteins that trigger migration in leukocytes. In earlier studies using mouse models, the researchers had already shown that CXCR4 is temporarily upregulated after a heart attack. They suspected that this is also the case in humans and that it could enable the prediction of harmful remodelling processes in the left ventricle and thus the remaining heart function. ‘To verify this, we examined 49 patients within the first week after an AMI using various imaging techniques,’ says Dr Johanna Diekmann, senior physician at the Clinic for Nuclear Medicine and first author of the study.
Tracers make processes in the heart visible
In addition to magnetic resonance imaging (MRI) and myocardial perfusion imaging (MPI), a nuclear medicine examination that shows the blood flow in the heart muscle, the researchers also used high-resolution positron emission tomography (PET) in combination with computed tomography (CT). They used so-called radiotracers to examine the exact processes after a heart attack. The tiny tracer substances are weakly radioactive for a short time and can be visualised in PET/CT. When injected into the body, the tracer attaches itself specifically to the CXCR4 binding site of the white blood cells in the heart muscle. Using a PET scanner, the inflammatory reaction in the heart can thus be visualised directly and spatially accurately without additional intervention. Another advantage of non-invasive imaging is that the tracer procedure does not influence the reaction in the body and therefore does not distort the measurement results.
Assessing individual risk
The approach showed that CXCR4 upregulation extends beyond the actual core region of the heart attack. ‘The inflammation also affects the peripheral areas and leads to remodelling of the left ventricle, which can ultimately result in heart failure,’ explains Dr Tobias König, senior consultant at the Clinic for Cardiology and Angiology. ‘With PET/CT, we can see directly whether there is excessive inflammation and how severe it is.’ While conventional imaging techniques such as MPI and cardiac MRI mainly detect the extent of irreversible tissue damage, PET/CT shows the exact processes of the inflammatory response that controls the healing process. When CXCR4-specific PET is used to supplement imaging examinations, doctors can determine which patients have excessive or persistent inflammation, which may indicate unfavourable remodelling of the left ventricle and heart failure. ‘In the future, this information could help us assess the individual risk of heart failure and offer therapies tailored specifically to the patient,’ says the cardiologist.
The long-standing cooperation between the two clinics has already made significant advances in personalised medicine for heart attack patients. Nuclear medicine specialist Dr Diekmann is certain that CXCR4 PET technology will facilitate image-guided treatment strategies, enabling nuclear medicine to play an active role in the monitoring and treatment of heart attacks in the future.
SERVICE:
For further information please contact Dr Johanna Diekmann, diekmann.johanna@mh-hannover.de, and Dr Tobias König, koenig.tobias@mh-hannover.de.
The original paper, ‘CXCR4 PET/CT Predicts Left Ventricular Recovery 8 Months After Acute Myocardial Infarction,’ can be found here: https://jnm.snmjournals.org/content/early/2025/09/18/jnumed.125.270807.
Dr Johanna Diekmann and Dr Tobias König have used new imaging techniques to examine the region of th ...
Copyright: Karin Kaiser/MHH.
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Dr Johanna Diekmann and Dr Tobias König have used new imaging techniques to examine the region of th ...
Copyright: Karin Kaiser/MHH.
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