Pulmonary Arterial Hypertension (PAH)
Conditions
Keywords
[68Ga]Ga-FAPI PET/CT (FAPI), [68Ga]Ga-MAA lung perfusion PET/CT
Brief summary
Pulmonary arterial hypertension (PAH) is a rare, progressive disease characterized by structural changes in the pulmonary arteries, leading to increased pulmonary vascular resistance and elevated pulmonary arterial pressure and, if untreated, right heart failure. Diagnosis requires a comprehensive evaluation, including right heart catheterization performed in specialized centers. Despite advances in the understanding and management of the disease, PAH remains a severe condition. Current approved therapies primarily target three key pathways involved in endothelial dysfunction: the endothelin, nitric oxide, and prostacyclin pathways. Pulmonary arterial remodeling is characterized by alterations in endothelial cells, smooth muscle cells, and fibroblasts, with fibroblast activation and macrophage involvement contributing to disease progression. Two positron emission tomography/computed tomography (PET/CT) imaging approaches are currently under investigation in PAH. \[⁶⁸Ga\]Ga-FAPI PET/CT targets activated fibroblasts and enables noninvasive assessment of fibroblast activity and tissue remodeling. \[⁶⁸Ga\]Ga-MAA lung perfusion PET/CT is an emerging imaging technique that provides higher spatial resolution and sensitivity than conventional lung perfusion imaging and allows evaluation of regional pulmonary perfusion. Sotatercept is a novel fusion protein that modulates signaling within the transforming growth factor-beta (TGF-β) superfamily by binding select ligands involved in vascular remodeling. Its mechanism of action is distinct from that of currently approved PAH therapies. Sotatercept has been evaluated in clinical development programs, including the PULSAR and STELLAR studies. Reported adverse events include epistaxis, dizziness, increased hemoglobin levels, and changes in blood pressure. This study is designed with the following objectives: Primary objective: To assess pulmonary vascular remodeling in patients with PAH using \[⁶⁸Ga\]Ga-FAPI PET/CT imaging. Secondary objectives: To evaluate \[⁶⁸Ga\]Ga-FAPI uptake and regional lung perfusion using \[⁶⁸Ga\]Ga-MAA lung perfusion PET/CT imaging at predefined study time points.
Interventions
DIAGNOSTIC_TEST[68Ga]Ga-FAPI PET/CT
\[68Ga\]Ga-FAPI PET/CT
DIAGNOSTIC_TEST[68Ga]Ga-MAA PET/CT
\[68Ga\]Ga-MAA PET/CT
Sponsors
University Hospital, Brest
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Intervention model description
This pilot study explores innovative imaging techniques, including \[⁶⁸Ga\]Ga-FAPI PET/CT and \[⁶⁸Ga\]Ga-MAA lung perfusion PET/CT , which have not yet been fully evaluated in patients with pulmonary arterial hypertension. Patients with an indication for sotatercept will be screened for eligibility according to predefined inclusion criteria. Eligible participants will be enrolled in the study. Each participant will undergo a comprehensive assessment including \[⁶⁸Ga\]Ga-FAPI PET/CT and \[⁶⁸Ga\]Ga-MAA PET/CT at baseline and at a follow-up visit 24 weeks later.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years * Documented diagnostic right heart catheterization (RHC) within 12 months of screening documenting a minimum PVR of ≥ 4 Wood units and pulmonary capillary wedge pressure (PCWP) or left ventricular end-diastolic pressure (LVEDP) of ≤ 15 mmHg, with the diagnosis of WHO PAH Group 1 in any of the following subtypes: * Idiopathic PAH * Heritable PAH * Drug/toxine-induced PAH * PAH associated with connective tissue disease * PAH associated with simple, congenital systemic-to- pulmonary shunts at least 1year following repair * Patients under bi or tri-background-therapy * Symptomatic PAH classified WHO FC II or III * Patients will be started on Sotatercept * Ability to adhere to study visit schedule and understand and comply with all the protocol requirement. * Ability to understand and provide written informed consent
Exclusion criteria
* Diagnosis of PH WHO Groups 2, 3, 4, or 5 * Diagnosis of the following PAH Group 1 subtypes: human immunodeficiency virus (HIV)-associated PAH, PAH associated with portal hypertension, schistosomiasis associated PAH, pulmonary veno occlusive disease and pulmonary capillary hemangiomatosis. * Hemoglobin at screening above gender-specific ULN, per local laboratory test * Pregnant or breastfeeding women * Any of the following clinical laboratory values at the Screening visit: * eGFR \< 30 mL/min/1.73 m2 (as defined by MDRD equation) * Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), or total bilirubin levels \> 3 × ULN * Platelet count \< 50,000/mm3 (\< 50.0 × 109/L) * Known allergic reaction to sotatercept (ACE-011), its excipients, or luspatercept
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Vascular remodeling as assessed by [68Ga] Ga-FAPI uptake of pulmonary arteries on PET/CT imaging. | at baseline | A positive uptake will be defined as a ratio of the Standardized uptake value (SUV) max of the pulmonary arteries and the SUVmean of the vascular background activity measured at the center of the left ventricle greater than 1.5. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline in [68Ga] Ga-FAPI uptake on pulmonary arteries as assessed by SUVmax at 24 weeks. | At baseline and at 24 weeks. | \[68Ga\] Ga-FAPI uptake on pulmonary arteries. This will be assessed using a visual scale and the Standardized uptake value (SUVmax). |
| Visual assessment of pulmonary artery [68Ga]Ga-FAPI uptake | At baseline and at 24 weeks. | Change from baseline in regional lung perfusion as assessed by the Pulmonary vascular obstruction index (PVOI) (in %) on \[68Ga\]Ga-MAA lung perfusion PET/CT imaging at 24 weeks. |
| [68Ga] Ga-FAPI uptake on the right ventricule (RV) assessed by SUVmax at 24 weeks. | At week 24 | — |
| RV ventricule dysfunction based on Tricuspid annular plane systolic excursion (TAPSE)<17mm at 24 weeks. | At 24 weeks. | — |
| Change from baseline in [68Ga] Ga-FAPI uptake on the RV as assessed by SUVmax at 24 weeks. | At baseline and at 24 weeks. | — |
| Mean pulmonary arterial pressure (mPAP) (in mmHg) at baseline. | At baseline. | mPAP will be measured by right Heart catheterism (RHC). |
| Cardiac output (CO) (l/mn) at baseline. | At baseline. | CO will be measured by RHC. |
| Right atrial pressure (RAP) (mmHg) at baseline. | at baseline | RAP will be measured by RHC. |
| Right ventricular pressure (RVP) (mmHg) at baseline. | At baseline. | CO will be measured by RHC. |
| Pulmonary vascular resistance (PVR) (Wood unit) at baseline. | At baseline. | CO will be measured by RHC. |
| Mean pulmonary arterial pressure (mPAP) (mmHg) at 24 weeks. | At 24 weeks. | mPAP will be measured by right Heart catheterism (RHC). |
| Cardiac output (CO) (l/mn) at 24 weeks. | At 24 weeks. | CO will be measured by RHC. |
| Right atrial pressure (RAP) (mmHg) at 24 weeks. | At 24 weeks. | RAP will be measured by RHC. |
| Right ventricular pressure (RVP) (mmHg) at 24 weeks. | at baseline | CO will be measured by RHC. |
| 6 minutes walking test result (6MWT) (meters) at baseline. | At baseline. | — |
| Vascular remodeling on [68Ga]Ga-FAPI PET/CT is correlated with Nt-proBNP measure in PAH patients | at baseline | \[68Ga\] Ga-FAPI uptake on pulmonary arteries (SUVmax) will be correlated with Nt-proBNP measure in PAH patients |
| 6 minutes walking test result (6MWT) (meters) at 24 weeks. | At 24 weeks. | — |
| NYHA functional class at baseline. | At baseline. | The New York heart association (NYHA) scale will be used to classify the severity of the heart failure impact. Classes are defined as I, II, III, IV, with IV indicating severe limitations |
| NYHA functional class at 24 weeks. | At 24 weeks. | The New York heart association (NYHA) scale will be used to classify the severity of the heart failure impact extent of heart failure. Classes are defined as I, II, III, IV, with IV indicating severe limitations. |
| N-terminal pro B natriuretic peptide (NT-pro-BNP) (pg/ml) at baseline | At baseline. | biological mark indicating heart failure and impact on PH prognosis |
| N-terminal pro B natriuretic peptide (NT-pro-BNP) (pg/ml) at 24 weeks. | At 24 weeks. | biological mark indicating heart failure and impact on PH prognosis |
| Quality of life (QOL) assessed by emPHasis-10 scale at baseline. | At baseline. | The emPHasis-10 ranges from 0 to 50, with a higher score indicating a poorer health status and QOL. |
| QOL assessed by emPHasis-10 scale at 24 weeks. | At 24 weeks. | The emPHasis-10 ranges from 0 to 50, with a higher score indicating a poorer health status and QOL. |
Countries
France
Contacts
CONTACTCécile Tromeur
PRINCIPAL_INVESTIGATORCécile Tromeur
CHU BREST
Outcome results
None listed