Towards precision medicine in COPD: bioradiomic SPECT-CT quantification of active lung inflammation

Welham, Benjamin, Bennett, Michael, Ostridge, Kristoffer, Guy, Matthew, Zvavamwe, Clint, Sundram, Francis and Wilkinson, Tom (2023) Towards precision medicine in COPD: bioradiomic SPECT-CT quantification of active lung inflammation. European Respiratory Journal, 62 (Suppl. 67), [OA4856]. (doi:10.1183/13993003.congress-2023.OA4856).

Abstract

Introduction: multiple inflammatory endotypes exist as targets for therapy in COPD but novel precision medicine approaches are needed to define these. We aim to develop non-invasive imaging methods to quantify specific inflammatory cytokines in the lung as potential targets for therapy.

Methods: using SPECT-CT, we developed techniques to quantify cytokine activity. Five patients with COPD and 5 healthy volunteers were recruited and gave informed consent. They underwent SPECT-CT of the lungs at 6 (+/- 1) and 24 (+/- 4) hours after infusion of 99mTc-anti-TNF-α to quantify TNF-α activity in the lungs. Quantification (figure 1) was normalised to aortic arch signal to account for biological clearance.

Results: isotope signals were quantified at 6 and 24 hours. Median normalised lung SPECT counts (CN) were higher in the healthy group at both time points. However, the increase in CN at 24 hours calculated as a percentage of the 6-hour scan (a measure of tissue bound signal) was higher in the COPD group at 64.88% +/- (SD) 31.04 compared with 35.38% +/- 34.33 in the healthy group - a significant change in the COPD group (p=0.029, paired t-test) but not the healthy.

Conclusions: this proof-of-concept study provides early evidence that molecular imaging of inflammatory cytokines is possible in the lungs of patients with COPD.

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