18F-FDG PET reveals unique features of large vessel inflammation in patients with Takayasu’s arteritis

Incerti, Elena; Tombetti, Enrico; Fallanca, Federico; Baldissera, Elena; Alongi, Pierpaolo; Tombolini, Elisabetta; Sartorelli, Silvia; Sabbadini, Maria Grazia; Papa, Maurizio; Cobelli, Francesco De; Mason, Justin C.; Gianolli, Luigi; Manfredi, Angelo A.; Picchio, Maria

doi:10.1007/s00259-017-3639-y

Cited by 57 publications

(31 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, it appears increasingly clear that elevated levels identify subgroups of patients, such as those undergoing ischemic complications that represent the evolution of vacular lumen occlusion, such as optic neuritis in Giant Cell Arteritis or progression of the vascular involvement because of unrestrained mural remodeling in Takayasu Arteritis . The availability of novel, more refined non‐invasive imaging approaches will be instrumental for a better stratification of patients with large vessel vasculitis in homogenous groups …”

Section: Clinical Translation As a Biomarker Of Tissue And Vascular Dmentioning

confidence: 99%

“…208 The availability of novel, more refined non-invasive imaging approaches will be instrumental for a better stratification of patients with large vessel vasculitis in homogenous groups. 209,210 Of interest, patients with large vessel vasculitis are often treated with anti-cytokine agents targeting in particular TNFα and IL-6. PTX3 identified vascular progression only in patients who were not being treated with anti-TNFα agents, 208 in good agreement with the role of the cytokine as a major stimulus driving PTX3 expression in vivo (see above).…”

Section: Clinical Translation As a Biomarker Of Tissue And Vascularmentioning

confidence: 99%

See 1 more Smart Citation

The long pentraxin PTX3: A prototypical sensor of tissue injury and a regulator of homeostasis

Erreni

Manfredi

Garlanda

et al. 2017

Immunological Reviews

Self Cite

View full text Add to dashboard Cite

Tissue damage frequently occurs. The immune system senses it and enforces homeostatic responses that lead to regeneration and repair. The synthesis of acute phase molecules is emerging as a crucial event in this program. The prototypic long pentraxin PTX3 orchestrates the recruitment of leukocytes, stabilizes the provisional matrix in order to facilitate leukocyte and stem progenitor cells trafficking, promotes swift and safe clearance of dying cells and of autoantigens, limiting autoimmunity and protecting the vasculature. These non-redundant actions of PTX3 are necessary for the resolution of inflammation. Recent studies have highlighted the mechanisms by which PTX3 adapts the functions of innate immune cells, orchestrates tissue repair and contributes to select the appropriate acquired immune response in various tissues. Conversely, PTX3 continues to be produced in diseases where the inflammatory response does not resolve. It is therefore a valuable biomarker for more precise and personalized stratification of patients, often independently predicting clinical evolution and outcome. There is strong promise for novel therapies based on understanding the mechanisms with which PTX3 plays its homeostatic role, especially in regulating leukocyte migration and the resolution of inflammatory processes.

show abstract

Section: Clinical Translation As a Biomarker Of Tissue And Vascular Dmentioning

confidence: 99%

Section: Clinical Translation As a Biomarker Of Tissue And Vascularmentioning

confidence: 99%

The long pentraxin PTX3: A prototypical sensor of tissue injury and a regulator of homeostasis

Erreni

Manfredi

Garlanda

et al. 2017

Immunological Reviews

Self Cite

View full text Add to dashboard Cite

show abstract

“…A recent study attempted to address the utility of PET‐CT in the assessment of disease activity in 30 patients with TA. The authors found that uptake on PET‐CT as well as the SUV max values in the involved vessels did not differ in patients with presence or absence of elevation in inflammatory markers ESR or CRP, nor did they differ in those with active versus inactive disease as per the NIH criteria . This led the authors to conclude that activity on PET‐CT provides complementary information to that available from inflammatory markers and composite disease activity indices, and this requires to be explored further …”

Section: Challenges In Assessment Of Disease Activity and Damagementioning

confidence: 99%

Recent advances in the management of Takayasu arteritis

et al. 2019

View full text Add to dashboard Cite

Takayasu arteritis (TA) is a challenging large vessel vasculitis to treat. Distinguishing disease activity from vascular damage is difficult, often relying on clinician judgement aided by composite clinical disease activity indices with angiographic evidence of vessel wall thickening or vessel wall hypermetabolism demonstrable on positron emission tomography computerized tomography (PET CT). Glucocorticoids form the mainstay of remission induction. While other conventional disease modifying anti-rheumatic drugs (cDMARDs) or biologic DMARDs (bDMARDs) are commonly used, evidence supporting their usefulness is sparse and generally of low quality. The only two randomized controlled trials (RCT) of a DMARD in TA failed to show efficacy of abatacept in reducing relapses of TA, however, tocilizumab showed a trend towards reduction in time to relapses. Of the cDMARDs, methotrexate, azathioprine, mycophenolate mofetil (MMF), leflunomide and cyclophosphamide have shown clinical efficacy in case series, with some evidence that methotrexate, azathioprine and MMF might retard angiographic progression. Among bDMARDs, anti-tumor necrosis factor alpha agents and tocilizumab may be useful in patients refractory to cDMARDs with retardation of angiographic progression, based on evidence derived from mostly retrospective case series, whereas the role of rituximab and ustekinumab needs further elucidation. Revascularization, either surgical or endovascular, is the treatment of choice to relieve critical, symptomatic stenoses and are best undertaken during inactive disease. Emerging evidence suggests that patients with TA also have increased cardiovascular risk and this requires appropriate management. Large studies involving multiple centers are the need of the hour to appropriately evaluate utility of currently available immunosuppressive therapy in TA.

show abstract

“…However, a recent systematic review confirmed variable sensitivity and specificity of either computed tomographic angiography (CTA) or MRA for disease activity assessment in TA . Positron emission tomography CT (PET‐CT) had a pooled sensitivity of 81% and specificity of 74% to detect active TA, and recent literature suggests that this modality may identify a distinct population of active TA in whom traditional inflammatory markers like CRP are not raised . A recent meta‐analysis of nine published studies reporting the use of PET‐CT in TA confirmed only a modest association of CRP elevations with PET‐CT positivity, lending further credence to the above hypothesis .…”

Section: Takayasu Arteritismentioning

confidence: 99%

“…Positron emission tomography CT (PET‐CT) had a pooled sensitivity of 81% and specificity of 74% to detect active TA, and recent literature suggests that this modality may identify a distinct population of active TA in whom traditional inflammatory markers like CRP are not raised . A recent meta‐analysis of nine published studies reporting the use of PET‐CT in TA confirmed only a modest association of CRP elevations with PET‐CT positivity, lending further credence to the above hypothesis . Quantification of angiographic extent of vascular damage in TA is an area of active research, and a recently proposed angiographic score (Combined Arteritis Damage Score—CARDS) has potential for common use in both TA and GCA .…”

Section: Takayasu Arteritismentioning

confidence: 99%

Vasculitis research: Current trends and future perspectives

et al. 2018

View full text Add to dashboard Cite

We discuss recent and prospective research in small and large vessel vasculitis. Large cohorts of Takayasu arteritis (TA) have been recently published from across the world, clarifying our understanding of this uncommon disease. Novel open-ended approaches like large-scale genotyping, proteomics and metabolomics have helped gain novel insights into TA, giant cell arteritis (GCA) and anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). Recent advances in the imaging of TA and GCA offer promise for earlier diagnosis and better monitoring of response to therapy. Although two randomized controlled trials of abatacept and tocilizumab failed to meet their primary end-points, successful large-scale studies of abatacept and tocilizumab in GCA hold promise for better disease control. While cyclophosphamide has revolutionized the management of AAV, increasing use of rituximab as an alternative induction regimen, as well as use of novel approaches involving reduced or no corticosteroid use for AAV and alternative agents such as avacopan (a complement 5a receptor antagonist) hold promise for lesser toxic induction regimens in the future. Increasingly, the risk of cardiovascular events and comorbidities such as osteoporosis are being recognized as factors affecting long-term prospects of patients with vasculitis. There is a shift in emphasis to utilize patient-reported outcomes to more accurately gauge the impact of vasculitides and their treatment.

show abstract

18F-FDG PET reveals unique features of large vessel inflammation in patients with Takayasu’s arteritis

Cited by 57 publications

References 39 publications

The long pentraxin PTX3: A prototypical sensor of tissue injury and a regulator of homeostasis

The long pentraxin PTX3: A prototypical sensor of tissue injury and a regulator of homeostasis

Recent advances in the management of Takayasu arteritis

Vasculitis research: Current trends and future perspectives

Contact Info

Product

Resources

About