PT  - JOURNAL ARTICLE
AU  - Kerstin Fuchs
AU  - Anna Kuehn
AU  - Moritz Mahling
AU  - Philipp Guenthoer
AU  - Andreas Hector
AU  - Johannes Schwenck
AU  - Dominik Hartl
AU  - Stefan Laufer
AU  - Ursula Kohlhofer
AU  - Leticia Quintanilla-Martinez
AU  - Gerald Reischl
AU  - Martin Röcken
AU  - Bernd J. Pichler
AU  - Manfred Kneilling
TI  - In Vivo Hypoxia PET Imaging Quantifies the Severity of Arthritic Joint Inflammation in Line with Overexpression of Hypoxia-Inducible Factor and Enhanced Reactive Oxygen Species Generation
AID  - 10.2967/jnumed.116.185934
DP  - 2017 May 01
TA  - Journal of Nuclear Medicine
PG  - 853--860
VI  - 58
IP  - 5
4099  - http://jnm.snmjournals.org/content/58/5/853.short
4100  - http://jnm.snmjournals.org/content/58/5/853.full
SO  - J Nucl Med2017 May 01; 58
AB  - Hypoxia is essential for the development of autoimmune diseases such as rheumatoid arthritis (RA) and is associated with the expression of reactive oxygen species (ROS), because of the enhanced infiltration of immune cells. The aim of this study was to demonstrate the feasibility of measuring hypoxia noninvasively in vivo in arthritic ankles with PET/MRI using the hypoxia tracers 18F-fluoromisonidazole (18F-FMISO) and 18F-fluoroazomycinarabinoside (18F-FAZA). Additionally, we quantified the temporal dynamics of hypoxia and ROS stress using L-012, an ROS-sensitive chemiluminescence optical imaging probe, and analyzed the expression of hypoxia-inducible factors (HIFs). Methods: Mice underwent noninvasive in vivo PET/MRI to measure hypoxia or optical imaging to analyze ROS expression. Additionally, we performed ex vivo pimonidazole-/HIF-1α immunohistochemistry and HIF-1α/2α Western blot/messenger RNA analysis of inflamed and healthy ankles to confirm our in vivo results. Results: Mice diseased from experimental RA exhibited a 3-fold enhancement in hypoxia tracer uptake, even in the early disease stages, and a 45-fold elevation in ROS expression in inflamed ankles compared with the ankles of healthy controls. We further found strong correlations of our noninvasive in vivo hypoxia PET data with pimonidazole and expression of HIF-1α in arthritic ankles. The strongest hypoxia tracer uptake was observed as soon as day 3, whereas the most pronounced ROS stress was evident on day 6 after the onset of experimental RA, indicating that tissue hypoxia can precede ROS stress in RA. Conclusion: Collectively, for the first time to our knowledge, we have demonstrated that the noninvasive measurement of hypoxia in inflammation using 18F-FAZA and 18F-FMISO PET imaging represents a promising new tool for uncovering and monitoring rheumatic inflammation in vivo. Further, because hypoxic inflamed tissues are associated with the overexpression of HIFs, specific inhibition of HIFs might represent a new powerful treatment strategy.