Renal Molecular Imaging of Mesangial Cell Function with Tc-99m-Tilmanocept
使用 Tc-99m-Tilmanocept 对系膜细胞功能进行肾脏分子成像
基本信息
- 批准号:10375348
- 负责人:
- 金额:$ 62.7万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2021
- 资助国家:美国
- 起止时间:2021-04-01 至 2025-02-28
- 项目状态:未结题
- 来源:
- 关键词:Adverse eventAlbuminuriaBindingBiodistributionBiological MarkersBladderBloodCell physiologyCell surfaceChemicalsChronic Kidney FailureClinicalClinical TrialsClinical Trials DesignClinical trial protocol documentCreatinineDataDevelopmentDiabetes MellitusDiabetic NephropathyDiabetic mouseDiagnosisDiagnosticDiagnostic testsDiscipline of Nuclear MedicineDiseaseDisease modelDoseDrug KineticsEarly DiagnosisEarly treatmentEffective Renal Plasma FlowEuropeanEvaluationFutureGlomerular Filtration RateGlomerular Mesangial CellHalf-LifeHeartHepatocyteHistologicHumanHypertensionImageIndividualInternationalIntervention TrialIntravenousJournalsKidneyKidney DiseasesKineticsLaboratoriesLaboratory StudyLiverMolecularMotivationPathologyPatientsPeriodicityPersonsPhase I Clinical TrialsPlasmaPositron-Emission TomographyPrevalenceProtocols documentationPublishingRadiolabeledRadiopharmaceuticalsRattusRenal HypertensionRiskSafetySamplingScanningSerumSpecificitySurfaceTechnetium 99mTestingTherapeutic InterventionTimeUrinebasedb/db mousedesigndiabeticdiabetic patientdrug developmentfirst-in-humanglomerular filtrationhigh riskimaging agentimaging biomarkerkidney cortexkidney imagingkidney medullamacrophagemesangial cellmicroPETmolecular imagingnuclear imagingopen labelphase I trialradiation absorbed doseresearch clinical testingsingle photon emission computed tomographystandard of caretool
项目摘要
In 2017 the International Diabetes Federation estimated that the worldwide prevalence of diabetes would
increase from 415 million in 2015 to 642 million in 2040. Approximately 40% of individuals with diabetes
develop diabetic nephropathy (DN). Twenty percent of these individuals do not follow the typical path toward
chronic kidney disease, which is a slow multi-decade increase in albuminuria and serum creatinine, the current
standard-of-care for surveillance of chronic kidney disease (KD). Consequently, there is an unmet clinical need
for routine surveillance during the first decade of chronic KD.
We propose external imaging of mesangial cell function as a biomarker for diabetic nephropathy. Our
reasoning is based on the following. Mesangial cell matrix (MCM) expansion is a histologic hallmark of diabetic
nephropathy, which precedes the reduction of a patient’s glomerular filtration rate or increase in albuminuria.
Additionally, all the clinical manifestations of diabetic nephropathy are highly correlated with MCM expansion.
There currently does not exist an imaging, serum, or urine biomarker that is sensitive to mesangial cell
function. Current imaging agents and biomarkers are only sensitive to glomerular filtration, effective renal
plasma flow, or albuminuria, which are altered late in the disease when therapeutic intervention is not effective.
We propose a Phase 1 clinical trial of Tc-99m-tilmanocept, which accumulates in the liver and kidneys. The
molecular mechanism is binding to CD206, which resides on the cell surface of fixed macrophages within the
liver and mesangial cells within the kidney. We present preliminary data consisting of human SPECT/CT and
rat microPET images of renal cortex. Additionally, we present evidence of sensitivity to MCM expansion via Tc-
99m-tilmanocept dynamic imaging of db/db mice, an accepted disease model of diabetic nephropathy.
We propose an open-label study to investigate the biodistribution at two dose levels (2.0 & 20 nmol) of Tc-
99m-tilmanocept. We will study 5 groups at each dose (10 subjects each): 1) Advance DN, 2) early DN, 3)
diabetes with no kidney disease, 4) advanced hypertension (HTN) with KD, and 5) HTN without KD. The study
will include a 30-min dynamic followed be a 30-min kidney SPECT/CT, and periodic blood and urine sampling.
Dynamic imaging will yield plasma clearance half-lifes, and liver and kidney accumulation rates; SPECT/CT will
yield SUVs for the heart, liver, renal cortex, renal medulla. We will also calculate urinary bladder accumulation.
We expect the renograms and biodistribution data to reflect the following pathology: Group 1, severe MCM
expansion; G2, mild MCM expansion; G3 & G5, no MCM expansion; and G4, low MCM expansion.
This study is the necessary first step toward FDA-approval of Tc-99m-tilmancoept as a kidney imaging
agent. The study will also provide evidence of imaging sensitivity to MCM expansion in DN patients, and
insensitivity to patients with HTN. This senerio will be required if Tc-99m-tilmanocept renograms as “first-line”
diagnostic test for diabetic patients.
2017年,国际糖尿病联合会估计,全球糖尿病患病率将
从2015年的4.15亿增加到2040年的6.42亿。约40%的糖尿病患者
发展为糖尿病肾病(DN)。这些人中有20%没有遵循典型的
慢性肾脏疾病,这是一种几十年来缓慢增加的蛋白尿和血清肌酐,目前
慢性肾脏疾病(KD)监测的护理标准。因此,临床需求尚未得到满足。
在慢性KD的第一个十年期间进行常规监测。
我们建议体外成像肾小球系膜细胞功能作为糖尿病肾病的生物标志物。我们的
推理基于以下几点。系膜细胞基质(MCM)扩张是糖尿病的组织学特征
肾病,患者肾小球滤过率降低或蛋白尿增加的先兆。
此外,糖尿病肾病的所有临床表现与MCM扩张高度相关。
目前尚不存在对系膜细胞敏感的影像、血清或尿液生物标志物
功能。目前的显像剂和生物标志物只对肾小球滤过敏感,有效的肾脏
血浆流量,或蛋白尿,当治疗干预无效时,在疾病晚期改变。
我们建议进行一期临床试验,即在肝脏和肾脏中蓄积的99m-替马诺普。这个
分子机制是与CD206结合,CD206位于细胞表面的固定巨噬细胞内
肝脏和肾脏内的系膜细胞。我们提供了由人类SPECT/CT和
大鼠肾皮质的microPET图像。此外,我们提出了通过TC-MCM扩展的敏感性的证据。
糖尿病肾病公认的疾病模型db/db小鼠的99m-tilmanocept动态显像。
我们提出了一项开放标记的研究,以研究两个剂量水平(2.0和20nmol)的TC-
99M-替马诺普。我们将在每个剂量下研究5组(每组10名受试者):1)进展期糖尿病肾病,2)早期糖尿病肾病,3)
糖尿病无肾脏疾病,4)高血压合并KD,5)HTN无KD。这项研究
将包括30分钟的动态肾脏SPECT/CT,以及定期的血液和尿液采样。
动态成像将得出血浆清除半衰期,以及肝和肾的蓄积率;SPECT/CT将
为心脏、肝脏、肾皮质、肾髓质提供SUV。我们还将计算膀胱蓄积量。
我们预计肾图和生物分布数据将反映以下病理:第1组,重度MCM
扩张;G2,轻度MCM扩张;G3和G5,没有MCM扩张;G4,低MCM扩张。
这项研究是FDA批准99m-替曼考作为肾脏显像剂的必要的第一步
探员。这项研究还将提供糖尿病肾病患者对MCM扩大的影像敏感性的证据,以及
对HTN患者不敏感。如果将~(99m)Tc-替马诺普肾图作为“一线”,则需要进行此检查。
糖尿病患者的诊断测试。
项目成果
期刊论文数量(0)
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CHARLES GINSBERG其他文献
CHARLES GINSBERG的其他文献
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{{ truncateString('CHARLES GINSBERG', 18)}}的其他基金
Renal Molecular Imaging of Mesangial Cell Function with Tc-99m-Tilmanocept
使用 Tc-99m-Tilmanocept 对系膜细胞功能进行肾脏分子成像
- 批准号:
10733137 - 财政年份:2021
- 资助金额:
$ 62.7万 - 项目类别:
Influence of Vitamin D Binding Protein on Clinical Measures of Vitamin D Status and Bone Health
维生素 D 结合蛋白对维生素 D 状态和骨骼健康临床指标的影响
- 批准号:
10394279 - 财政年份:2018
- 资助金额:
$ 62.7万 - 项目类别:
Influence of Vitamin D Binding Protein on Clinical Measures of Vitamin D Status and Bone Health
维生素 D 结合蛋白对维生素 D 状态和骨骼健康临床指标的影响
- 批准号:
9910387 - 财政年份:2018
- 资助金额:
$ 62.7万 - 项目类别:
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