Biomarkers for Radiation Pneumonitis Using Non-invasive Molecular Imaging

Meetha Medhora, Medical College of Wisconsin
Steven Thomas Haworth, Medical College of Wisconsin
Yu Liu, Medical College of Wisconsin
Jayashree Narayanan, Medical College of Wisconsin
Feng Gao, Medical College of Wisconsin
Ming Zhao, Northwestern University
Said H. Audi, Marquette University
Elizabeth R. Jacobs, Medical College of Wisconsin
Brian L. Fish, Medical College of Wisconsin
Anne V. Clough, Marquette University

Journal of Nuclear Medicine, Vol. 57, No. 8 (2016): 1296-1301. DOI.


Rationale: Our goal is to develop minimally-invasive biomarkers for predicting radiation-induced lung injury before symptoms develop. Currently there are no biomarkers that can predict radiation pneumonitis. Radiation is commonly delivered to the lungs during radiotherapy for lung and breast cancers. Since the lung is a radiosensitive organ, radiation damage to the whole lung is a serious risk in nuclear accidents or in case of radiological terrorism. Our previous studies have shown a single dose of 15 Gy X-rays to the thorax causes severe pneumonitis in rats by 6-8 weeks. We have also developed a mitigator for radiation pneumonitis and fibrosis that can be started as late as 5 weeks after radiation. Methods: We used two functional single photon emission computed tomography (SPECT) probes in vivo in irradiated rat lungs. Regional pulmonary perfusion was measured by injection of technetium labeled macroaggregated albumin (99mTc-MAA). Perfused volume was determined by comparing the volume of distribution of 99mTc-MAA to the anatomical lung volume obtained by micro-CT. A second probe, technetium labeled duramycin that binds to apoptotic cells, was used to measure pulmonary cell death in the same rat model. Results: Perfused volume of lung was decreased by ~25% at 1, 2 and 3 weeks after 15 Gy and 99mTc-duramycin uptake was more than doubled at 2 and 3 weeks. There was no change in body weight, breathing rate or lung histology between irradiated and non-irradiated rats at these times. Pulmonary vascular resistance and vascular permeability measured in isolated perfused lungs ex vivo increased at 2 weeks after 15 Gy. Principal conclusions: Our results suggest the potential for SPECT biomarkers for predicting radiation injury to the lungs before substantial functional or histological damage is observed. Early prediction of radiation pneumonitis will benefit those receiving radiation in the context of therapy, accidents or terrorism in time to initiate mitigation.