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Radiotracers for fungal infection imaging
Antonella Lupetti1, Mark G J de Boer, Paola Erba
1Dipartimento di Patologia Sperimentale, Biotecnologie Mediche, Infettivologia ed Epidemiologia, Università di Pisa,Via San Zeno 35-39, Pisa, Italy. alupetti@biomed.unipi.it
Abstract:
Invasive fungal infections are recognized as an important cause of morbidity and mortality in the immunocompromised host. Rapid initiation of adequate antifungal treatment is often hampered by the limitations of current diagnostic methods. This review encompasses the promises and limitations of newer tracers (believed to target the infectious agents), i.e., radiolabeled antimicrobial peptides, antifungals and chitin-specific agents, for fungal infection imaging by scintigraphy. In mice (99m)Tc-labeled peptides derived from human ubiquicidin (UBI29-41) and lactoferrin (hLF1-11) distinguished local Candida albicans and Aspergillus fumigatus infections from sterile inflammatory processes, but not from bacterial infections. Clinical trials showed that (99m)Tc-UBI29-41 can distinguish infections from inflammatory lesions with 80% specificity and 100% sensitivity. (99m)Tc-hLF1-11 was able to monitor the antifungal effects of fluconazole on C. albicans infections. Moreover, (99m)Tc-fluconazole proved to be an excellent tracer for C. albicans infections as it did not accumulate in bacterial infections and inflammatory processes. However this tracer poorly detected A. fumigatus infections. Furthermore, (123)I-chitinase and (99m)Tc-HYNIC-CBP21 accumulated in both C. albicans and A. fumigatus infections in mice at later time points. In conclusion, despite the recent advances in radiolabeled imaging techniques for invasive fungal infections, the search for better tracers for fungal infection imaging should be continued.
Insights
New radiolabeled tracers show promise for imaging invasive fungal infections in immunocompromised patients. While some agents can detect infections, further research is needed to develop more effective fungal imaging agents.
Area of Science:
- Nuclear Medicine
- Medical Imaging
- Infectious Diseases
Background:
- Invasive fungal infections pose significant morbidity and mortality risks in immunocompromised individuals.
- Current diagnostic methods for fungal infections have limitations, delaying crucial antifungal treatment.
- Novel imaging tracers targeting infectious agents are being explored for improved diagnosis.
Purpose of the Study:
- To review the potential and limitations of new radiolabeled tracers for scintigraphic imaging of fungal infections.
- To evaluate tracers like radiolabeled antimicrobial peptides, antifungals, and chitin-specific agents.
- To assess their efficacy in distinguishing fungal infections from other conditions.
Main Methods:
- Evaluation of (99m)Tc-labeled peptides (UBI29-41, hLF1-11) in mice models for differentiating fungal infections.
- Clinical trial assessment of (99m)Tc-UBI29-41 for infection vs. inflammation detection.
- Testing of (99m)Tc-fluconazole for its specificity in imaging Candida albicans infections.
- Assessment of (123)I-chitinase and (99m)Tc-HYNIC-CBP21 for detecting both Candida albicans and Aspergillus fumigatus infections.
Main Results:
- (99m)Tc-labeled peptides differentiated fungal infections from sterile inflammation but not bacterial infections in mice.
- (99m)Tc-UBI29-41 showed 80% specificity and 100% sensitivity in clinical trials for distinguishing infections.
- (99m)Tc-hLF1-11 demonstrated utility in monitoring antifungal treatment response.
- (99m)Tc-fluconazole was specific for Candida albicans but poorly detected Aspergillus fumigatus.
- (123)I-chitinase and (99m)Tc-HYNIC-CBP21 showed accumulation in both fungal types at later time points.
Conclusions:
- Recent advances in radiolabeled imaging show promise for invasive fungal infections.
- Existing tracers have limitations in specificity and detection of certain fungal species.
- Continued development of novel tracers is essential for improved fungal infection imaging.
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