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FAP in cardiovascular pathophysiology: Advances in non-invasive imaging and therapeutic targeting for myocardial
Jinli Pei1, Xinzhi Zhao1, Yizhen Pang1
1Shandong Provincial Key Laboratory of Precision Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Abstract:
Fibroblast activation protein (FAP), a key biomarker of activated fibroblasts in pathological tissue remodeling, is up-regulated in injured myocardium, driving cardiac fibrosis and adverse ventricular dysfunction. FAP's specificity for activated fibroblasts enables its use as a target for non-invasive molecular imaging, risk stratification and therapeutic efficacy. Radiolabeled FAP inhibitors (FAPIs), allow positron emission tomography to visualize fibroblast activity in myocardial infarction, non-ischemic cardiomyopathies, heart failure, atherosclerosis, and cardiotoxicity. Therapeutically, FAP-targeted strategies such as 177Lu-FAPI, chimeric antigen receptor-engineered natural killer cells and T cells, FAP vaccines show promise in mitigating fibrosis. The integration of FAP-targeted imaging and therapy offers a paradigm for precision medicine in cardiac fibrosis management. Here we synthesize current translational and clinical evidence for FAPI PET tracers in cardiovascular disease and succinctly outline emerging FAP-targeted anti-fibrotic strategies.
