Inflammatory material

A new scanning technique developed at the University of Cambridge could revolutionise the diagnosis and treatment of heart disease and stroke, by letting doctors see damaged arteries in more detail.

Heart disease symptoms are caused by narrowing of the arteries by fatty deposits, called atherosclerotic plaques, on the inside of the artery wall. If a plaque breaks down or ruptures, a blood clot forms leading to a heart attack or stroke, depending on the vessel involved.

Current diagnosis techniques are good at identifying arterial disease only once patients are displaying symptoms, such as angina. Angiography, in which a dye that will show up under x-ray is injected into the bloodstream, will show the narrowed arteries, but will not give any indication of which plaques might rupture.

Now, for the first time, potentially dangerous ‘hot spots’ in a patient’s arteries can be pinpointed, allowing doctors to identify where there is a risk of plaque rupture. It is the first technique to measure directly the underlying inflammatory process that leads to plaque rupture, and it works by injecting a metabolic marker into the patient, who is then scanned using an advanced type of scan, called positron emission tomography.

The marker is able to pinpoint the ‘hot spots’ because is absorbed only by those cells that are using most energy – such as cells that are involved in inflammation.

The technique has been developed through a collaboration between several University departments, including the Wolfson Brain Imaging Centre and the British Heart Foundation Cardiovascular Research Laboratories.

Scientists working on the technique believe it could lead to an important shift in the way people are assessed and treated for vascular disease. Expensive drugs such as statins, which have recently been shown to reduce the risk of heart attacks and strokes in people most at risk – could potentially be targeted accurately, saving many more lives and money.

Professor Peter Weissberg, British Heart Foundation Professor of Cardiovascular Medicine in the University’s School of Clinical Medicine, and a co-author on the paper which described the breakthrough, explained:’We know that statins work by reducing inflammation in plaques, so we hope to be able to scan people before and after using the drugs and measure how well they are ‘cooling down’ hot spots.’

That means the technique may have huge potential for speeding up the development of drugs for cardiovascular problems, and drug companies have already shown an interest in the team’s work. The researchers also hope that, with development and refinement, it could evolve to become a standard screening technique for everyone over a certain age.

‘The important thing is that, for the first time, we have a technique that informs doctors about the underlying disease process,’ added Professor Weissberg. ‘A whole new area of research has been opened up. It’s crucial that others, such as drug companies, copy the technique and refine it.’

The research was published recently in the journal Circulation, by Dr James Rudd, Dr Hazel Jones and Professor Peter Weissberg, in the Division of Cardiovascular Medicine; Dr Elizabeth Warburton, in the Division of Stroke Medicine; Dr Tim Fryer, Dr John Clark and Professor John Pickard, in the Wolfson Brain Imaging Centre; Dr Naggui Antoun, in the Department of Radiology; Dr Peter Johnström and Dr Anthony Davenport, in the Clinical Pharmacology Unit; Mr Peter Kirkpatrick, in the Division of Neurosurgery; and Dr Barbara Arch, in the Centre for Medical Statistics.

The project was funded by the British Heart Foundation and the Medical Research Council, through a Technology Foresight Challenge Award to the Clinical School and SmithKline Beecham (now GlaxoSmithKline).