Clinical Transfer of a Tracer of the Vulnerable Atheroma Plate: 99mTc-cAbVCAM1-5. (ATHENA).

This is a phase I/IIa, prospective, monocentric, non-controlled, non-randomized, open-label, interventional study.

Cardiovascular disease (CVD) is the leading cause of death worldwide with more than 17.6 million deaths. Of these 17.6 millions deaths, 15 millions (85.1%) are attributable to coronary heart disease and cerebrovascular disease, and in both cases the main etiology is atherosclerosis.

In the coronary arteries, while the presence of a stenosing atherosclerotic plate can be detected by the coronary angiography technique that allows visualization of the lumen of the vessels, the same cannot be said of a plate that is vulnerable to eccentric remodeling. Indeed, this plate has little or no effect on the lumen of the artery. As a result, it is undetectable on coronary angiography. These vulnerable coronary atheromatous plaques are characterized by intense inflammatory phenomena leading to the formation of a large lipidic and necrotic heart covered by a thin fibrous capsule. They are prone to rupture, with the immediate consequence of the formation of a thrombus that can cause ischemia and necrosis of the downstream myocardial territory. In practice, 68% of myocardial infarctions are caused by the rupture of vulnerable plaques resulting in stenosis of less than 50% of the vascular lumen. In addition, in two-thirds of cases the infarction is the inaugural clinical event of coronary artery disease.

Currently, there are no validated non-invasive techniques for diagnosing vulnerable atheroma plate. In this context, the Laboratory Radiopharmaceutiques Biocliniques (LRB, UMR_S1039), has selected Vascular Cell Adhesion Molecule 1 (VCAM-1) as a potential target for molecular imaging of vulnerable plate. Indeed, in the arterial tree, its expression is restricted to atheromatous plates presenting an inflammatory phenotype which is considered a major vulnerability criterion. A radiopharmaceutical targeting VCAM-1 (99mTccAbVCAM1-5) has therefore been developed and validated in preclinical studies.

The final objective of this project is to evaluate in clinical practice the potential of this new imaging agent for the non invasive diagnosis of the vulnerable atheroma plates.

Inclusion Criteria:

Healthy volunteers:

• Ages 18-55
• No nuclear imaging or CT scans in the year prior to inclusion
• A person not exposed to ionizing radiation according to the labour code.

Patients:

• Ages between 18 and 80
• Atherosclerosis with asymptomatic carotid atheroma plate.
• Indication of carotid endarterectomy.

All:

• Person affiliated with or benefiting from social security
• Person who has given written informed consent

Non inclusion Criteria:

• Woman of childbearing potential in the absence of highly effective contraception or man of childbearing potential without mechanical contraception.
• Medical history that significantly interferes with biodistribution
• History of disease which may impair the absorption, diffusion and excretion of the radiopharmaceutical: Crohn's disease, celiac disease.
• Known allergy to one of the constituents of the product.
• Intoxication with alcohol or drugs on purpose
• Grade 3 haematological toxicity for the following parameters : Hemoglobin, platelets, leukocytes and neutrophil polynuclear cells.
• Grade 2 renal toxicity for the following parameters: Urea and creatinine and/or Glomerular filtration rate according to the CPK-EPI formula < 60mL/min/1.73m².
• Grade 2 liver toxicity for the following parameters : AST, ALT, GGT, PAL and bilirubin.
• Grade 2 pancreatic toxicity for the following parameter: lipase.
• Blood or urine pregnancy test (confirmed in blood) inconclusive or positive for women of childbearing potential.
• Participation in other research involving the type 1 or 2 human being at the same time
• Person in a period of exclusion from other research involving the human person
• Living conditions suggesting an inability to follow all the visits provided for in the protocol.
• Subject who would receive more than 4,500 euros in compensation as a result of participation in other research involving the human person in the 12 months preceding this study.
• Subject not contactable in case of emergency
• Protected person (Sections L1121-5 to L1121-8 of the CSP)