Myocarditis represents a major cause of dilated cardiomyopathy and sudden cardiac death in younger adults. Currently, definitive diagnosis of myocarditis requires endomyocardial biopsy, which is highly invasive and has the drawback of variable sensitivity due to inherent sampling error. Therefore, reliable noninvasive methods to detect and monitor cardiac inflammation are clinically relevant. In this study, we explored the potential of radiolabeled methionine to assess myocardial inflammatory activity in a rat model of experimental autoimmune myocarditis (EAM). Methods: Autoimmune myocarditis was induced by immunizing Lewis rats twice with porcine cardiac myosin and Freund complete adjuvant. Control animals were treated with adjuvant alone. Dual-tracer autoradiography was performed to assess 14 C-methionine uptake and to compare the distributions of 14 C-methionine versus 18 F-FDG. Hematoxylin and eosin staining and anti-CD68 macrophage staining were performed for histologic analysis. Additionally, cardiac 11 C-methionine PET was performed to evaluate the feasibility of in vivo imaging. 18 F-FDG PET was also conducted to compare the in vivo uptake of 11 C-methionine and 18 F-FDG. Results: Multiple focal cardiac inflammatory lesions were histologically identified in myosin-immunized rats, whereas no cardiac lesions were observed in the controls. Autoradiographic images clearly showed a high-density accumulation of 14 C-methionine in inflammatory lesions of EAM rats, whereas no significant uptake was observed in the control animals. 14 C-methionine uptake was significantly higher in inflammatory lesions than in remote noninflammatory areas and control rat hearts. The distribution of 14 C-methionine correlated well with that of 18 F-FDG and with macrophage density. The contrast between inflammatory and noninflammatory areas was higher for 18 F-FDG than for 14 C-methionine (3.45 ± 0.68 vs. 2.07 ± 0.21, respectively; P , 0.05). In the PET imaging study, the regional 11 C-methionine uptake (percentage injected dose per cubic centimeter) observed in EAM rats was significantly higher than the values obtained for control animals (0.64 ± 0.09 vs. 0.28 ± 0.02, respectively; P , 0.001). A good positive correlation between 11 C-methionine and 18 F-FDG uptake was found. Conclusion: In a rat model of autoimmune myocarditis, we demonstrated the colocalization of radiolabeled methionine accumulation with 18 F-FDG uptake in histologically proven inflammatory lesions. These data suggest that 11 C-methionine might represent a promising candidate for the noninvasive detection and monitoring of myocarditis.

Aims Chronic heart failure (CHF) can be caused by autoantibodies stimulating the heart via binding to first and/or second extracellular loops of cardiac β 1-adrenoceptors. Allosteric receptor activation depends on conformational features of the autoantibody binding site. Elucidating these features will pave the way for the development of specific diagnostics and therapeutics. Our aim was (i) to fine-map the conformational epitope within the second extracellular loop of the human β 1adrenoceptor (β 1 EC II) that is targeted by stimulating β 1-receptor (auto)antibodies and (ii) to generate competitive cyclopeptide inhibitors of allosteric receptor activation, which faithfully conserve the conformational auto-epitope. Methods and results Non-conserved amino acids within the β 1 EC II loop (compared with the amino acids constituting the EC II loop of the β 2-adrenoceptor) were one by one replaced with alanine; potential intra-loop disulfide bridges were probed by cysteine-serine exchanges. Effects on antibody binding and allosteric receptor activation were assessed (i) by (auto)antibody neutralization using cyclopeptides mimicking β 1 EC II ± the above replacements, and (ii) by (auto)antibody stimulation of human β 1-adrenoceptors bearing corresponding point mutations. With the use of stimulating β 1-receptor (auto)antibodies raised in mice, rats, or rabbits and isolated from exemplary dilated cardiomyopathy patients, our series of experiments unmasked two features of the β 1 EC II loop essential for (auto)antibody binding and allosteric receptor activation: (i) the NDPK 211-214 motif and (ii) the intra-loop disulfide bond C 209 ↔C 215. Of note, aberrant intra-loop disulfide bond C 209 ↔C 216 almost fully disrupted the functional auto-epitope in cyclopeptides. Conclusions The conformational auto-epitope targeted by cardio-pathogenic β 1-receptor autoantibodies is faithfully conserved in cyclopeptide homologues of the β 1 EC II loop bearing the NDPK 211-214 motif and the C 209 ↔C 215 bridge while lacking cysteine C 216. Such molecules provide promising tools for novel diagnostic and therapeutic approaches in β 1-autoantibodypositive CHF.

18F-FDG PET imaging can provide non-invasive serial monitoring of cardiac inflammation in a rat model of acute myocarditis.