A First-In-Human, Microdosing, Clinical Trial to Investigate Binding of the PET Tracer [68Ga]Ga-DOTA-CYS-ATH001 Targeting PDGFRβ in Healthy Subjects as Compared to Patients With MASH, PSC and CD
The goal of this clinical trial is to use positron emission tomography (PET) to evaluate and compare the binding of the novel tracer \[68Ga\]Ga-DOTA-Cys-ATH001 in the liver and/or gastrointestinal tract between healthy volunteers and different patient groups including patients with metabolically caused steatohepatitis (MASH), patients with fibrostenotic Crohn´s Disease (CD) and patients with primary sclerosing cholangitis (PSC).The study will also assess the safety of a microdose of 68Ga\]Ga-DOTA-Cys-ATH001 and how it is distributed in different parts of the body. The main questions the study aims to answer are: * What does the uptake of the \[68Ga\]Ga-DOTA-Cys-ATH001 PET-tracer look like in the liver of healthy subjects, and in that of patients with MASH and PSC? * What does the uptake of the \[68Ga\]Ga-DOTA-Cys-ATH001 PET-tracer look like in the GI tract of healthy subjects, and that of patients with fibrostenotic CD? * How much \[68Ga\]Ga-DOTA-Cys-ATH001 PET-tracer can be found in the blood after injection? * How is \[68Ga\]Ga-DOTA-Cys-ATH001 uptake distributed in the body? * What medical problems do participants have when receiving \[68Ga\]Ga-DOTA-Cys-ATH001? Participants will: Receive one administration of \[68Ga\]Ga-DOTA-Cys-ATH001, after which examination with PET is performed. Magnetic Resonance Imaging (MRI) is also used in the study to create a detailed picture of the body and its function which will facilitate the interpretation of the results of the PET examination. A subset of participants will have blood samples collected after the tracer administration to assess the blood levels of the tracer over time. A subset of participants will come back for a second visit where they will receive a second administration of \[68Ga\]Ga-DOTA-Cys-ATH001, followed by PET and MRI. A health check-up is performed before dosing, and a safety assessment will be performed after dosing. A remote follow-up visit is performed the day after the dosing visit.
• Willing and able to give written informed consent for participation in the trial and able to comply with all trial procedures and requirements.
• Male or female participant aged 18 to 75 years, inclusive, at the screening visit.
• Body mass index (BMI) ≥ 19 and \< 40.0 kg/m2 at the time of the screening visit.
• Women of childbearing potential (WOCBP) must practice abstinence from heterosexual intercourse (only allowed when this is the preferred and usual lifestyle of the participant) or must agree to use a highly effective method of contraception with a failure rate of \< 1 % to prevent pregnancy from at least 2 weeks prior to administration of tracer for at least 1 week after the PET imaging examination (or for at least 1 weak after the last PET imaging examination for those participants undergoing test/retest PET imaging). In addition, any male partner of a female participant must, unless he has undergone vasectomy, agree to use a condom during the same time period.
• The following are considered highly effective methods of contraception:
⁃ combined (estrogen and progestogen-containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal, transdermal),
⁃ progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable, implantable),
⁃ intra-uterine device \[IUD\]or intra-uterine hormone-releasing system \[IUS\]) WOCBP must refrain from donating eggs until 3 months after the last tracer administration.
• WOCBP with an exclusive male partner who has undergone vasectomy may choose not to use contraceptives.
• Women of non-childbearing potential are pre-menopausal females who have undergone any of the following surgical procedures; hysterectomy, bilateral salpingectomy, or bilateral oophorectomy, or who are post-menopausal defined as 12 months of amenorrhea (in questionable cases a blood sample with detection of follicle-stimulating hormone \[FSH\] \>25 IU/L is confirmatory).
• Male participants must be willing to use condom or be vasectomized or practice sexual abstinence from heterosexual intercourse (only allowed when this is the preferred and usual lifestyle of the participant) to prevent pregnancy and drug exposure of a partner and refrain from donating sperm from the administration of tracer until 3 months after the administration of tracer. Any female partner of a non-vasectomized male participant who is of childbearing potential must use contraceptive methods with a failure rate of \< 1% to prevent pregnancy (see above) from at least 2 weeks prior to administration of tracer to 4 weeks after administration of tracer.
• Cohort-specific inclusion criteria:
• Cohort 1 (healthy participants)
• Medically healthy participant without abnormal clinically significant medical history, physical findings, vital signs, ECG, and laboratory values at the time of the screening visit, as judged by the Investigator.
• Cohort 2 (presumed MASH patients) MASH diagnosis based on non-invasive assessments. Participants should have a high level of disease activity with regards to pro-peptide of type III collagen (ProC3) as a marker of ongoing fibrogenesis.
• Steatosis according to biopsy, radiology, or controlled attenuation parameter (CAP) (≥ 280 dB/M 8), assessments ≤ 24 weeks prior to the screening visit.
• At least 1 cardiometabolic criteria from the following list:
• A. BMI ≥ 25 kg/m2 \[23 Asia\] OR waist circumference (WC) \> 94 cm (M) 80 cm (F) OR ethnicity adjusted, B. Fasting serum glucose ≥ 5.6 mmol/L \[100 mg/dL\] OR 2-hour post-load glucose levels ≥ 7.8 mmol/L \[≥ 140 mg/dL\] OR HbA1c ≥ 5.7% \[39 mmol/L) OR type 2 diabetes OR treatment for type 2 diabetes, C. Blood pressure ≥ 130/85 mmHg OR specific antihypertensive drug treatment, D. Plasma triglycerides ≥ 1.70 mmol/L \[150 mg/dL\] OR lipid-lowering treatment, E. Plasma high-density lipoprotein (HDL)-cholesterol ≤ 1.0 mmol/L \[40 mg/dL\] (M) and ≤ 1.3 mmol/L \[50 mg/dL\] (F) OR lipid-lowering treatment.
• ProC3 ≥ 12.6 ng/mL. Cohort 3 (verified MASH patients) MASH diagnosis based on historical liver biopsy. Participants should have a high level of disease activity with regards to ProC3 as a marker of ongoing fibrogenesis, to allow for correlation to PET-tracer uptake.
• Evidence of steatosis according to biopsy, radiology, or CAP (≥ 280 dB/M) or MRI-PDFF, assessments ≤ 24 weeks prior to the screening visit.
⁃ At least 1 cardiometabolic criteria from the following list:
⁃ A. BMI ≥ 25 kg/m2 \[23 Asia\] OR WC \> 94 cm (M) 80 cm (F) OR ethnicity adjusted, B. Fasting serum glucose ≥ 5.6 mmol/L \[100 mg/dL\] OR 2-hour post-load glucose levels ≥ 7.8 mmol/L \[≥ 140 mg/dL\] OR HbA1c ≥ 5.7% \[39 mmol/L) OR type 2 diabetes OR treatment for type 2 diabetes, C. Blood pressure ≥ 130/85 mmHg OR specific antihypertensive drug treatment, D. Plasma triglycerides ≥ 1.70 mmol/L \[150 mg/dL\] lipid-lowering treatment, E. Plasma HDL-cholesterol ≤ 1.0 mmol/L \[40 mg/dL\] (M) and ≤ 1.3 mmol/L \[50 mg/dL\] (F) OR lipid-lowering treatment.
⁃ Historical liver biopsy 24 weeks to 4 weeks prior to inclusion with histologically proven metabolic dysfunction-associated steatotic liver disease (MASLD).
⁃ ProC3 ≥ 12.6 ng/mL. Cohort 4 (fibrostenotic CD patients)
⁃ Fibrostenotic CD as evidenced by persistent luminal narrowing with or without obstructive symptoms as assessed with MRI, ≤ 24 weeks prior to the screening visit OR fibrostenotic CD by positive colonoscopy up to 24 weeks prior to the screening visit.
⁃ Crohn's disease activity index (CDAI) \< 150
⁃ Calprotectin \< 250
⁃ C-reactive protein (CRP) \< 20 Cohort 5 (PSC patients)
⁃ Large duct PSC, including intrahepatic bile duct involvement, according to MRI/MRCP.
⁃ ProC3 ≥ 12.6 ng/mL