ReviewEJNMMI research2026
Metabolic [¹⁸F]F-AraG PET imaging of T Cell activation: a functional complement to cell-specific immune tracers.
Review in EJNMMI research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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9 authors.
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Abstract
backgroundSolid tumors remain a clinical challenge due to the complexity of the tumor microenvironment (TME) and high variability of immune responses to treatment. Monitoring immunological activity within the TME has emerged as a critical determinant of tumor progression and therapeutic outcome. With the advent of radiotracers that can non-invasively visualize immunological activity, research interest has grown in their potential to enhance precision oncology and support adaptive clinical decision-making. Among these, metabolic positron emission tomography (PET) imaging with [¹⁸F]F-AraG, a fluorine-18-labeled guanine nucleoside analog, offers a promising functional approach for visualizing activated T-cells by leveraging their unique mitochondrial nucleotide salvage pathways. Unlike antibody-based immuno-PET tracers that typically bind to cell surface biomarkers, [¹⁸F]F-AraG accumulates in activated T-cells due to elevated deoxyguanosine kinase (dGK) activity and reduced SAMHD1 expression, serving as a functional imaging biomarker of immune activation. MAIN BODY: This review summarizes current preclinical and clinical evidence on [¹⁸F]F-AraG PET imaging as a tool for immune monitoring, examining its molecular mechanism, immune cell specificity, and performance in detecting early treatment responses. Compared with anti-CD8-targeted radiotracers, [¹⁸F]F-AraG offers distinct advantages by distinguishing active from inert immune cell infiltration. Early clinical data demonstrate that [¹⁸F]F-AraG PET images can capture treatment response within days of treatment initiation. Furthermore, the review discusses future directions for clinical integration, including its potential in treatment stratification, adaptive therapy guidance, and combination with other imaging modalities.
conclusionThese complementary PET strategies enable non-invasive functional immune monitoring by assessing T cell activation, cytotoxic engagement, and spatial infiltration, thereby advancing personalized, immune-guided treatment. Realizing this potential requires prospective clinical validation, harmonized quantitative standards, and continued development of short-lived radionuclide-labeled constructs optimized for spatial resolution, patient scheduling, and radiation burden.
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