# CXCR4 imaging instead of adrenal vein sampling

Source: https://nuclide.cc/opportunities/opp-cxcr4-primary-aldosteronism/  
Nuclide record `opp-cxcr4-primary-aldosteronism` (Opportunity). Data CC BY-NC 4.0, attribute "Data from Nuclide (nuclide.cc)"; commercial use needs a licence.

## TL;DR

A common and curable cause of high blood pressure is almost never cured, because finding out which adrenal gland is at fault needs an invasive procedure few hospitals do well. A PET scan can answer the same question, and one is now heading into a registrational trial.

## Summary

Primary aldosteronism accounts for 5 to 14% of all hypertension and 20 to 25% of treatment-resistant hypertension, and it can be cured by removing one adrenal gland if the excess comes from one side. Establishing which side requires adrenal vein sampling, an invasive procedure that the MATCH investigators describe as requiring a day off work, causing severe pain and hospitalisation in 1 to 3% of patients, available with a success rate above 50% in few hospitals. The consequence they report is stark: fewer than 1% of patients with primary aldosteronism are identified and fully investigated.

This is not a radiopharmaceutical looking for a use. It is the clearest standalone diagnostic case outside oncology, and it is already being built. 68Ga-PentixaFor from Pentixapharm holds EMA PRIME status granted in October 2024 and FDA Fast Track designation granted in July 2026, with an IND cleared and a phase 3 trial, PANDA, planned at approximately 270 patients in the United States. The academic evidence behind it is substantial: in a 100-patient prospective study, PET/CT agreed with adrenal vein sampling in 90% of patients against 54% for conventional CT, and a meta-analysis of seven studies covering 603 patients has been reported at pooled sensitivity 80% and specificity 91%.

The agent is also validated against pathology rather than just against another test: consistency between PET uptake and CXCR4 staining was 92.9%, and all 43 CYP11B2-positive functional nodules in one series were CXCR4-positive. What makes this record worth carrying is not that anything is missing, but that it is the field's best worked example of what an unmet-need-first opportunity looks like when it succeeds.

## Fields

- Kind: Opportunity
- Last checked: 2026-09-23
- Also known as: PentixaFor PET; CXCR4 PET in primary aldosteronism
- Tags: unmet need first; standalone diagnostic; non-oncology; hypertension

## Sources

- MATCH: molecular imaging against adrenal vein sampling, Nature Medicine 2023: https://www.nature.com/articles/s41591-022-02114-5
- 68Ga-pentixafor against adrenal vein sampling in 100 patients, JAMA Network Open 2023: https://pmc.ncbi.nlm.nih.gov/articles/PMC9936343/
- FDA Fast Track designation for 68Ga-PentixaFor in primary aldosteronism: https://www.eqs-news.com/news/corporate/pentixapharm-receives-fda-fast-track-designation-for-phase-3-diagnostic-candidate-e281b6e281b8gaga-pentixafor-in-primary-aldosteronism/239d14bc-6e9e-4077-9909-43e52edf7a09_en
- EMA PRIME status for 68Ga-PentixaFor: https://www.pentixapharm.com/news/ema-grants-prime-status-to-pentixapharms-lead-candidate-pentixafor
- 68Ga-pentixafor dosimetry, J Nucl Med 2015: https://jnm.snmjournals.org/content/56/3/410
- Endocrine Society primary aldosteronism guideline 2025: https://www.endocrine.org/clinical-practice-guidelines/primary-aldosteronism-2

## Connected records

- isotopes: [Gallium-68](https://nuclide.cc/isotopes/ga-68/)
- indications: [Primary aldosteronism](https://nuclide.cc/indications/primary-aldosteronism/)
- technologies: [PET (positron emission tomography)](https://nuclide.cc/technologies/pet/), [PET/CT](https://nuclide.cc/technologies/pet-ct/)
- targets: [CXCR4](https://nuclide.cc/targets/cxcr4/)
- drugs: [Gallium-68 pentixafor](https://nuclide.cc/drugs/ga-68-pentixafor/)

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