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de Vries LE, Huitinga I, Kessels HW, Swaab DF, Verhaagen J. The concept of resilience to Alzheimer's Disease: current definitions and cellular and molecular mechanisms. Mol Neurodegener 2024; 19:33. [PMID: 38589893 PMCID: PMC11003087 DOI: 10.1186/s13024-024-00719-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/20/2024] [Indexed: 04/10/2024] Open
Abstract
Some individuals are able to maintain their cognitive abilities despite the presence of significant Alzheimer's Disease (AD) neuropathological changes. This discrepancy between cognition and pathology has been labeled as resilience and has evolved into a widely debated concept. External factors such as cognitive stimulation are associated with resilience to AD, but the exact cellular and molecular underpinnings are not completely understood. In this review, we discuss the current definitions used in the field, highlight the translational approaches used to investigate resilience to AD and summarize the underlying cellular and molecular substrates of resilience that have been derived from human and animal studies, which have received more and more attention in the last few years. From these studies the picture emerges that resilient individuals are different from AD patients in terms of specific pathological species and their cellular reaction to AD pathology, which possibly helps to maintain cognition up to a certain tipping point. Studying these rare resilient individuals can be of great importance as it could pave the way to novel therapeutic avenues for AD.
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Affiliation(s)
- Luuk E de Vries
- Department of Neuroregeneration, Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences, 1105 BA, Amsterdam, The Netherlands.
| | - Inge Huitinga
- Department of Neuroimmunology, Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences, 1105 BA, Amsterdam, The Netherlands
| | - Helmut W Kessels
- Swammerdam Institute for Life Sciences, Amsterdam Neuroscience, University of Amsterdam, 1098 XH, Amsterdam, the Netherlands
| | - Dick F Swaab
- Department of Neuropsychiatric Disorders, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, 1105 BA, Amsterdam, Netherlands
| | - Joost Verhaagen
- Department of Neuroregeneration, Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences, 1105 BA, Amsterdam, The Netherlands
- Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus Amsterdam, VU University, Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
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Souchet B, Michaïl A, Billoir B, Braudeau J. Biological Diagnosis of Alzheimer's Disease Based on Amyloid Status: An Illustration of Confirmation Bias in Medical Research? Int J Mol Sci 2023; 24:17544. [PMID: 38139372 PMCID: PMC10744068 DOI: 10.3390/ijms242417544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Alzheimer's disease (AD) was first characterized by Dr. Alois Alzheimer in 1906 by studying a demented patient and discovering cerebral amyloid plaques and neurofibrillary tangles. Subsequent research highlighted the roles of Aβ peptides and tau proteins, which are the primary constituents of these lesions, which led to the amyloid cascade hypothesis. Technological advances, such as PET scans using Florbetapir, have made it possible to visualize amyloid plaques in living patients, thus improving AD's risk assessment. The National Institute on Aging and the Alzheimer's Association introduced biological diagnostic criteria in 2011, which underlined the amyloid deposits diagnostic value. However, potential confirmation bias may have led researchers to over-rely on amyloid markers independent of AD's symptoms, despite evidence of their limited specificity. This review provides a critical examination of the current research paradigm in AD, including, in particular, the predominant focus on amyloid and tau species in diagnostics. We discuss the potential multifaceted consequences of this approach and propose strategies to mitigate its overemphasis in the development of new biomarkers. Furthermore, our study presents comprehensive guidelines aimed at enhancing the creation of biomarkers for accurately predicting AD dementia onset. These innovations are crucial for refining patient selection processes in clinical trial enrollment and for the optimization of therapeutic strategies. Overcoming confirmation bias is essential to advance the diagnosis and treatment of AD and to move towards precision medicine by incorporating a more nuanced understanding of amyloid biomarkers.
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Affiliation(s)
| | | | | | - Jérôme Braudeau
- AgenT SAS, 4 Rue Pierre Fontaine, 91000 Evry-Courcouronnes, France; (B.S.); (A.M.); (B.B.)
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Dybing KM, Vetter CJ, Dempsey DA, Chaudhuri S, Saykin AJ, Risacher SL. Traumatic brain injury and Alzheimer's Disease biomarkers: A systematic review of findings from amyloid and tau positron emission tomography (PET). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.30.23298528. [PMID: 38077068 PMCID: PMC10705648 DOI: 10.1101/2023.11.30.23298528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Traumatic brain injury (TBI) has been discussed as a risk factor for Alzheimer's disease (AD) due to its association with dementia risk and earlier cognitive symptom onset. However, the mechanisms behind this relationship are unclear. Some studies have suggested TBI may increase pathological protein deposition in an AD-like pattern; others have failed to find such associations. This review covers literature that uses positron emission tomography (PET) of amyloid-β and/or tau to examine subjects with history of TBI who are at risk for AD due to advanced age. A comprehensive literature search was conducted on January 9, 2023, and 24 resulting citations met inclusion criteria. Common methodological concerns included small samples, limited clinical detail about subjects' TBI, recall bias due to reliance on self-reported TBI, and an inability to establish causation. For both amyloid and tau, results were widespread but inconsistent. The regions which showed the most compelling evidence for increased amyloid deposition were the cingulate gyrus, cuneus/precuneus, and parietal lobe. Evidence for increased tau was strongest in the medial temporal lobe, entorhinal cortex, precuneus, and frontal, temporal, parietal, and occipital lobes. However, conflicting findings across most regions of interest in both amyloid- and tau-PET studies indicate the critical need for future work in expanded samples and with greater clinical detail to offer a clearer picture of the relationship between TBI and protein deposition in older subjects at risk for AD.
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Affiliation(s)
- Kaitlyn M. Dybing
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Cecelia J. Vetter
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Desarae A. Dempsey
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Soumilee Chaudhuri
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Andrew J. Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Shannon L. Risacher
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
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Cogswell PM, Fan AP. Multimodal comparisons of QSM and PET in neurodegeneration and aging. Neuroimage 2023; 273:120068. [PMID: 37003447 PMCID: PMC10947478 DOI: 10.1016/j.neuroimage.2023.120068] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/17/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Quantitative susceptibility mapping (QSM) has been used to study susceptibility changes that may occur based on tissue composition and mineral deposition. Iron is a primary contributor to changes in magnetic susceptibility and of particular interest in applications of QSM to neurodegeneration and aging. Iron can contribute to neurodegeneration through inflammatory processes and via interaction with aggregation of disease-related proteins. To better understand the local susceptibility changes observed on QSM, its signal has been studied in association with other imaging metrics such as positron emission tomography (PET). The associations of QSM and PET may provide insight into the pathophysiology of disease processes, such as the role of iron in aging and neurodegeneration, and help to determine the diagnostic utility of QSM as an indirect indicator of disease processes typically evaluated with PET. In this review we discuss the proposed mechanisms and summarize prior studies of the associations of QSM and amyloid PET, tau PET, TSPO PET, FDG-PET, 15O-PET, and F-DOPA PET in evaluation of neurologic diseases with a focus on aging and neurodegeneration.
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Affiliation(s)
- Petrice M Cogswell
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Audrey P Fan
- Department of Biomedical Engineering and Department of Neurology, University of California, Davis, 1590 Drew Avenue, Davis, CA 95618, USA
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Engels-Domínguez N, Koops EA, Prokopiou PC, Van Egroo M, Schneider C, Riphagen JM, Singhal T, Jacobs HIL. State-of-the-art imaging of neuromodulatory subcortical systems in aging and Alzheimer's disease: Challenges and opportunities. Neurosci Biobehav Rev 2023; 144:104998. [PMID: 36526031 PMCID: PMC9805533 DOI: 10.1016/j.neubiorev.2022.104998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/30/2022] [Accepted: 11/07/2022] [Indexed: 12/14/2022]
Abstract
Primary prevention trials have shifted their focus to the earliest stages of Alzheimer's disease (AD). Autopsy data indicates that the neuromodulatory subcortical systems' (NSS) nuclei are specifically vulnerable to initial tau pathology, indicating that these nuclei hold great promise for early detection of AD in the context of the aging brain. The increasing availability of new imaging methods, ultra-high field scanners, new radioligands, and routine deep brain stimulation implants has led to a growing number of NSS neuroimaging studies on aging and neurodegeneration. Here, we review findings of current state-of-the-art imaging studies assessing the structure, function, and molecular changes of these nuclei during aging and AD. Furthermore, we identify the challenges associated with these imaging methods, important pathophysiologic gaps to fill for the AD NSS neuroimaging field, and provide future directions to improve our assessment, understanding, and clinical use of in vivo imaging of the NSS.
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Affiliation(s)
- Nina Engels-Domínguez
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Elouise A Koops
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Prokopis C Prokopiou
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maxime Van Egroo
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Christoph Schneider
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joost M Riphagen
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tarun Singhal
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Heidi I L Jacobs
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands.
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6
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Krasnovskaya O, Kononova A, Erofeev A, Gorelkin P, Majouga A, Beloglazkina E. Aβ-Targeting Bifunctional Chelators (BFCs) for Potential Therapeutic and PET Imaging Applications. Int J Mol Sci 2022; 24:ijms24010236. [PMID: 36613679 PMCID: PMC9820683 DOI: 10.3390/ijms24010236] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/13/2022] [Accepted: 12/17/2022] [Indexed: 12/25/2022] Open
Abstract
Currently, more than 55 million people live with dementia worldwide, and there are nearly 10 million new cases every year. Alzheimer's disease (AD) is the most common neurodegenerative disease resulting in personality changes, cognitive impairment, memory loss, and physical disability. Diagnosis of AD is often missed or delayed in clinical practice due to the fact that cognitive deterioration occurs already in the later stages of the disease. Thus, methods to improve early detection would provide opportunities for early treatment of disease. All FDA-approved PET imaging agents for Aβ plaques use short-lived radioisotopes such as 11C (t1/2 = 20.4 min) and 18F (t1/2 = 109.8 min), which limit their widespread use. Thus, a novel metal-based imaging agent for visualization of Aβ plaques is of interest, due to the simplicity of its synthesis and the longer lifetimes of its constituent isotopes. We have previously summarized a metal-containing drug for positron emission tomography (PET), magnetic resonance imaging (MRI), and single-photon emission computed tomography (SPECT) imaging of Alzheimer's disease. In this review, we have summarized a recent advance in design of Aβ-targeting bifunctional chelators for potential therapeutic and PET imaging applications, reported after our previous review.
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Affiliation(s)
- Olga Krasnovskaya
- Department of Materials Science of Semiconductors and Dielectrics, National University of Science and Technology (MISIS), Leninskiy Prospect 4, 119049 Moscow, Russia
- Chemistry Department, Lomonosov Moscow State University, Leninskie Gory 1-3, 119991 Moscow, Russia
- Correspondence:
| | - Aina Kononova
- Department of Materials Science of Semiconductors and Dielectrics, National University of Science and Technology (MISIS), Leninskiy Prospect 4, 119049 Moscow, Russia
| | - Alexander Erofeev
- Department of Materials Science of Semiconductors and Dielectrics, National University of Science and Technology (MISIS), Leninskiy Prospect 4, 119049 Moscow, Russia
- Chemistry Department, Lomonosov Moscow State University, Leninskie Gory 1-3, 119991 Moscow, Russia
| | - Peter Gorelkin
- Department of Materials Science of Semiconductors and Dielectrics, National University of Science and Technology (MISIS), Leninskiy Prospect 4, 119049 Moscow, Russia
| | - Alexander Majouga
- Department of Materials Science of Semiconductors and Dielectrics, National University of Science and Technology (MISIS), Leninskiy Prospect 4, 119049 Moscow, Russia
- Chemistry Department, Lomonosov Moscow State University, Leninskie Gory 1-3, 119991 Moscow, Russia
| | - Elena Beloglazkina
- Chemistry Department, Lomonosov Moscow State University, Leninskie Gory 1-3, 119991 Moscow, Russia
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Matthews DC, Lukic AS, Andrews RD, Wernick MN, Strother SC, Schmidt ME. Measurement of neurodegeneration using a multivariate early frame amyloid PET classifier. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12325. [PMID: 35846158 PMCID: PMC9270637 DOI: 10.1002/trc2.12325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/28/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022]
Abstract
Introduction Amyloid measurement provides important confirmation of pathology for Alzheimer's disease (AD) clinical trials. However, many amyloid positive (Am+) early-stage subjects do not worsen clinically during a clinical trial, and a neurodegenerative measure predictive of decline could provide critical information. Studies have shown correspondence between perfusion measured by early amyloid frames post-tracer injection and fluorodeoxyglucose (FDG) positron emission tomography (PET), but with limitations in sensitivity. Multivariate machine learning approaches may offer a more sensitive means for detection of disease related changes as we have demonstrated with FDG. Methods Using summed dynamic florbetapir image frames acquired during the first 6 minutes post-injection for 107 Alzheimer's Disease Neuroimaging Initiative subjects, we applied optimized machine learning to develop and test image classifiers aimed at measuring AD progression. Early frame amyloid (EFA) classification was compared to that of an independently developed FDG PET AD progression classifier by scoring the FDG scans of the same subjects at the same time point. Score distributions and correlation with clinical endpoints were compared to those obtained from FDG. Region of interest measures were compared between EFA and FDG to further understand discrimination performance. Results The EFA classifier produced a primary pattern similar to that of the FDG classifier whose expression correlated highly with the FDG pattern (R-squared 0.71), discriminated cognitively normal (NL) amyloid negative (Am-) subjects from all Am+ groups, and that correlated in Am+ subjects with Mini-Mental State Examination, Clinical Dementia Rating Sum of Boxes, and Alzheimer's Disease Assessment Scale-13-item Cognitive subscale (R = 0.59, 0.63, 0.73) and with subsequent 24-month changes in these measures (R = 0.67, 0.73, 0.50). Discussion Our results support the ability to use EFA with a multivariate machine learning-derived classifier to obtain a sensitive measure of AD-related loss in neuronal function that correlates with FDG PET in preclinical and early prodromal stages as well as in late mild cognitive impairment and dementia. Highlights The summed initial post-injection minutes of florbetapir positron emission tomography correlate with fluorodeoxyglucose.A machine learning classifier enabled sensitive detection of early prodromal Alzheimer's disease.Early frame amyloid (EFA) classifier scores correlate with subsequent change in Mini-Mental State Examination, Clinical Dementia Rating Sum of Boxes, and Alzheimer's Disease Assessment Scale-13-item Cognitive subscale.EFA classifier effect sizes and clinical prediction outperformed region of interest standardized uptake value ratio.EFA classification may aid in stratifying patients to assess treatment effect.
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Affiliation(s)
| | | | | | | | - Stephen C. Strother
- Baycrest Hospitaland Department of Medical BiophysicsUniversity of TorontoNorth YorkOntarioCanada
| | - Mark E. Schmidt
- Janssen Research and DevelopmentDivision of Janssen PharmaceuticaBeerseBelgium
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Nakai T, Yamada K, Mizoguchi H. Alzheimer's Disease Animal Models: Elucidation of Biomarkers and Therapeutic Approaches for Cognitive Impairment. Int J Mol Sci 2021; 22:ijms22115549. [PMID: 34074018 PMCID: PMC8197360 DOI: 10.3390/ijms22115549] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022] Open
Abstract
Alzheimer’s disease (AD) is an age-related and progressive neurodegenerative disorder. It is widely accepted that AD is mainly caused by the accumulation of extracellular amyloid β (Aβ) and intracellular neurofibrillary tau tangles. Aβ begins to accumulate years before the onset of cognitive impairment, suggesting that the benefit of currently available interventions would be greater if they were initiated in the early phases of AD. To understand the mechanisms of AD pathogenesis, various transgenic mouse models with an accelerated accumulation of Aβ and tau tangles have been developed. However, none of these models exhibit all pathologies present in human AD. To overcome these undesirable phenotypes, APP knock-in mice, which were presented with touchscreen-based tasks, were developed to better evaluate the efficacy of candidate therapeutics in mouse models of early-stage AD. This review assesses several AD mouse models from the aspect of biomarkers and cognitive impairment and discusses their potential as tools to provide novel AD therapeutic approaches.
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Affiliation(s)
- Tsuyoshi Nakai
- Department of Neuropsychopharmacology and Hospital Pharmacy, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (T.N.); (K.Y.)
| | - Kiyofumi Yamada
- Department of Neuropsychopharmacology and Hospital Pharmacy, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (T.N.); (K.Y.)
| | - Hiroyuki Mizoguchi
- Department of Neuropsychopharmacology and Hospital Pharmacy, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (T.N.); (K.Y.)
- Medical Interactive Research and Academia Industry Collaboration Center, Research Institute of Environmental Medicine, Nagoya University, Nagoya 464-8601, Japan
- Correspondence: ; Tel.: +81-52-744-2674; Fax: +81-52-744-2979
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Bao W, Xie F, Zuo C, Guan Y, Huang YH. PET Neuroimaging of Alzheimer's Disease: Radiotracers and Their Utility in Clinical Research. Front Aging Neurosci 2021; 13:624330. [PMID: 34025386 PMCID: PMC8134674 DOI: 10.3389/fnagi.2021.624330] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/23/2021] [Indexed: 12/14/2022] Open
Abstract
Alzheimer's Disease (AD), the leading cause of senile dementia, is a progressive neurodegenerative disorder affecting millions of people worldwide and exerting tremendous socioeconomic burden on all societies. Although definitive diagnosis of AD is often made in the presence of clinical manifestations in late stages, it is now universally believed that AD is a continuum of disease commencing from the preclinical stage with typical neuropathological alterations appearing decades prior to its first symptom, to the prodromal stage with slight symptoms of amnesia (amnestic mild cognitive impairment, aMCI), and then to the terminal stage with extensive loss of basic cognitive functions, i.e., AD-dementia. Positron emission tomography (PET) radiotracers have been developed in a search to meet the increasing clinical need of early detection and treatment monitoring for AD, with reference to the pathophysiological targets in Alzheimer's brain. These include the pathological aggregations of misfolded proteins such as β-amyloid (Aβ) plagues and neurofibrillary tangles (NFTs), impaired neurotransmitter system, neuroinflammation, as well as deficient synaptic vesicles and glucose utilization. In this article we survey the various PET radiotracers available for AD imaging and discuss their clinical applications especially in terms of early detection and cognitive relevance.
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Affiliation(s)
- Weiqi Bao
- PET Center, Huanshan Hospital, Fudan University, Shanghai, China
| | - Fang Xie
- PET Center, Huanshan Hospital, Fudan University, Shanghai, China
| | - Chuantao Zuo
- PET Center, Huanshan Hospital, Fudan University, Shanghai, China
| | - Yihui Guan
- PET Center, Huanshan Hospital, Fudan University, Shanghai, China
| | - Yiyun Henry Huang
- Department of Radiology and Biomedical Imaging, PET Center, Yale University School of Medicine, New Haven, CT, United States
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Yilmaz A, Bauersachs J, Bengel F, Büchel R, Kindermann I, Klingel K, Knebel F, Meder B, Morbach C, Nagel E, Schulze-Bahr E, Aus dem Siepen F, Frey N. Diagnosis and treatment of cardiac amyloidosis: position statement of the German Cardiac Society (DGK). Clin Res Cardiol 2021; 110:479-506. [PMID: 33459839 PMCID: PMC8055575 DOI: 10.1007/s00392-020-01799-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022]
Abstract
Systemic forms of amyloidosis affecting the heart are mostly light-chain (AL) and transthyretin (ATTR) amyloidoses. The latter is caused by deposition of misfolded transthyretin, either in wild-type (ATTRwt) or mutant (ATTRv) conformation. For diagnostics, specific serum biomarkers and modern non-invasive imaging techniques, such as cardiovascular magnetic resonance imaging (CMR) and scintigraphic methods, are available today. These imaging techniques do not only complement conventional echocardiography, but also allow for accurate assessment of the extent of cardiac involvement, in addition to diagnosing cardiac amyloidosis. Endomyocardial biopsy still plays a major role in the histopathological diagnosis and subtyping of cardiac amyloidosis. The main objective of the diagnostic algorithm outlined in this position statement is to detect cardiac amyloidosis as reliably and early as possible, to accurately determine its extent, and to reliably identify the underlying subtype of amyloidosis, thereby enabling subsequent targeted treatment.
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Affiliation(s)
- A Yilmaz
- Sektion für Herzbildgebung, Klinik für Kardiologie, Universitätsklinikum Münster, Von-Esmarch-Str. 48, 48149, Münster, Germany.
| | - J Bauersachs
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - F Bengel
- Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | - R Büchel
- Klinik für Nuklearmedizin, Universitätsspital Zürich, Zurich, Switzerland
| | - I Kindermann
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - K Klingel
- Institut für Pathologie und Neuropathologie, Universität Tübingen, Tübingen, Germany
| | - F Knebel
- Medizinische Klinik m.S. Kardiologie und Angiologie, Charite Universitätsmedizin Berlin Campus Mitte, Berlin, Germany
| | - B Meder
- Klinik für Innere Medizin III, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - C Morbach
- Klinik für Innere Medizin III, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - E Nagel
- Interdisziplinäres Amyloidosezentrum Nordbayern, Deutsches Zentrum für Herzinsuffizienz, Medizinische Klinik I der Universität Würzburg, Würzburg, Germany
| | - E Schulze-Bahr
- Institut für Experimentelle und translationale kardiovaskuläre Bildgebung, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - F Aus dem Siepen
- Institut für Genetik von Herzerkrankungen (IfGH), Universitätsklinikum Münster, Münster, Germany
| | - N Frey
- Klinik für Innere Medizin III, Schwerpunkt Kardiologie und Angiologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Kommission für Klinische Kardiovaskuläre Medizin, Deutsche Gesellschaft für Kardiologie, Düsseldorf, Germany
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A critical review of radiotracers in the positron emission tomography imaging of traumatic brain injury: FDG, tau, and amyloid imaging in mild traumatic brain injury and chronic traumatic encephalopathy. Eur J Nucl Med Mol Imaging 2020; 48:623-641. [DOI: 10.1007/s00259-020-04926-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/11/2020] [Indexed: 12/14/2022]
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Zha Z, Ploessl K, Choi SR, Alexoff D, Kung HF. Preclinical evaluation of [ 18F]D3FSP, deuterated AV-45, for imaging of β-amyloid in the brain. Nucl Med Biol 2020; 92:97-106. [PMID: 32245565 DOI: 10.1016/j.nucmedbio.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/13/2020] [Accepted: 03/18/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Since the approval of three 18F labeled β-amyloid-targeting PET imaging agents, Amyvid (florbetapir f18, AV-45), Neuraceq (florbetaben f18, AV-1) and Vizamyl (flutemetamol f18, F-PIB), they have increasingly been employed to assist differential diagnosis of Alzheimer's disease in patients with dementia. Also, they are frequently used in selecting patients participating drug trials aiming to reduce β-amyloid (Aβ) plaques in the brain. The first approved tracer in this class was [18F]AV-45, which is metabolized rapidly in blood and some of its N-demethylated metabolites cross the blood brain barrier and resulted in lowering the image contrast. To improve metabolic stability of [18F]AV-45, we hypothesized that substituting N-CH3 with N-CD3 at the metabolically labile position, creating [18F]D3FSP, may reduce in vivo N-demethylation. We report the preclinical evaluation of [18F]D3FSP as an Aβ imaging agent. METHODS Preclinical pharmacology of [18F]D3FSP was evaluated using in vitro autoradiography and competitive binding assay. Biodistribution of [18F]D3FSP was evaluated in wild-type CD-1 mice. In vivo metabolism in mice and in vitro microsomal metabolism were analyzed by HPLC. Single dose acute toxicity of D3FSP was also performed in rats. RESULTS [18F]D3FSP showed high binding affinity to β-amyloid plaques (Ki = 3.44 ± 1.22 nM, a value similar as AV-45 (Ki = 4.02 ± 0.22 nM)), and displayed excellent β-amyloid binding in AD brain sections consistent with known Aβ regional distribution. After an iv injection it exhibited good initial brain uptake and fast washout in wild-type CD-1 mice. In vitro microsomal metabolism and in vivo metabolism in mice did not result in any significant differences between [18F]D3FSP and [18F]AV-45. No treatment-related mortality or any adverse effects were observed in single dose acute toxicity studies administered at hundred-folds of maximum human dose. CONCLUSION A new small molecule, [18F]D3FSP, was prepared and tested as an alternative to [18F]AV-45 to reduce N-demethylation in vivo. This strategy did not lead to better in vivo stability. However, [18F]D3FSP displayed very similar Aβ targeting property comparable to [18F]AV-45. Preclinical studies suggest that [18F]D3FSP is useful as a β-amyloid-targeting PET imaging agent.
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Affiliation(s)
- Zhihao Zha
- Five Eleven Pharma Inc., Philadelphia, PA 19104, USA; Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Karl Ploessl
- Five Eleven Pharma Inc., Philadelphia, PA 19104, USA
| | - Seok Rye Choi
- Five Eleven Pharma Inc., Philadelphia, PA 19104, USA
| | - David Alexoff
- Five Eleven Pharma Inc., Philadelphia, PA 19104, USA
| | - Hank F Kung
- Five Eleven Pharma Inc., Philadelphia, PA 19104, USA; Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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14
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Meyer PF, McSweeney M, Gonneaud J, Villeneuve S. AD molecular: PET amyloid imaging across the Alzheimer's disease spectrum: From disease mechanisms to prevention. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 165:63-106. [PMID: 31481172 DOI: 10.1016/bs.pmbts.2019.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The advent of amyloid-beta (Aβ) positron emission tomography (PET) imaging has transformed the field of Alzheimer's disease (AD) by enabling the quantification of cortical Aβ accumulation and propagation in vivo. This revolutionary tool has made it possible to measure direct associations between Aβ and other AD biomarkers, to identify factors that influence Aβ accumulation and to redefine entry criteria into clinical trials as well as measure drug target engagement. This chapter summarizes the main findings on the associations of Aβ with other biomarkers of disease progression across the AD spectrum. It discusses investigations of the timing at which Aβ pathology starts to accumulate, demonstrates the clinical utility of Aβ PET imaging and discusses some ethical implications. Finally, it presents genetic and potentially modifiable lifestyle factors that might influence Aβ accumulation and therefore be targets for AD prevention.
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Affiliation(s)
- Pierre-François Meyer
- Centre for Studies on the Prevention of Alzheimer's Disease, Douglas Mental Health University Institute, Montréal, Canada; McGill University, Montréal, Canada
| | - Melissa McSweeney
- Centre for Studies on the Prevention of Alzheimer's Disease, Douglas Mental Health University Institute, Montréal, Canada; McGill University, Montréal, Canada
| | - Julie Gonneaud
- Centre for Studies on the Prevention of Alzheimer's Disease, Douglas Mental Health University Institute, Montréal, Canada; McGill University, Montréal, Canada
| | - Sylvia Villeneuve
- Centre for Studies on the Prevention of Alzheimer's Disease, Douglas Mental Health University Institute, Montréal, Canada; McGill University, Montréal, Canada.
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Gong NJ, Dibb R, Bulk M, van der Weerd L, Liu C. Imaging beta amyloid aggregation and iron accumulation in Alzheimer's disease using quantitative susceptibility mapping MRI. Neuroimage 2019; 191:176-185. [PMID: 30739060 DOI: 10.1016/j.neuroimage.2019.02.019] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/16/2019] [Accepted: 02/06/2019] [Indexed: 10/27/2022] Open
Abstract
Beta amyloid is a protein fragment snipped from the amyloid precursor protein (APP). Aggregation of these peptides into amyloid plaques is one of the hallmarks of Alzheimer's disease. MR imaging of beta amyloid plaques has been attempted using various techniques, notably with T2* contrast. The non-invasive detectability of beta amyloid plaques in MR images has so far been largely attributed to focal iron deposition accompanying the plaques. It is believed that the T2* shortening effects of paramagnetic iron are the primary source of contrast between plaques and surrounding tissue. Amyloid plaque itself has been reported to induce no magnetic susceptibility effect. We hypothesized that aggregations of beta amyloid would increase electron density and induce notable changes in local susceptibility value, large enough to generate contrast relative to surrounding normal tissues that can be visualized by quantitative susceptibility mapping (QSM) MR imaging. To test this hypothesis, we first demonstrated in a phantom that beta amyloid is diamagnetic and can generate strong contrast on susceptibility maps. We then conducted experiments on a transgenic mouse model of Alzheimer's disease that is known to mimic the formation of human beta amyloid but without neurofibrillary tangles or neuronal death. Over a period of 18 months, we showed that QSM can be used to longitudinally monitor beta amyloid accumulation and accompanied iron deposition in vivo. Individual beta amyloid plaque can also be visualized ex vivo in high resolution susceptibility maps. Moreover, the measured negative susceptibility map and positive susceptibility map could provide histology-like image contrast for identifying deposition of beta amyloid plaques and iron. Finally, we demonstrated that the diamagnetic susceptibility of beta amyloid can also be observed in brain specimens of AD patients. The ability to assess beta amyloid aggregation non-invasively with QSM MR imaging may aid the diagnosis of Alzheimer's disease.
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Affiliation(s)
- Nan-Jie Gong
- Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai, China.
| | - Russell Dibb
- Center for In Vivo Microscopy, Duke University School of Medicine, Durham, NC, USA
| | - Marjolein Bulk
- Department of Radiology & Human Genetics, Leiden University Medical Center, the Netherlands
| | - Louise van der Weerd
- Department of Radiology & Human Genetics, Leiden University Medical Center, the Netherlands
| | - Chunlei Liu
- Electrical Engineering and Computer Sciences, University of California, Berkeley, CA, USA; Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA.
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Bouter C, Vogelgsang J, Wiltfang J. Comparison between amyloid-PET and CSF amyloid-β biomarkers in a clinical cohort with memory deficits. Clin Chim Acta 2019; 492:62-68. [PMID: 30735665 DOI: 10.1016/j.cca.2019.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 11/25/2022]
Abstract
With increasing prevalence of Alzheimer's disease (AD) and advances in research of therapeutic approaches, an early and accurate in-vivo diagnosis is crucial. Different biomarkers that are able to identify AD are currently in focus. However, whether and to which extend results of cerebrospinal fluid (CSF) and imaging biomarkers are comparable, is unclear. This study aims to correlate CSF and amyloid imaging biomarkers comparing them to cognitive measurements in order to determine whether these methods provide identical or complementary information. The study comprises 33 consecutive patients with suspected cognitive decline that underwent lumbar puncture for CSF biomarker analysis and Amyloid-PET/CT within the diagnostic evaluation of memory impairment. Amyloid PET/CTs were evaluated visually and quantitatively. CSF and imaging data were retrospectively evaluated and results were compared to cognition tests, age, gender, and ApoE status. Global cortex SUVr levels correlated highly with CSF Aβ42/40 and moderately with Aβ42 but not with Aβ40. Global cortex SUVr and Aβ42/40 correlated with mini mental status examination. This study indicates that Amyloid-PET and CSF biomarkers might not reflect identical clinical information and a combination of both seems to be the most accurate way to characterize clinically unclear cognitive decline.
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Affiliation(s)
- Caroline Bouter
- University Medical Center Goettingen (UMG), Georg-August-University, Dept. of Nuclear Medicine, Robert-Koch-Str. 40, D-37075 Goettingen, Germany.
| | - Jonathan Vogelgsang
- University Medical Center Goettingen (UMG), Georg-August-University, Dept. of Psychiatry and Psychotherapy, Von-Siebold-Str. 5, D-37075 Goettingen, Germany
| | - Jens Wiltfang
- University Medical Center Goettingen (UMG), Georg-August-University, Dept. of Psychiatry and Psychotherapy, Von-Siebold-Str. 5, D-37075 Goettingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Von-Siebold-Str. 3a, D-37075 Goettingen, Germany; iBiMED, Medical Science Department, University of Aveiro, Portugal
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Femminella GD, Thayanandan T, Calsolaro V, Komici K, Rengo G, Corbi G, Ferrara N. Imaging and Molecular Mechanisms of Alzheimer's Disease: A Review. Int J Mol Sci 2018; 19:E3702. [PMID: 30469491 PMCID: PMC6321449 DOI: 10.3390/ijms19123702] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023] Open
Abstract
Alzheimer's disease is the most common form of dementia and is a significant burden for affected patients, carers, and health systems. Great advances have been made in understanding its pathophysiology, to a point that we are moving from a purely clinical diagnosis to a biological one based on the use of biomarkers. Among those, imaging biomarkers are invaluable in Alzheimer's, as they provide an in vivo window to the pathological processes occurring in Alzheimer's brain. While some imaging techniques are still under evaluation in the research setting, some have reached widespread clinical use. In this review, we provide an overview of the most commonly used imaging biomarkers in Alzheimer's disease, from molecular PET imaging to structural MRI, emphasising the concept that multimodal imaging would likely prove to be the optimal tool in the future of Alzheimer's research and clinical practice.
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Affiliation(s)
| | - Tony Thayanandan
- Imperial Memory Unit, Charing Cross Hospital, Imperial College London, London W6 8RF, UK.
| | - Valeria Calsolaro
- Neurology Imaging Unit, Imperial College London, London W12 0NN, UK.
| | - Klara Komici
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy.
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy.
- Istituti Clinici Scientifici Maugeri SPA-Società Benefit, IRCCS, 82037 Telese Terme, Italy.
| | - Graziamaria Corbi
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy.
| | - Nicola Ferrara
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy.
- Istituti Clinici Scientifici Maugeri SPA-Società Benefit, IRCCS, 82037 Telese Terme, Italy.
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Abstract
The past decade has seen tremendous efforts in biomarker discovery and validation for neurodegenerative diseases. The source and type of biomarkers has continued to grow for central nervous system diseases, from biofluid-based biomarkers (blood or cerebrospinal fluid (CSF)), to nucleic acids, tissue, and imaging. While DNA remains a predominant biomarker used to identify familial forms of neurodegenerative diseases, various types of RNA have more recently been linked to familial and sporadic forms of neurodegenerative diseases during the past few years. Imaging approaches continue to evolve and are making major contributions to target engagement and early diagnostic biomarkers. Incorporation of biomarkers into drug development and clinical trials for neurodegenerative diseases promises to aid in the development and demonstration of target engagement and drug efficacy for neurologic disorders. This review will focus on recent advancements in developing biomarkers for clinical utility in Alzheimer's disease (AD), Parkinson's disease (PD), and amyotrophic lateral sclerosis (ALS).
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Affiliation(s)
| | - Robert Bowser
- Iron Horse Diagnostics, Inc., Scottsdale, AZ, 85255, USA.
- Divisions of Neurology and Neurobiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA.
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Abstract
PURPOSE OF REVIEW To present the new PET markers that could become in the coming years, relevant to advanced clinical approaches to dementia diagnosis, drug trials, and treatment strategies and discuss their advantages and limitations. RECENT FINDINGS The most advanced new PET tracers are the markers of the amyloid plaques, the τ compounds and the tracers of the translocator protein as markers of neuroinflammation. The main advantages but also the weaknesses of each of these markers are discussed. The main pitfall remains the heterogeneity of the available results that cast doubt to a rapid introduction of these new ligands in clinical practice. SUMMARY With the advent of biomarkers in clinical management and findings of molecular neuroimaging studies in the evaluation of patients with suspected dementia, the impact of functional neuroimaging has increased considerably these last years and has been integrated into many clinical guidelines in the field of dementia. In addition to conventional single PET brain perfusion and dopaminergic neurotransmission, 18F-fluorodeoxyglucose (18F-FDG) PET is used in advanced diagnosis procedures. Furthermore, new tracers are being developed to quantify key neuropathological features in the brain tissue as highly specific diagnosis is crucial to comply with the global medical and public health objectives in this domain. A strategic road map for further developments, adapted from the approach to cancer biomarkers, should be proposed so as to optimize the rationale of the PET-based molecular diagnosis of Alzheimer's disease and related disorders.
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20
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Villemagne VL, Doré V, Burnham SC, Masters CL, Rowe CC. Imaging tau and amyloid-β proteinopathies in Alzheimer disease and other conditions. Nat Rev Neurol 2018; 14:225-236. [DOI: 10.1038/nrneurol.2018.9] [Citation(s) in RCA: 230] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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21
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Oh SJ, Kim MH, Han SJ, Kang KJ, Ko IO, Kim Y, Park JA, Choi JY, Lee KC, Chi DY, Lee YJ, Kim KM. Preliminary PET Study of 18F-FC119S in Normal and Alzheimer’s Disease Models. Mol Pharm 2017; 14:3114-3120. [DOI: 10.1021/acs.molpharmaceut.7b00351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Se Jong Oh
- Division
of RI-Convergence Research, Korea Institute Radiological and Medical Sciences, 01812 Seoul, Korea
- Radiological & Medico-Oncological Sciences, Korea University of Science and Technology, 34113 Daejeon, Korea
| | - Min Hwan Kim
- Division
of RI-Convergence Research, Korea Institute Radiological and Medical Sciences, 01812 Seoul, Korea
| | - Sang Jin Han
- Division
of RI-Convergence Research, Korea Institute Radiological and Medical Sciences, 01812 Seoul, Korea
| | - Kyung Jun Kang
- Division
of RI-Convergence Research, Korea Institute Radiological and Medical Sciences, 01812 Seoul, Korea
| | - In Ok Ko
- Division
of RI-Convergence Research, Korea Institute Radiological and Medical Sciences, 01812 Seoul, Korea
| | - YoungSoo Kim
- Department
of Pharmacy and Integrated Science and Engineering Division, Yonsei University, 03722 Incheon, Korea
| | - Ji-Ae Park
- Division
of RI-Convergence Research, Korea Institute Radiological and Medical Sciences, 01812 Seoul, Korea
| | - Jae Yong Choi
- Division
of RI-Convergence Research, Korea Institute Radiological and Medical Sciences, 01812 Seoul, Korea
| | - Kyo Chul Lee
- Division
of RI-Convergence Research, Korea Institute Radiological and Medical Sciences, 01812 Seoul, Korea
| | - Dae Yoon Chi
- Research Institute of Labeling, FutureChem Co., Ltd, Seoul 04782, Republic of Korea
| | - Yong Jin Lee
- Division
of RI-Convergence Research, Korea Institute Radiological and Medical Sciences, 01812 Seoul, Korea
| | - Kyeong Min Kim
- Radiological & Medico-Oncological Sciences, Korea University of Science and Technology, 34113 Daejeon, Korea
- Division
of Medical Radiation Equipment, Korea Institute Radiological and Medical Sciences, 01812 Seoul, Korea
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Chen K, Cui M. Recent progress in the development of metal complexes as β-amyloid imaging probes in the brain. MEDCHEMCOMM 2017; 8:1393-1407. [PMID: 30108850 PMCID: PMC6072098 DOI: 10.1039/c7md00064b] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 05/11/2017] [Indexed: 01/28/2023]
Abstract
In this review, we have focused on the recent progress in metal complexes that are able to bind to β-amyloid (Aβ) species. We have discussed various radioactive complexes of 99mTc, 68Ga, 64Cu, 89Zr, and 111In, which were designed as Aβ imaging agents for positron emission tomography (PET) and single photon emission computed tomography (SPECT) imaging, non-radioactive Re and Ru complexes as Aβ sensors using luminescence methods, and Gd3+ complexes as contrast agents for magnetic resonance imaging (MRI).
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Affiliation(s)
- Kaihua Chen
- Key Laboratory of Radiopharmaceuticals , Ministry of Education , College of Chemistry , Beijing Normal University , Beijing 100875 , P. R. China . ; ; Tel: +86 10 58808891
| | - Mengchao Cui
- Key Laboratory of Radiopharmaceuticals , Ministry of Education , College of Chemistry , Beijing Normal University , Beijing 100875 , P. R. China . ; ; Tel: +86 10 58808891
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Salabert AS, Fontan C, Fonta C, Alonso M, Loukh N, Delisle MB, Tafani M, Payoux P. Radiosynthesis of [ 18F]AV1451 in pharmaceutical conditions and its biological characteristics. Appl Radiat Isot 2017; 128:101-107. [PMID: 28689157 DOI: 10.1016/j.apradiso.2017.06.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 11/30/2022]
Abstract
In this study, we describe the radiosynthesis of [18F]AV1451 in terms of its pharmaceutical quality and characterise its physical and biological properties. We performed an in vitro serum stability study in fresh human plasma and a plasma protein binding study. The radiochemical yield was 24% (decay corrected), and the product met all regulatory quality requirements. We found that this compound is stable in fresh human plasma and binds tightly to plasma proteins, especially lipoproteins.
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Affiliation(s)
- Anne-Sophie Salabert
- "Toulouse Neuro-imaging Centre" Research Unit (UMR 1214) INSERM, Toulouse, France; Radiopharmacy Department, Toulouse University Hospital, Toulouse, France.
| | - Charlotte Fontan
- Radiopharmacy Department, Toulouse University Hospital, Toulouse, France.
| | - Caroline Fonta
- Brain & Cognition Research Centre (CERCO UMR 5549), Toulouse, France.
| | - Mathieu Alonso
- Radiopharmacy Department, Toulouse University Hospital, Toulouse, France.
| | - Najat Loukh
- "Toulouse Neuro-imaging Centre" Research Unit (UMR 1214) INSERM, Toulouse, France; Neuropathology, Toulouse University Hospital, Toulouse, France.
| | - Marie Bernadette Delisle
- "Toulouse Neuro-imaging Centre" Research Unit (UMR 1214) INSERM, Toulouse, France; Neuropathology, Toulouse University Hospital, Toulouse, France.
| | - Mathieu Tafani
- "Toulouse Neuro-imaging Centre" Research Unit (UMR 1214) INSERM, Toulouse, France; Radiopharmacy Department, Toulouse University Hospital, Toulouse, France.
| | - Pierre Payoux
- "Toulouse Neuro-imaging Centre" Research Unit (UMR 1214) INSERM, Toulouse, France; Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France.
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Villemagne VL, Doré V, Bourgeat P, Burnham SC, Laws S, Salvado O, Masters CL, Rowe CC. Aβ-amyloid and Tau Imaging in Dementia. Semin Nucl Med 2017; 47:75-88. [DOI: 10.1053/j.semnuclmed.2016.09.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Counts SE, Ikonomovic MD, Mercado N, Vega IE, Mufson EJ. Biomarkers for the Early Detection and Progression of Alzheimer's Disease. Neurotherapeutics 2017; 14:35-53. [PMID: 27738903 PMCID: PMC5233625 DOI: 10.1007/s13311-016-0481-z] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The recent failures of potential disease-modifying drugs for Alzheimer's disease (AD) may reflect the fact that the enrolled participants in clinical trials are already too advanced to derive a clinical benefit. Thus, well-validated biomarkers for the early detection and accurate diagnosis of the preclinical stages of AD will be crucial for therapeutic advancement. The combinatorial use of biomarkers derived from biological fluids, such as cerebrospinal fluid (CSF), with advanced molecular imaging and neuropsychological testing may eventually achieve the diagnostic sensitivity and specificity necessary to identify people in the earliest stages of the disease when drug modification is most likely possible. In this regard, positive amyloid or tau tracer retention on positron emission tomography imaging, low CSF concentrations of the amyloid-β 1-42 peptide, high CSF concentrations in total tau and phospho-tau, mesial temporal lobe atrophy on magnetic resonance imaging, and temporoparietal/precuneus hypometabolism or hypoperfusion on 18F-fluorodeoxyglucose positron emission tomography have all emerged as biomarkers for the progression to AD. However, the ultimate AD biomarker panel will likely involve the inclusion of novel CSF and blood biomarkers more precisely associated with confirmed pathophysiologic mechanisms to improve its reliability for detecting preclinical AD. This review highlights advancements in biological fluid and imaging biomarkers that are moving the field towards achieving the goal of a preclinical detection of AD.
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Affiliation(s)
- Scott E Counts
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, USA
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA
- Hauenstein Neuroscience Center, Mercy Health Saint Mary's Hospital, Grand Rapids, MI, USA
| | - Milos D Ikonomovic
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Natosha Mercado
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Irving E Vega
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Elliott J Mufson
- Department of Neurobiology and Neurology, Barrow Neurological Institute, Phoenix, AZ, USA.
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Amyloid imaging: Past, present and future perspectives. Ageing Res Rev 2016; 30:95-106. [PMID: 26827784 DOI: 10.1016/j.arr.2016.01.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 11/23/2022]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterised by the gradual onset of dementia. The pathological hallmarks of the disease are Aβ amyloid plaques, and tau neurofibrillary tangles, along dendritic and synaptic loss and reactive gliosis. Functional and molecular neuroimaging techniques such as positron emission tomography (PET) using functional and molecular tracers, in conjuction with other Aβ and tau biomarkers in CSF, are proving valuable in the differential diagnosis of AD, as well as in establishing disease prognosis. With the advent of new therapeutic strategies, there has been an increasing application of these techniques for the determination of Aβ burden in vivo in the patient selection, evaluation of target engagement and assessment of the efficacy of therapeutic approaches aimed at reducing Aβ in the brain.
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Bauckneht M, Picco A, Nobili F, Morbelli S. Amyloid positron emission tomography and cognitive reserve. World J Radiol 2015; 7:475-483. [PMID: 26753062 PMCID: PMC4697121 DOI: 10.4329/wjr.v7.i12.475] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/01/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023] Open
Abstract
Alzheimer’s disease (AD) is characterized by a non-linear progressive course and several aspects influence the relationship between cerebral amount of AD pathology and the clinical expression of the disease. Brain cognitive reserve (CR) refers to the hypothesized capacity of an adult brain to cope with brain damage in order to minimize symptomatology. CR phenomenon contributed to explain the disjunction between the degree of neurodegeneration and the clinical phenotype of AD. The possibility to track brain amyloidosis (Aβ) in vivo has huge relevance for AD diagnosis and new therapeutic approaches. The clinical repercussions of positron emission tomography (PET)-assessed Aβ load are certainly mediated by CR thus potentially hampering the prognostic meaning of amyloid PET in selected groups of patients. Similarly, amyloid PET and cerebrospinal fluid amyloidosis biomarkers have recently provided new evidence for CR. The present review discusses the concept of CR in the framework of available neuroimaging studies and specifically deals with the reciprocal influences between amyloid PET and CR in AD patients and with the potential consequent interventional strategies for AD.
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Park MA, Padera RF, Belanger A, Dubey S, Hwang DH, Veeranna V, Falk RH, Di Carli MF, Dorbala S. 18F-Florbetapir Binds Specifically to Myocardial Light Chain and Transthyretin Amyloid Deposits: Autoradiography Study. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002954. [PMID: 26259579 DOI: 10.1161/circimaging.114.002954] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND (18)F-florbetapir is a promising imaging biomarker for cardiac light chain amyloidosis (AL) and transthyretin amyloidosis (ATTR). Our aim, using human autopsy myocardial specimens, was to test the hypothesis that (18)F-florbetapir binds specifically to myocardial AL and ATTR amyloid deposits. METHODS AND RESULTS We studied myocardial sections from 30 subjects with autopsy-documented AL (n=10), ATTR (n=10), and nonamyloid controls (n=10) using (18)F-florbetapir and cold florbetapir compound and digital autoradiography. Total and nonspecific binding of (18)F-florbetapir was determined using the maximum signal intensity values. Specific binding of (18)F-florbetapir was calculated by subtracting nonspecific from total binding measurements (in decays per minute/mm(2), DPM mm(2)) and was compared with cardiac structure and function on echocardiography and the histological extent of amyloid deposits. Diffuse or focally increased (18)F-florbetapir uptake was noted in all AL and ATTR samples and in none of the control samples. Compared with control samples, mean (18)F-florbetapir-specific uptake was significantly higher in the amyloid samples (0.94±0.43 versus 2.00±0.58 DPM/mm(2); P<0.001), and in the AL compared with the ATTR samples (2.48±0.40 versus 1.52±0.22 DPM/mm(2); P<0.001). The samples from subjects with atypical echocardiographic features of amyloidosis showed quantitatively more intense (18)F-florbetapir-specific uptake compared with control samples (1.50±0.17 versus 0.94±0.43 DPM/mm(2); P=0.004), despite smaller amyloid extent than in subjects with typical echocardiograms. CONCLUSIONS (18)F-florbetapir specifically binds to myocardial AL and ATTR deposits in humans and offers the potential to screen for the 2 most common types of myocardial amyloid.
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Affiliation(s)
- Mi-Ae Park
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (M.-A.P., A.B., S.D., V.V., M.F.D., S.D.), Noninvasive Cardiovascular Imaging Program, Department of Medicine (Cardiology) and Radiology (V.V., M.F.D., S.D.), Cardiac Amyloidosis Program, Department of Medicine (R.F.P., R.H.F., S.D.), and Department of Pathology (R.F.P., D.H.H.), Brigham and Women's Hospital, Boston, MA
| | - Robert F Padera
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (M.-A.P., A.B., S.D., V.V., M.F.D., S.D.), Noninvasive Cardiovascular Imaging Program, Department of Medicine (Cardiology) and Radiology (V.V., M.F.D., S.D.), Cardiac Amyloidosis Program, Department of Medicine (R.F.P., R.H.F., S.D.), and Department of Pathology (R.F.P., D.H.H.), Brigham and Women's Hospital, Boston, MA
| | - Anthony Belanger
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (M.-A.P., A.B., S.D., V.V., M.F.D., S.D.), Noninvasive Cardiovascular Imaging Program, Department of Medicine (Cardiology) and Radiology (V.V., M.F.D., S.D.), Cardiac Amyloidosis Program, Department of Medicine (R.F.P., R.H.F., S.D.), and Department of Pathology (R.F.P., D.H.H.), Brigham and Women's Hospital, Boston, MA
| | - Shipra Dubey
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (M.-A.P., A.B., S.D., V.V., M.F.D., S.D.), Noninvasive Cardiovascular Imaging Program, Department of Medicine (Cardiology) and Radiology (V.V., M.F.D., S.D.), Cardiac Amyloidosis Program, Department of Medicine (R.F.P., R.H.F., S.D.), and Department of Pathology (R.F.P., D.H.H.), Brigham and Women's Hospital, Boston, MA
| | - David H Hwang
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (M.-A.P., A.B., S.D., V.V., M.F.D., S.D.), Noninvasive Cardiovascular Imaging Program, Department of Medicine (Cardiology) and Radiology (V.V., M.F.D., S.D.), Cardiac Amyloidosis Program, Department of Medicine (R.F.P., R.H.F., S.D.), and Department of Pathology (R.F.P., D.H.H.), Brigham and Women's Hospital, Boston, MA
| | - Vikas Veeranna
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (M.-A.P., A.B., S.D., V.V., M.F.D., S.D.), Noninvasive Cardiovascular Imaging Program, Department of Medicine (Cardiology) and Radiology (V.V., M.F.D., S.D.), Cardiac Amyloidosis Program, Department of Medicine (R.F.P., R.H.F., S.D.), and Department of Pathology (R.F.P., D.H.H.), Brigham and Women's Hospital, Boston, MA
| | - Rodney H Falk
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (M.-A.P., A.B., S.D., V.V., M.F.D., S.D.), Noninvasive Cardiovascular Imaging Program, Department of Medicine (Cardiology) and Radiology (V.V., M.F.D., S.D.), Cardiac Amyloidosis Program, Department of Medicine (R.F.P., R.H.F., S.D.), and Department of Pathology (R.F.P., D.H.H.), Brigham and Women's Hospital, Boston, MA
| | - Marcelo F Di Carli
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (M.-A.P., A.B., S.D., V.V., M.F.D., S.D.), Noninvasive Cardiovascular Imaging Program, Department of Medicine (Cardiology) and Radiology (V.V., M.F.D., S.D.), Cardiac Amyloidosis Program, Department of Medicine (R.F.P., R.H.F., S.D.), and Department of Pathology (R.F.P., D.H.H.), Brigham and Women's Hospital, Boston, MA
| | - Sharmila Dorbala
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (M.-A.P., A.B., S.D., V.V., M.F.D., S.D.), Noninvasive Cardiovascular Imaging Program, Department of Medicine (Cardiology) and Radiology (V.V., M.F.D., S.D.), Cardiac Amyloidosis Program, Department of Medicine (R.F.P., R.H.F., S.D.), and Department of Pathology (R.F.P., D.H.H.), Brigham and Women's Hospital, Boston, MA.
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Matharu B, Spencer N, Howe F, Austen B. Gadolinium-complexed Aβ-binding contrast agents for MRI diagnosis of Alzheimer's Disease. Neuropeptides 2015; 53:63-70. [PMID: 26234669 DOI: 10.1016/j.npep.2015.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 07/14/2015] [Accepted: 07/16/2015] [Indexed: 12/16/2022]
Abstract
MRI contrast agents, containing peptide sequences that bind β-amyloid and gadolinium ions ligated to DOTA have been synthesized for evaluation in early diagnosis of Alzheimer's Disease in transgenic mice models. A number of brain penetration modifications were incorporated and sufficient amounts of contrast agent in the brain were achieved only by addition of a cationic cell penetration sequence along with the use of microparticle assisted ultrasound activation. In the T1 mode of a MRI scan, the peptide (R2) illuminated areas of brain rich in amyloid plaques.
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Affiliation(s)
- Balpreet Matharu
- Dept of Basic Medical Sciences, St George's University of London, Cranmer Terrace, London SW17 ORE, United Kingdom
| | - Nick Spencer
- Dept of Basic Medical Sciences, St George's University of London, Cranmer Terrace, London SW17 ORE, United Kingdom
| | - Franklyn Howe
- Dept of Cardiovascular Science, St George's University of London, Cranmer Terrace, London SW17 ORE, United Kingdom
| | - Brian Austen
- Dept of Basic Medical Sciences, St George's University of London, Cranmer Terrace, London SW17 ORE, United Kingdom.
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30
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Pistollato F, Cano SS, Elio I, Vergara MM, Giampieri F, Battino M. The Use of Neuroimaging to Assess Associations Among Diet, Nutrients, Metabolic Syndrome, and Alzheimer’s Disease. J Alzheimers Dis 2015; 48:303-18. [DOI: 10.3233/jad-150301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Francesca Pistollato
- Centre for Nutrition and Health, Universidad Europea del Atlántico (UEA), Santander, Spain
| | - Sandra Sumalla Cano
- Centre for Nutrition and Health, Universidad Europea del Atlántico (UEA), Santander, Spain
- Universidad Internacional Iberoamericana (UNINI), Campeche, Mexico
- Fundación Universitaria Iberoamericana, (FUNIBER), Barcelona, Spain
| | - Iñaki Elio
- Centre for Nutrition and Health, Universidad Europea del Atlántico (UEA), Santander, Spain
- Universidad Internacional Iberoamericana (UNINI), Campeche, Mexico
- Fundación Universitaria Iberoamericana, (FUNIBER), Barcelona, Spain
| | - Manuel Masias Vergara
- Centre for Nutrition and Health, Universidad Europea del Atlántico (UEA), Santander, Spain
- Universidad Internacional Iberoamericana (UNINI), Puerto Rico, USA
| | - Francesca Giampieri
- Centre for Nutrition and Health, Universidad Europea del Atlántico (UEA), Santander, Spain
- Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche, Sez. Biochimica, Università Politecnica delle Marche, Ancona, Italy
| | - Maurizio Battino
- Centre for Nutrition and Health, Universidad Europea del Atlántico (UEA), Santander, Spain
- Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche, Sez. Biochimica, Università Politecnica delle Marche, Ancona, Italy
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Fonseca-Santos B, Gremião MPD, Chorilli M. Nanotechnology-based drug delivery systems for the treatment of Alzheimer's disease. Int J Nanomedicine 2015; 10:4981-5003. [PMID: 26345528 PMCID: PMC4531021 DOI: 10.2147/ijn.s87148] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Alzheimer's disease is a neurological disorder that results in cognitive and behavioral impairment. Conventional treatment strategies, such as acetylcholinesterase inhibitor drugs, often fail due to their poor solubility, lower bioavailability, and ineffective ability to cross the blood-brain barrier. Nanotechnological treatment methods, which involve the design, characterization, production, and application of nanoscale drug delivery systems, have been employed to optimize therapeutics. These nanotechnologies include polymeric nanoparticles, solid lipid nanoparticles, nanostructured lipid carriers, microemulsion, nanoemulsion, and liquid crystals. Each of these are promising tools for the delivery of therapeutic devices to the brain via various routes of administration, particularly the intranasal route. The objective of this study is to present a systematic review of nanotechnology-based drug delivery systems for the treatment of Alzheimer's disease.
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Affiliation(s)
- Bruno Fonseca-Santos
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Maria Palmira Daflon Gremião
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Marlus Chorilli
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
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Weiner MW, Veitch DP, Hayes J, Neylan T, Grafman J, Aisen PS, Petersen RC, Jack C, Jagust W, Trojanowski JQ, Shaw LM, Saykin AJ, Green RC, Harvey D, Toga AW, Friedl KE, Pacifico A, Sheline Y, Yaffe K, Mohlenoff B. Effects of traumatic brain injury and posttraumatic stress disorder on Alzheimer's disease in veterans, using the Alzheimer's Disease Neuroimaging Initiative. Alzheimers Dement 2015; 10:S226-35. [PMID: 24924673 PMCID: PMC4392759 DOI: 10.1016/j.jalz.2014.04.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Both traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) are common problems resulting from military service, and both have been associated with increased risk of cognitive decline and dementia resulting from Alzheimer's disease (AD) or other causes. This study aims to use imaging techniques and biomarker analysis to determine whether traumatic brain injury (TBI) and/or PTSD resulting from combat or other traumas increase the risk for AD and decrease cognitive reserve in Veteran subjects, after accounting for age. Using military and Department of Veterans Affairs records, 65 Vietnam War veterans with a history of moderate or severe TBI with or without PTSD, 65 with ongoing PTSD without TBI, and 65 control subjects are being enrolled in this study at 19 sites. The study aims to select subject groups that are comparable in age, gender, ethnicity, and education. Subjects with mild cognitive impairment (MCI) or dementia are being excluded. However, a new study just beginning, and similar in size, will study subjects with TBI, subjects with PTSD, and control subjects with MCI. Baseline measurements of cognition, function, blood, and cerebrospinal fluid biomarkers; magnetic resonance images (structural, diffusion tensor, and resting state blood-level oxygen dependent (BOLD) functional magnetic resonance imaging); and amyloid positron emission tomographic (PET) images with florbetapir are being obtained. One-year follow-up measurements will be collected for most of the baseline procedures, with the exception of the lumbar puncture, the PET imaging, and apolipoprotein E genotyping. To date, 19 subjects with TBI only, 46 with PTSD only, and 15 with TBI and PTSD have been recruited and referred to 13 clinics to undergo the study protocol. It is expected that cohorts will be fully recruited by October 2014. This study is a first step toward the design and statistical powering of an AD prevention trial using at-risk veterans as subjects, and provides the basis for a larger, more comprehensive study of dementia risk factors in veterans.
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Affiliation(s)
- Michael W Weiner
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, CA, USA.
| | - Dallas P Veitch
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
| | - Jacqueline Hayes
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
| | - Thomas Neylan
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Jordan Grafman
- Department of Psychiatry, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul S Aisen
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | | | - Clifford Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - William Jagust
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | - John Q Trojanowski
- Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Alzheimer's Disease Core Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Udall Parkinson's Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging, Institute of Neuroimaging and Informatics, University of Southern California Los Angeles, Los Angeles, CA, USA
| | - Karl E Friedl
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Anthony Pacifico
- Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, Fort Detrick, MD, USA
| | - Yvette Sheline
- Department of Psychiatry, Washington University School of Medicine, Washington University, St. Louis, MO, USA
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, CA, USA
| | - Brian Mohlenoff
- Department of Psychiatry, University of California, San Francisco, CA, USA
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Dehabadi MH, Davis BM, Wong TK, Cordeiro MF. Retinal manifestations of Alzheimer's disease. Neurodegener Dis Manag 2015; 4:241-52. [PMID: 25095818 DOI: 10.2217/nmt.14.19] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Alzheimer's disease (AD) is neurodegenerative condition and most common cause of dementia worldwide. Current criteria for its diagnosis and monitoring rely on subjective, expensive or invasive methods that lack sufficient sensitivity, such that a concrete diagnosis of AD can only be made postmortem. Given the structural similarities of the neuro-retina and central nervous system, researchers have shown many manifestations of AD to be detectible in the retinae of humans and transgenic models of AD. Due to the eye's unique optical properties allowing noninvasive in vivo imaging, the retina could provide a window for the early diagnosis and monitoring of AD long before symptom manifestation.
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Affiliation(s)
- Mohammad H Dehabadi
- Glaucoma & Retinal Neurodegeneration Research Group, Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
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Yousefi BH, von Reutern B, Scherübl D, Manook A, Schwaiger M, Grimmer T, Henriksen G, Förster S, Drzezga A, Wester HJ. FIBT versus florbetaben and PiB: a preclinical comparison study with amyloid-PET in transgenic mice. EJNMMI Res 2015; 5:20. [PMID: 25918674 PMCID: PMC4402683 DOI: 10.1186/s13550-015-0090-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 02/22/2015] [Indexed: 12/19/2022] Open
Abstract
Background Over the last decade, an increasing number of studies have been published on the use of amyloid-β (Aβ) PET imaging with different 18F-radiopharmaceuticals for clinical characterization of Alzheimer’s disease (AD) in different stages. However, distinct study cohorts and different quantification techniques allow only for an indirect comparison between the different tracers. Thus, the aim of this study was the direct intra-individual in vivo comparison of different Aβ-targeted radiopharmaceuticals for PET imaging, including the newly developed agent [18F]FIBT. Methods A small group of four animals of a well-characterized APP/PS1 transgenic (tg) mouse model of AD and gender-matched control (ctl) animals underwent a sequential and standardized PET imaging regimen for direct comparison of [18F]FIBT, [18F]florbetaben, and [11C]PiB. The quantitative PET imaging data were cross-validated with the cerebral Aβ plaque load as quantified ex vivo on histological sections. Results We found that FIBT (2-(p-methylaminophenyl)-7-(2-[18F]fluoroethoxy)imidazo[2,1-b]benzothiazole) compares favorably to florbetaben as a high-contrasting PET radiopharmaceutical for imaging Aβ pathology. The excellent pharmacokinetics of FIBT in combination with its high-binding affinity towards Aβ resulted in feasible high-contrast imaging of Aβ with high global cortex to cerebellum standard uptake value ratio (SUVR) in 24-month-old tg mice (tg 1.68 ± 0.15 vs. ctl 0.95 ± 0.02). The SUVRs in transgenic versus control animals (SUVRtg/SUVRctl) for FIBT (1.78 ± 0.16) were similar to the ratios as observed in humans (SUVRAD/SUVRctl) for the established gold standard Pittsburgh compound B (PiB) (1.65 ± 0.41). Conclusions This head-to-head PET tracer comparison study in mice indicated the good imaging properties of [18F]FIBT, such as high initial brain uptake, fast clearance of the brain, and high binding affinity towards Aβ as directly compared to the established amyloid tracers. Moreover, the preclinical study design is recommendable for reliable assessment and comparison of novel radiopharmaceuticals. Electronic supplementary material The online version of this article (doi:10.1186/s13550-015-0090-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Behrooz H Yousefi
- Department of Pharmaceutical Radiochemistry, Technische Universität München, Walther-Meißner-Str. 3, 85748 Garching, Germany
| | - Boris von Reutern
- Department of Nuclear Medicine, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany ; Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Wilhelm-Johnen-Straße, 52428 Jülich, Germany
| | - Daniela Scherübl
- Department of Nuclear Medicine, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - André Manook
- Department of Pharmaceutical Radiochemistry, Technische Universität München, Walther-Meißner-Str. 3, 85748 Garching, Germany ; Department of Nuclear Medicine, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Gjermund Henriksen
- Department of Nuclear Medicine, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Stefan Förster
- Department of Nuclear Medicine, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Alexander Drzezga
- Department of Nuclear Medicine, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany ; Department of Nuclear Medicine, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Hans-Jürgen Wester
- Department of Pharmaceutical Radiochemistry, Technische Universität München, Walther-Meißner-Str. 3, 85748 Garching, Germany
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Congdon EE, Krishnaswamy S, Sigurdsson EM. Harnessing the immune system for treatment and detection of tau pathology. J Alzheimers Dis 2015; 40 Suppl 1:S113-21. [PMID: 24603943 DOI: 10.3233/jad-132435] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The tau protein is an attractive target for therapy and diagnosis. We started a tau immunotherapy program about 13 years ago and have since demonstrated that active and passive immunotherapies diminish tau pathology and improve function, including cognition, in different mouse models. These findings have been confirmed and extended by several groups. We routinely detect neuronal, and to a lesser extent microglial, antibody uptake correlating with tau pathology. Antibodies bind tau aggregates in the endosomal/lysosomal system, enhancing clearance presumably by promoting their disassembly. Extracellular clearance has recently been shown by others, using antibodies that apparently are not internalized. As most pathological tau is neuronal, intracellular targeting may be more efficacious. However, extracellular tau may be more accessible to antibodies, with tau-antibody complexes a target for microglial phagocytosis. The extent of involvement of each pathway may depend on numerous factors including antibody properties, degree of pathology, and experimental model. On the imaging front, multiple tau ligands derived from β-sheet dyes have been developed by several groups, some with promising results in clinical PET tests. Postmortem analysis should clarify their tau specificity, as in theory and based on histological staining, those are likely to have some affinity for various amyloids. We are developing antibody-derived tau probes that should be more specific, and have in mouse models shown in vivo detection and binding to pathological tau after peripheral injection. These are exciting times for research on tau therapies and diagnostic agents that hopefully can be applied to humans in the near future.
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Affiliation(s)
- Erin E Congdon
- Departments of Neuroscience and Physiology, New York University School of Medicine, NY, USA
| | | | - Einar M Sigurdsson
- Departments of Neuroscience and Physiology, New York University School of Medicine, NY, USA Departments of Psychiatry, New York University School of Medicine, NY, USA
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Barth V, Need A. Identifying novel radiotracers for PET imaging of the brain: application of LC-MS/MS to tracer identification. ACS Chem Neurosci 2014; 5:1148-53. [PMID: 24828747 DOI: 10.1021/cn500072r] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Nuclear medicine imaging biomarker applications are limited by the radiotracers available. Radiotracers enable the measurement of target engagement, or occupancy in relation to plasma exposure. These tracers can also be used as pharmacodynamic biomarkers to demonstrate functional consequences of binding a target. More recently, radiotracers have also been used for patient tailoring in Alzheimer's disease seen with amyloid imaging. Radiotracers for the central nervous system (CNS) are challenging to identify, as they require a unique intersection of multiple properties. Recent advances in tangential technologies, along with the use of iterative learning for the purposes of deriving in silico models, have opened up additional opportunities to identify radiotracers. Mass spectral technologies and in silico modeling have made it possible to measure and predict in vivo characteristics of molecules to indicate potential tracer performance. By analyzing these data alongside other measures, it is possible to delineate guidelines to increase the likelihood of selecting compounds that can perform as radiotracers or serve as the best starting point to develop a radiotracer following additional structural modification. The application of mass spectrometry based technologies is an efficient way to evaluate compounds as tracers in vivo, but more importantly enables the testing of potential tracers that have either no label site or complex labeling chemistry which may deter assessment by traditional means; therefore, use of this technology allows for more rapid iterative learning. The ability to differentially distribute toward target rich tissues versus tissue with no/less target present is a unique defining feature of a tracer. By testing nonlabeled compounds in vivo and analyzing tissue levels by LC-MS/MS, rapid assessment of a compound's ability to differentially distribute in a manner consistent with target expression biology guides the focus of chemistry resources for both designing and labeling tracer candidates. LC-MS/MS has only recently been used for de novo tracer identification; however, this connection of mass spectral technology to imaging has initiated engagement from a wider community that brings diverse backgrounds into the tracer discovery arena.
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Affiliation(s)
- Vanessa Barth
- Eli Lilly and Co., Lilly Research Laboratories, Indianapolis, Indiana 46285, United States
| | - Anne Need
- Eli Lilly and Co., Lilly Research Laboratories, Indianapolis, Indiana 46285, United States
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Senda M, Sasaki M, Yamane T, Shimizu K, Patt M, Barthel H, Sattler B, Nagasawa T, Schultze-Mosgau M, Aitoku Y, Dinkelborg L, Sabri O. Ethnic comparison of pharmacokinetics of (18)F-florbetaben, a PET tracer for beta-amyloid imaging, in healthy Caucasian and Japanese subjects. Eur J Nucl Med Mol Imaging 2014; 42:89-96. [PMID: 25143073 PMCID: PMC4244559 DOI: 10.1007/s00259-014-2890-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/31/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE (18)F-Florbetaben is a positron emission tomography (PET) tracer indicated for imaging cerebral beta-amyloid deposition in adult patients with cognitive impairment who are being evaluated for Alzheimer's disease and other causes of cognitive decline. The present study examined ethnic comparability of the plasma pharmacokinetics, which is the input to the brain, between Caucasian and Japanese subjects. METHODS Two identical phase I trials were performed in 18 German and 18 Japanese healthy volunteers to evaluate the plasma pharmacokinetics of a single dose of 300 MBq (18)F-florbetaben, either of low (≤5 μg, LD) or high (50-55 μg, HD) mass dose. Pharmacokinetic parameters were evaluated based on the total (18)F radioactivity measurements in plasma followed by metabolite analysis using radio-HPLC. RESULTS The pharmacokinetics of (18)F-florbetaben was characterized by a rapid elimination from plasma. The dose-normalized areas under the curve of (18)F-florbetaben in plasma as an indicator of the input to the brain were comparable between Germans (LD: 0.38 min/l, HD: 0.55 min/l) and Japanese (LD: 0.35 min/l, HD: 0.45 min/l) suggesting ethnic similarity, and the mass dose effect was minimal. A polar metabolite fraction was the main radiolabelled degradation product in plasma and was also similar between the doses and the ethnic groups. CONCLUSION Absence of a difference in the pharmacokinetics of (18)F-florbetaben in Germans and Japanese has warranted further global development of the PET imaging agent.
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Affiliation(s)
- Michio Senda
- Division of Molecular Imaging, Institute of Biomedical Research and Innovation, 2-2 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan,
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Saidlitz P, Voisin T, Vellas B, Payoux P, Gabelle A, Formaglio M, Delrieu J. Amyloid imaging in alzheimer’s disease: A literature review. J Nutr Health Aging 2014. [DOI: 10.1007/s12603-014-0485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
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Gomperts SN. Imaging the Role of Amyloid in PD Dementia and Dementia with Lewy Bodies. Curr Neurol Neurosci Rep 2014; 14:472. [DOI: 10.1007/s11910-014-0472-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Marik J, Bohorquez SMS, Williams SP, van Bruggen N. New imaging paradigms in drug development: the PET imaging approach. DRUG DISCOVERY TODAY. TECHNOLOGIES 2014; 8:e63-9. [PMID: 24990264 DOI: 10.1016/j.ddtec.2011.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Molecular imaging is becoming an indispensable part of clinical drug development. The presented review highlights few state-of-the-art examples that serve to illustrate specific points and discuss future directions of the use of positron emission tomography (PET) imaging in various phases of clinical drug development.:
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Affiliation(s)
- Jan Marik
- Genentech Research and Early Development (gRED), Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA.
| | - Sandra M Sanabria Bohorquez
- Genentech Research and Early Development (gRED), Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Simon-Peter Williams
- Genentech Research and Early Development (gRED), Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Nicholas van Bruggen
- Genentech Research and Early Development (gRED), Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
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Molecular imaging of misfolded protein pathology for early clues to involvement of the heart. Eur J Nucl Med Mol Imaging 2014; 41:1649-51. [DOI: 10.1007/s00259-014-2832-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 06/03/2014] [Indexed: 11/25/2022]
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Saidlitz P, Voisin T, Vellas B, Payoux P, Gabelle A, Formaglio M, Delrieu J. Amyloid imaging in Alzheimer's disease: a literature review. J Nutr Health Aging 2014; 18:723-40. [PMID: 25226113 DOI: 10.1007/s12603-014-0507-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Therapies targeting amyloid-β peptide currently represent approximately 50% of drugs now being developed for Alzheimer's disease. Some, including active and passive anti-Aβ immunotherapy, directly target the amyloid plaques. The new amyloid tracers are increasingly being included in the proposed updated diagnostic criteria, and may allow earlier diagnosis. Those targeting amyloid-β peptide allow identification of amyloid plaques in vivo. We need to gain insight into all aspects of their application. As florbetapir (Amyvid™) and flutemetamol (Vizamyl™) have received marketing authorization, clinicians require deeper knowledge to be rationally used in diagnosis. In this paper, we review both completed and ongoing observational, longitudinal and interventional studies of these tracers, our main objective being to show the performance of the four most commonly used tracers and their validation.
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Affiliation(s)
- P Saidlitz
- Saidlitz Pascal, Alzheimer's disease center, 170 avenue de Casselardit, TSA 40031, Purpan University Hospital, 31059 Toulouse Cedex 09, +33676298221
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Abstract
Over the past 35 years or so, PET brain imaging has allowed powerful and unique insights into brain function under normal conditions and in disease states. Initially, as PET instrumentation continued to develop, studies were focused on brain perfusion and glucose metabolism. This permitted refinement of brain imaging for important, non-oncologic clinical indications. The ability of PET to not only provide spatial localization of metabolic changes but also to accurately and consistently quantify their distribution proved valuable for applications in the clinical setting. Specifically, glucose metabolism brain imaging using (F-18) fluorodeoxyglucose continues to be invaluable for evaluating patients with intractable seizures for identifying seizure foci and operative planning. Cerebral glucose metabolism also contributes to diagnosis of neurodegenerative diseases that cause dementia. Alzheimer disease, dementia with Lewy bodies, and the several variants of frontotemporal lobar degeneration have differing typical patterns of hypometabolism. In Alzheimer disease, hypometabolism has furthermore been associated with poorer cognitive performance and ensuing cognitive and functional decline. As the field of radiochemistry evolved, novel radioligands including radiolabeled flumazenil, dopamine transporter ligands, nicotine receptor ligands, and others have allowed for further understanding of molecular changes in the brain associated with various diseases. Recently, PET brain imaging reached another milestone with the approval of (F-18) florbetapir imaging by the United States Federal Drug Administration for detection of amyloid plaque accumulation in brain, the major histopathologic hallmark of Alzheimer disease, and efforts have been made to define the clinical role of this imaging agent in the setting of the currently limited treatment options. Hopefully, this represents the first of many new radiopharmaceuticals that would allow improved diagnostic and prognostic information in these and other clinical applications, including Parkinson disease and traumatic brain injury.
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Affiliation(s)
- Ilya Nasrallah
- Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
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Imaging cardiac amyloidosis: a pilot study using ¹⁸F-florbetapir positron emission tomography. Eur J Nucl Med Mol Imaging 2014; 41:1652-62. [PMID: 24841414 DOI: 10.1007/s00259-014-2787-6] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/15/2014] [Indexed: 12/25/2022]
Abstract
PURPOSE Cardiac amyloidosis, a restrictive heart disease with high mortality and morbidity, is underdiagnosed due to limited targeted diagnostic imaging. The primary aim of this study was to evaluate the utility of (18)F-florbetapir for imaging cardiac amyloidosis. METHODS We performed a pilot study of cardiac (18)F-florbetapir PET in 14 subjects: 5 control subjects without amyloidosis and 9 subjects with documented cardiac amyloidosis. Standardized uptake values (SUV) of (18)F-florbetapir in the left ventricular (LV) myocardium, blood pool, liver, and vertebral bone were determined. A (18)F-florbetapir retention index (RI) was computed. Mean LV myocardial SUVs, target-to-background ratio (TBR, myocardial/blood pool SUV ratio) and myocardial-to-liver SUV ratio between 0 and 30 min were calculated. RESULTS Left and right ventricular myocardial uptake of (18)F-florbetapir were noted in all the amyloid subjects and in none of the control subjects. The RI, TBR, LV myocardial SUV and LV myocardial to liver SUV ratio were all significantly higher in the amyloidosis subjects than in the control subjects (RI median 0.043 min(-1), IQR 0.034 - 0.051 min(-1), vs. 0.023 min(-1), IQR 0.015 - 0.025 min(-1), P = 0.002; TBR 1.84, 1.64 - 2.50, vs. 1.26, IQR 0.91 - 1.36, P = 0.001; LV myocardial SUV 3.84, IQR 1.87 - 5.65, vs. 1.35, IQR 1.17 - 2.28, P = 0.029; ratio of LV myocardial to liver SUV 0.67, IQR 0.44 - 1.64, vs. 0.18, IQR 0.15 - 0.35, P = 0.004). The myocardial RI, TBR and myocardial to liver SUV ratio also distinguished the control subjects from subjects with transthyretin and those with light chain amyloid. CONCLUSION (18)F-Florbetapir PET may be a promising technique to image light chain and transthyretin cardiac amyloidosis. Its role in diagnosing amyloid in other organ systems and in assessing response to therapy needs to be further studied.
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Mitsis EM, Bender HA, Kostakoglu L, Machac J, Martin J, Woehr JL, Sewell MC, Aloysi A, Goldstein MA, Li C, Sano M, Gandy S. A consecutive case series experience with [18 F] florbetapir PET imaging in an urban dementia center: impact on quality of life, decision making, and disposition. Mol Neurodegener 2014; 9:10. [PMID: 24484858 PMCID: PMC3913628 DOI: 10.1186/1750-1326-9-10] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 01/30/2014] [Indexed: 11/17/2022] Open
Abstract
Background Identification and quantification of fibrillar amyloid in brain using positron emission tomography (PET) imaging and Amyvid™ ([18 F] Amyvid, [18 F] florbetapir, 18 F-AV-45) was recently approved by the US Food and Drug Administration as a clinical tool to estimate brain amyloid burden in patients being evaluated for cognitive impairment or dementia. Imaging with [18 F] florbetapir offers in vivo confirmation of the presence of cerebral amyloidosis and may increase the accuracy of the diagnosis and likely cause of cognitive impairment (CI) or dementia. Most importantly, amyloid imaging may improve certainty of etiology in situations where the differential diagnosis cannot be resolved on the basis of standard clinical and laboratory criteria. Results A consecutive case series of 30 patients (age 50-89; 16 M/14 F) were clinically evaluated at a cognitive evaluation center of urban dementia center and referred for [18 F] florbetapir PET imaging as part of a comprehensive dementia workup. Evaluation included neurological examination and neuropsychological assessment by dementia experts. [18 F] florbetapir PET scans were read by trained nuclear medicine physicians using the qualitative binary approach. Scans were rated as either positive or negative for the presence of cerebral amyloidosis. In addition to a comprehensive dementia evaluation, post [18 F] florbetapir PET imaging results caused diagnoses to be changed in 10 patients and clarified in 9 patients. Four patients presenting with SCI were negative for amyloidosis. These results show that [18 F] florbetapir PET imaging added diagnostic clarification and discrimination in over half of the patients evaluated. Conclusions Amyloid imaging provided novel and essential data that: (1) caused diagnosis to be revised; and/or (2) prevented the initiation of incorrect or suboptimal treatment; and/or (3) avoided inappropriate referral to an anti-amyloid clinical trial.
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Affiliation(s)
- Effie M Mitsis
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L, Levy Place, Box 1230, New York, NY 10029, USA.
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Stonnington CM, Chen K, Lee W, Locke DEC, Dueck AC, Liu X, Roontiva A, Fleisher AS, Caselli RJ, Reiman EM. Fibrillar amyloid correlates of preclinical cognitive decline. Alzheimers Dement 2014; 10:e1-8. [PMID: 23583233 PMCID: PMC3713087 DOI: 10.1016/j.jalz.2013.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 12/22/2012] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND It is not known whether preclinical cognitive decline is associated with fibrillar β-amyloid (Aβ) deposition irrespective of apolipoprotein E (APOE) ε4 status. METHODS From a prospective observational study of 623 cognitively normal individuals, we identified all subjects who showed preclinical decline of at least 2 standard deviations beyond the decline of the entire group in memory or executive function. Fourteen decliners were matched by APOE ε4 gene dose, age, sex, and education with 14 nondecliners. Dynamic Pittsburgh compound B (PiB) positron emission tomography (PET) scans, the Logan method, statistical parametric mapping, and automatically labeled regions of interest were used to characterize and compare cerebral-to-cerebellar PiB distribution volume ratios (DVRs), reflecting fibrillar Aβ burden. RESULTS At P < .005 (uncorrected), decliners had significantly greater DVRs in comparison to nondecliners. CONCLUSIONS Asymptomatic longitudinal neuropsychological decline is associated with subsequent increased fibrillar amyloid deposition, even when controlling for APOE ε4 genotype.
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Affiliation(s)
| | - Kewei Chen
- Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - Wendy Lee
- Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - Dona E C Locke
- Department of Psychiatry & Psychology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - Amylou C Dueck
- Department of Biostatistics, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - Xiaofen Liu
- Banner Alzheimer's Institute, Phoenix, AZ, USA
| | | | - Adam S Fleisher
- Banner Alzheimer's Institute, Phoenix, AZ, USA; Department of Neurosciences, University of California-San Diego, San Diego, CA, USA
| | - Richard J Caselli
- Department of Neurology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
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Tosun D, Joshi S, Weiner MW. Neuroimaging predictors of brain amyloidosis in mild cognitive impairment. Ann Neurol 2013; 74:188-98. [PMID: 23686534 DOI: 10.1002/ana.23921] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 04/22/2013] [Accepted: 04/24/2013] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To identify a neuroimaging signature predictive of brain amyloidosis as a screening tool to identify individuals with mild cognitive impairment (MCI) that are most likely to have high levels of brain amyloidosis or to be amyloid-free. METHODS The prediction model cohort included 62 MCI subjects screened with structural magnetic resonance imaging (MRI) and (11) C-labeled Pittsburgh compound B positron emission tomography (PET). We identified an anatomical shape variation-based neuroimaging predictor of brain amyloidosis and defined a structural MRI-based brain amyloidosis score (sMRI-BAS). Amyloid beta positivity (Aβ(+) ) predictive power of sMRI-BAS was validated on an independent cohort of 153 MCI patients with cerebrospinal fluid Aβ1-42 biomarker data but no amyloid PET scans. We compared the Aβ(+) predictive power of sMRI-BAS to those of apolipoprotein E (ApoE) genotype and hippocampal volume, the 2 most relevant candidate biomarkers for the prediction of brain amyloidosis. RESULTS Anatomical shape variations predictive of brain amyloidosis in MCI embraced a characteristic spatial pattern known for high vulnerability to Alzheimer disease pathology, including the medial temporal lobe, temporal-parietal association cortices, posterior cingulate, precuneus, hippocampus, amygdala, caudate, and fornix/stria terminals. Aβ(+) prediction performance of sMRI-BAS and ApoE genotype jointly was significantly better than the performance of each predictor separately (area under the curve [AUC] = 0.88 vs AUC = 0.70 and AUC = 0.81, respectively) with >90% sensitivity and specificity at 20% false-positive rate and false-negative rate thresholds. Performance of hippocampal volume as an independent predictor of brain amyloidosis in MCI was only marginally better than random chance (AUC = 0.56). INTERPRETATION As one of the first attempts to use an imaging technique that does not require amyloid-specific radioligands for identification of individuals with brain amyloidosis, our findings could lead to development of multidisciplinary/multimodality brain amyloidosis biomarkers that are reliable, minimally invasive, and widely available.
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Affiliation(s)
- Duygu Tosun
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA; Veterans Administration Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA
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Cohen AD, Rabinovici GD, Mathis CA, Jagust WJ, Klunk WE, Ikonomovic MD. Using Pittsburgh Compound B for in vivo PET imaging of fibrillar amyloid-beta. ADVANCES IN PHARMACOLOGY 2013; 64:27-81. [PMID: 22840744 DOI: 10.1016/b978-0-12-394816-8.00002-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The development of Aβ-PET imaging agents has allowed for detection of fibrillar Aβ deposition in vivo and marks a major advancement in understanding the role of Aβ in Alzheimer's disease (AD). Imaging Aβ thus has many potential clinical benefits: early or perhaps preclinical detection of disease and accurately distinguishing AD from dementias of other non-Aβ causes in patients presenting with mild or atypical symptoms or confounding comorbidities (in which the distinction is difficult to make clinically). From a research perspective, imaging Aβ allows us to study relationships between amyloid pathology and changes in cognition, brain structure, and function across the continuum from normal aging to mild cognitive impairment (MCI) to AD; and to monitor the effectiveness of anti-Aβ drugs and relate them to neurodegeneration and clinical symptoms. Here, we will discuss the application of one of the most broadly studied and widely used Aβ imaging agents, Pittsburgh Compound-B (PiB).
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Affiliation(s)
- Ann D Cohen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Influence of scan duration on the accuracy of β-amyloid PET with florbetaben in patients with Alzheimer's disease and healthy volunteers. Eur J Nucl Med Mol Imaging 2012; 40:238-44. [PMID: 23104671 DOI: 10.1007/s00259-012-2268-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Florbetaben is a β-amyloid-targeted PET tracer with significant potential for augmenting the toolbox in the clinical diagnosis of Alzheimer's disease (AD). In dementia imaging, shortening of scan duration may simplify future clinical use. The aim of this retrospective study was to investigate the effect of scan duration on diagnostic accuracy. METHODS PET scans obtained from 25 AD patients and 25 healthy volunteers (HVs) were analysed. In each subject, scans of three different durations (5, 10 and 20 min; all starting 90 min after injection) were obtained, randomized, and visually assessed by three experts blinded to the subject's identity and group affiliation. Presence/absence of β-amyloid and diagnostic confidence (0-100 %) were scored, and 10 % of the scans were re-read. Further, randomly selected datasets of ten AD patients and ten HVs were quantified using an established VOI-based approach and using a voxel-based approach. RESULTS The sensitivity and specificity of the blinded read were 80 % and 96 %, respectively, for all scan durations. Diagnostic confidence was high (97 ± 6 %, 97 ± 6 % and 95 ± 8 % for the 20-min, 10-min and 5-min scans, respectively; n.s.), as was interreader agreement (kappa(20 min) = 0.94, kappa(10 min) = 0.94, kappa(5 min) = 0.89; n.s.). Intrareader agreement was highest for the 20-min scan (kappa = 1.00) and lower for the 10-min scan (kappa = 0.71) and 5-min scan (kappa = 0.80; p = 0.002 and 0.003 vs. the 20-min scan). For all scan durations, composite SUVRs (Cohen's d effect size 4.5, 3.9 and 4.8 for the 5-min, 10-min and 20-min scans; p < 0.0001 each) and individual brain volumes affected by β-amyloid (Cohen's d effect size 1.6, 1.8 and 2.0 for the 5-min, 10-min and 20-min scans; p < 0.005 each) were significantly higher in AD patients than in HVs. CONCLUSION Reduction in scan duration did not relevantly affect the accuracy of florbetaben PET scans in discriminating between AD patients and HVs. Thus, a reduction in scan duration seems conceivable for the future clinical use of florbetaben.
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Affiliation(s)
- Lucie Yang
- Division of Medical Imaging Products, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
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