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Ruppert-Junck MC, Kräling G, Greuel A, Tittgemeyer M, Timmermann L, Drzezga A, Eggers C, Pedrosa D. Random forest analysis of midbrain hypometabolism using [ 18F]-FDG PET identifies Parkinson's disease at the subject-level. Front Comput Neurosci 2024; 18:1328699. [PMID: 38384375 PMCID: PMC10879348 DOI: 10.3389/fncom.2024.1328699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
Parkinson's disease (PD) is currently diagnosed largely on the basis of expert judgement with neuroimaging serving only as a supportive tool. In a recent study, we identified a hypometabolic midbrain cluster, which includes parts of the substantia nigra, as the best differentiating metabolic feature for PD-patients based on group comparison of [18F]-fluorodeoxyglucose ([18F]-FDG) PET scans. Longitudinal analyses confirmed progressive metabolic changes in this region and, an independent study showed great potential of nigral metabolism for diagnostic workup of parkinsonian syndromes. In this study, we applied a machine learning approach to evaluate midbrain metabolism measured by [18F]-FDG PET as a diagnostic marker for PD. In total, 51 mid-stage PD-patients and 16 healthy control subjects underwent high-resolution [18F]-FDG PET. Normalized tracer update values of the midbrain cluster identified by between-group comparison were extracted voxel-wise from individuals' scans. Extracted uptake values were subjected to a random forest feature classification algorithm. An adapted leave-one-out cross validation approach was applied for testing robustness of the model for differentiating between patients and controls. Performance of the model across all runs was evaluated by calculating sensitivity, specificity and model accuracy for the validation data set and the percentage of correctly categorized subjects for test data sets. The random forest feature classification of voxel-based uptake values from the midbrain cluster identified patients in the validation data set with an average sensitivity of 0.91 (Min: 0.82, Max: 0.94). For all 67 runs, in which each of the individuals was treated once as test data set, the test data set was correctly categorized by our model. The applied feature importance extraction consistently identified a subset of voxels within the midbrain cluster with highest importance across all runs which spatially converged with the left substantia nigra. Our data suggest midbrain metabolism measured by [18F]-FDG PET as a promising diagnostic imaging tool for PD. Given its close relationship to PD pathophysiology and very high discriminatory accuracy, this approach could help to objectify PD diagnosis and enable more accurate classification in relation to clinical trials, which could also be applicable to patients with prodromal disease.
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Affiliation(s)
- Marina C. Ruppert-Junck
- Department of Neurology, Philipps-University of Marburg, Marburg, Germany
- Clinic for Neurology, University Hospital Gießen and Marburg GmbH, Marburg, Germany
- Center for Mind, Brain and Behavior, Philipps-University of Marburg and Justus-Liebig University Gießen, Marburg, Germany
| | - Gunter Kräling
- Clinic for Neurology, University Hospital Gießen and Marburg GmbH, Marburg, Germany
| | - Andrea Greuel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital Neukölln, Berlin, Germany
| | - Marc Tittgemeyer
- Max Planck Institute for Metabolism Research, Cologne, Germany
- Cluster of Excellence in Cellular Stress and Aging Associated Disease (CECAD), Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, Philipps-University of Marburg, Marburg, Germany
- Clinic for Neurology, University Hospital Gießen and Marburg GmbH, Marburg, Germany
- Center for Mind, Brain and Behavior, Philipps-University of Marburg and Justus-Liebig University Gießen, Marburg, Germany
| | - Alexander Drzezga
- Cluster of Excellence in Cellular Stress and Aging Associated Disease (CECAD), Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-2), Research Center Jülich, Jülich, Germany
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Carsten Eggers
- Department of Neurology, Philipps-University of Marburg, Marburg, Germany
- Department of Neurology, Knappschaftskrankenhaus Bottrop, Bottrop, Germany
| | - David Pedrosa
- Department of Neurology, Philipps-University of Marburg, Marburg, Germany
- Clinic for Neurology, University Hospital Gießen and Marburg GmbH, Marburg, Germany
- Center for Mind, Brain and Behavior, Philipps-University of Marburg and Justus-Liebig University Gießen, Marburg, Germany
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Gündel D, Toussaint M, Lai TH, Deuther-Conrad W, Cumming P, Schröder S, Teodoro R, Moldovan RP, Pan-Montojo F, Sattler B, Kopka K, Sabri O, Brust P. Quantitation of the A2A Adenosine Receptor Density in the Striatum of Mice and Pigs with [18F]FLUDA by Positron Emission Tomography. Pharmaceuticals (Basel) 2022; 15:ph15050516. [PMID: 35631343 PMCID: PMC9146919 DOI: 10.3390/ph15050516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 12/10/2022] Open
Abstract
The cerebral expression of the A2A adenosine receptor (A2AAR) is altered in neurodegenerative diseases such as Parkinson’s (PD) and Huntington’s (HD) diseases, making these receptors an attractive diagnostic and therapeutic target. We aimed to further investigate the pharmacokinetic properties in the brain of our recently developed A2AAR–specific antagonist radiotracer [18F]FLUDA. For this purpose, we retrospectively analysed dynamic PET studies of healthy mice and rotenone–treated mice, and conducted dynamic PET studies with healthy pigs. We performed analysis of mouse brain time–activity curves to calculate the mean residence time (MRT) by non–compartmental analysis, and the binding potential (BPND) of [18F]FLUDA using the simplified reference tissue model (SRTM). For the pig studies, we performed a Logan graphical analysis to calculate the radiotracer distribution volume (VT) at baseline and under blocking conditions with tozadenant. The MRT of [18F]FLUDA in the striatum of mice was decreased by 30% after treatment with the A2AAR antagonist istradefylline. Mouse results showed the highest BPND (3.9 to 5.9) in the striatum. SRTM analysis showed a 20% lower A2AAR availability in the rotenone–treated mice compared to the control–aged group. Tozadenant treatment significantly decreased the VT (14.6 vs. 8.5 mL · g−1) and BPND values (1.3 vs. 0.3) in pig striatum. This study confirms the target specificity and a high BPND of [18F]FLUDA in the striatum. We conclude that [18F]FLUDA is a suitable tool for the non–invasive quantitation of altered A2AAR expression in neurodegenerative diseases such as PD and HD, by PET.
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Affiliation(s)
- Daniel Gündel
- Department of Neuroradiopharmaceuticals, Institute of Radiopharmaceutical Cancer Research, Helmholtz–Zentrum Dresden–Rossendorf, 04308 Leipzig, Germany; (M.T.); (T.H.L.); (W.D.-C.); (R.T.); (R.-P.M.); (K.K.); (P.B.)
- Correspondence: ; Tel.: +49-341-234179-4615
| | - Magali Toussaint
- Department of Neuroradiopharmaceuticals, Institute of Radiopharmaceutical Cancer Research, Helmholtz–Zentrum Dresden–Rossendorf, 04308 Leipzig, Germany; (M.T.); (T.H.L.); (W.D.-C.); (R.T.); (R.-P.M.); (K.K.); (P.B.)
| | - Thu Hang Lai
- Department of Neuroradiopharmaceuticals, Institute of Radiopharmaceutical Cancer Research, Helmholtz–Zentrum Dresden–Rossendorf, 04308 Leipzig, Germany; (M.T.); (T.H.L.); (W.D.-C.); (R.T.); (R.-P.M.); (K.K.); (P.B.)
- Department of Research and Development, ROTOP Pharmaka Ltd., 01328 Dresden, Germany;
| | - Winnie Deuther-Conrad
- Department of Neuroradiopharmaceuticals, Institute of Radiopharmaceutical Cancer Research, Helmholtz–Zentrum Dresden–Rossendorf, 04308 Leipzig, Germany; (M.T.); (T.H.L.); (W.D.-C.); (R.T.); (R.-P.M.); (K.K.); (P.B.)
| | - Paul Cumming
- Department of Nuclear Medicine, Bern University Hospital, 3010 Bern, Switzerland;
- School of Psychology and Counselling, Queensland University of Technology, Brisbane 4000, Australia
| | - Susann Schröder
- Department of Research and Development, ROTOP Pharmaka Ltd., 01328 Dresden, Germany;
| | - Rodrigo Teodoro
- Department of Neuroradiopharmaceuticals, Institute of Radiopharmaceutical Cancer Research, Helmholtz–Zentrum Dresden–Rossendorf, 04308 Leipzig, Germany; (M.T.); (T.H.L.); (W.D.-C.); (R.T.); (R.-P.M.); (K.K.); (P.B.)
- Department of Research and Development, Life Molecular Imaging GmbH, 13353 Berlin, Germany
| | - Rareş-Petru Moldovan
- Department of Neuroradiopharmaceuticals, Institute of Radiopharmaceutical Cancer Research, Helmholtz–Zentrum Dresden–Rossendorf, 04308 Leipzig, Germany; (M.T.); (T.H.L.); (W.D.-C.); (R.T.); (R.-P.M.); (K.K.); (P.B.)
| | - Francisco Pan-Montojo
- Department of Psychiatry, University Hospital Munich, Ludwig–Maximilians–Universität (LMU) Munich, 80336 Munich, Germany;
- Department of Neurology, University Hospital Munich, Ludwig–Maximilians–Universität (LMU) Munich, 81377 Munich, Germany
| | - Bernhard Sattler
- Department for Nuclear Medicine, University Hospital Leipzig, 04103 Leipzig, Germany; (B.S.); (O.S.)
| | - Klaus Kopka
- Department of Neuroradiopharmaceuticals, Institute of Radiopharmaceutical Cancer Research, Helmholtz–Zentrum Dresden–Rossendorf, 04308 Leipzig, Germany; (M.T.); (T.H.L.); (W.D.-C.); (R.T.); (R.-P.M.); (K.K.); (P.B.)
- Faculty of Chemistry and Food Chemistry, School of Science, TU Dresden, 01069 Dresden, Germany
| | - Osama Sabri
- Department for Nuclear Medicine, University Hospital Leipzig, 04103 Leipzig, Germany; (B.S.); (O.S.)
| | - Peter Brust
- Department of Neuroradiopharmaceuticals, Institute of Radiopharmaceutical Cancer Research, Helmholtz–Zentrum Dresden–Rossendorf, 04308 Leipzig, Germany; (M.T.); (T.H.L.); (W.D.-C.); (R.T.); (R.-P.M.); (K.K.); (P.B.)
- The Lübeck Institute of Experimental Dermatology, University Medical Center Schleswig–Holstein, 23562 Lübeck, Germany
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Brašić JR, Nandi A, Russell DS, Jennings D, Barret O, Mathur A, Slifer K, Sedlak T, Martin SD, Brinson Z, Vyas P, Seibyl JP, Berry-Kravis EM, Wong DF, Budimirovic DB. Reduced Expression of Cerebral Metabotropic Glutamate Receptor Subtype 5 in Men with Fragile X Syndrome. Brain Sci 2020; 10:E899. [PMID: 33255214 PMCID: PMC7760509 DOI: 10.3390/brainsci10120899] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/07/2020] [Accepted: 11/14/2020] [Indexed: 12/28/2022] Open
Abstract
Glutamatergic receptor expression is mostly unknown in adults with fragile X syndrome (FXS). Favorable behavioral effects of negative allosteric modulators (NAMs) of the metabotropic glutamate receptor subtype 5 (mGluR5) in fmr1 knockout (KO) mouse models have not been confirmed in humans with FXS. Measurement of cerebral mGluR5 expression in humans with FXS exposed to NAMs might help in that effort. We used positron emission tomography (PET) to measure the mGluR5 density as a proxy of mGluR5 expression in cortical and subcortical brain regions to confirm target engagement of NAMs for mGluR5s. The density and the distribution of mGluR5 were measured in two independent samples of men with FXS (N = 9) and typical development (TD) (N = 8). We showed the feasibility of this complex study including MRI and PET, meaning that this challenging protocol can be accomplished in men with FXS with an adequate preparation. Analysis of variance of estimated mGluR5 expression showed that mGluR5 expression was significantly reduced in cortical and subcortical regions of men with FXS in contrast to age-matched men with TD.
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Affiliation(s)
- James R. Brašić
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (A.N.); (A.M.); (T.S.); (S.D.M.); (Z.B.); (P.V.); (D.F.W.)
| | - Ayon Nandi
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (A.N.); (A.M.); (T.S.); (S.D.M.); (Z.B.); (P.V.); (D.F.W.)
| | - David S. Russell
- Clinical Research, Institute for Neurodegenerative Disorders, New Haven, CT 06510, USA; (D.S.R.); (D.J.); (O.B.); (J.P.S.)
- Research Clinic, Invicro LLC, New Haven, CT 06510, USA
| | - Danna Jennings
- Clinical Research, Institute for Neurodegenerative Disorders, New Haven, CT 06510, USA; (D.S.R.); (D.J.); (O.B.); (J.P.S.)
- Research Clinic, Invicro LLC, New Haven, CT 06510, USA
- Denali Therapeutics, Inc., South San Francisco, CA 94080, USA
| | - Olivier Barret
- Clinical Research, Institute for Neurodegenerative Disorders, New Haven, CT 06510, USA; (D.S.R.); (D.J.); (O.B.); (J.P.S.)
| | - Anil Mathur
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (A.N.); (A.M.); (T.S.); (S.D.M.); (Z.B.); (P.V.); (D.F.W.)
| | - Keith Slifer
- Department of Psychiatry and Behavioral Sciences-Child Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD 21205, USA
| | - Thomas Sedlak
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (A.N.); (A.M.); (T.S.); (S.D.M.); (Z.B.); (P.V.); (D.F.W.)
- Department of Psychiatry and Behavioral Sciences-General Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Samuel D. Martin
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (A.N.); (A.M.); (T.S.); (S.D.M.); (Z.B.); (P.V.); (D.F.W.)
- Department of Neuroscience, Zanvyl Krieger School of Arts and Sciences, The Johns Hopkins University, Baltimore, MD 21218, USA
| | - Zabecca Brinson
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (A.N.); (A.M.); (T.S.); (S.D.M.); (Z.B.); (P.V.); (D.F.W.)
| | - Pankhuri Vyas
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (A.N.); (A.M.); (T.S.); (S.D.M.); (Z.B.); (P.V.); (D.F.W.)
| | - John P. Seibyl
- Clinical Research, Institute for Neurodegenerative Disorders, New Haven, CT 06510, USA; (D.S.R.); (D.J.); (O.B.); (J.P.S.)
- Research Clinic, Invicro LLC, New Haven, CT 06510, USA
| | - Elizabeth M. Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, and Biochemistry, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Dean F. Wong
- Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (A.N.); (A.M.); (T.S.); (S.D.M.); (Z.B.); (P.V.); (D.F.W.)
- Precision Radio-Theranostics Translational Laboratories, Mallinckrodt Institute of Radiology, School of Medicine, Washington University, Saint Louis, MO 63110, USA
| | - Dejan B. Budimirovic
- Department of Psychiatry and Behavioral Sciences-Child Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
- Departments of Psychiatry and Neurogenetics, Kennedy Krieger Institute, Baltimore, MD 21205, USA
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Ruppert MC, Greuel A, Tahmasian M, Schwartz F, Stürmer S, Maier F, Hammes J, Tittgemeyer M, Timmermann L, van Eimeren T, Drzezga A, Eggers C. Network degeneration in Parkinson’s disease: multimodal imaging of nigro-striato-cortical dysfunction. Brain 2020; 143:944-959. [DOI: 10.1093/brain/awaa019] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/21/2019] [Accepted: 12/11/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
The spreading hypothesis of neurodegeneration assumes an expansion of neural pathologies along existing neural pathways. Multimodal neuroimaging studies have demonstrated distinct topographic patterns of cerebral pathologies in neurodegeneration. For Parkinson’s disease the hypothesis so far rests largely on histopathological evidence of α-synuclein spreading in a characteristic pattern and progressive nigrostriatal dopamine depletion. Functional consequences of nigrostriatal dysfunction on cortical activity remain to be elucidated. Our goal was to investigate multimodal imaging correlates of degenerative processes in Parkinson’s disease by assessing dopamine depletion and its potential effect on striatocortical connectivity networks and cortical metabolism in relation to parkinsonian symptoms. We combined 18F-DOPA-PET, 18F-fluorodeoxyglucose (FDG)-PET and resting state functional MRI to multimodally characterize network alterations in Parkinson’s disease. Forty-two patients with mild-to-moderate stage Parkinson’s disease and 14 age-matched healthy control subjects underwent a multimodal imaging protocol and comprehensive clinical examination. A voxel-wise group comparison of 18F-DOPA uptake identified the exact location and extent of putaminal dopamine depletion in patients. Resulting clusters were defined as seeds for a seed-to-voxel functional connectivity analysis. 18F-FDG metabolism was compared between groups at a whole-brain level and uptake values were extracted from regions with reduced putaminal connectivity. To unravel associations between dopaminergic activity, striatocortical connectivity, glucose metabolism and symptom severity, correlations between normalized uptake values, seed-to-cluster β-values and clinical parameters were tested while controlling for age and dopaminergic medication. Aside from cortical hypometabolism, 18F-FDG-PET data for the first time revealed a hypometabolic midbrain cluster in patients with Parkinson’s disease that comprised caudal parts of the bilateral substantia nigra pars compacta. Putaminal dopamine synthesis capacity was significantly reduced in the bilateral posterior putamen and correlated with ipsilateral nigral 18F-FDG uptake. Resting state functional MRI data indicated significantly reduced functional connectivity between the dopamine depleted putaminal seed and cortical areas primarily belonging to the sensorimotor network in patients with Parkinson’s disease. In the inferior parietal cortex, hypoconnectivity in patients was significantly correlated with lower metabolism (left P = 0.021, right P = 0.018). Of note, unilateral network alterations quantified with different modalities corresponded with contralateral motor impairments. In conclusion, our results support the hypothesis that degeneration of nigrostriatal fibres functionally impairs distinct striatocortical connections, disturbing the efficient interplay between motor processing areas and impairing motor control in patients with Parkinson’s disease. The present study is the first to reveal trimodal evidence for network-dependent degeneration in Parkinson’s disease by outlining the impact of functional nigrostriatal pathway impairment on striatocortical functional connectivity networks and cortical metabolism.
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Affiliation(s)
- Marina C Ruppert
- Department of Neurology, University Hospital of Marburg, Germany
- Center for Mind, Brain and Behavior - CMBB, Universities Marburg and Gießen, Germany
| | - Andrea Greuel
- Department of Neurology, University Hospital of Marburg, Germany
| | - Masoud Tahmasian
- Institue of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Frank Schwartz
- Department of Neurology, Hospital of the Brothers of Mercy, Trier, Germany
| | - Sophie Stürmer
- Max Planck Institute for Metabolism Research, Cologne, Germany
- Department of Neurology, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Germany
| | - Franziska Maier
- Department of Psychiatry, University Hospital Cologne, Medical Faculty, Cologne, Germany
| | - Jochen Hammes
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Germany
| | - Marc Tittgemeyer
- Max Planck Institute for Metabolism Research, Cologne, Germany
- Cluster of Excellence in Cellular Stress and Aging Associated Disease (CECAD), Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Marburg, Germany
- Center for Mind, Brain and Behavior - CMBB, Universities Marburg and Gießen, Germany
| | - Thilo van Eimeren
- Department of Neurology, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Germany
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Germany
| | - Alexander Drzezga
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, Medical Faculty and University Hospital Cologne, University Hospital Cologne, Germany
- German Center for Neurodegenerative Diseases (DZNE), Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-2), Research Center Jülich, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital of Marburg, Germany
- Center for Mind, Brain and Behavior - CMBB, Universities Marburg and Gießen, Germany
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Segato A, Pieri V, Favaro A, Riva M, Falini A, De Momi E, Castellano A. Automated Steerable Path Planning for Deep Brain Stimulation Safeguarding Fiber Tracts and Deep Gray Matter Nuclei. Front Robot AI 2019; 6:70. [PMID: 33501085 PMCID: PMC7806057 DOI: 10.3389/frobt.2019.00070] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/18/2019] [Indexed: 12/20/2022] Open
Abstract
Deep Brain Stimulation (DBS) is a neurosurgical procedure consisting in the stereotactic implantation of stimulation electrodes to specific brain targets, such as deep gray matter nuclei. Current solutions to place the electrodes rely on rectilinear stereotactic trajectories (RTs) manually defined by surgeons, based on pre-operative images. An automatic path planner that accurately targets subthalamic nuclei (STN) and safeguards critical surrounding structures is still lacking. Also, robotically-driven curvilinear trajectories (CTs) computed on the basis of state-of-the-art neuroimaging would decrease DBS invasiveness, circumventing patient-specific obstacles. This work presents a new algorithm able to estimate a pool of DBS curvilinear trajectories for reaching a given deep target in the brain, in the context of the EU's Horizon EDEN2020 project. The prospect of automatically computing trajectory plans relying on sophisticated newly engineered steerable devices represents a breakthrough in the field of microsurgical robotics. By tailoring the paths according to single-patient anatomical constraints, as defined by advanced preoperative neuroimaging including diffusion MR tractography, this planner ensures a higher level of safety than the standard rectilinear approach. Ten healthy controls underwent Magnetic Resonance Imaging (MRI) on 3T scanner, including 3DT1-weighted sequences, 3Dhigh-resolution time-of-flight MR angiography (TOF-MRA) and high angular resolution diffusion MR sequences. A probabilistic q-ball residual-bootstrap MR tractography algorithm was used to reconstruct motor fibers, while the other deep gray matter nuclei surrounding STN and vessels were segmented on T1 and TOF-MRA images, respectively. These structures were labeled as obstacles. The reliability of the automated planner was evaluated; CTs were compared to RTs in terms of efficacy and safety. Targeting the anterior STN, CTs performed significantly better in maximizing the minimal distance from critical structures, by finding a tuned balance between all obstacles. Moreover, CTs resulted superior in reaching the center of mass (COM) of STN, as well as in optimizing the entry angle in STN and in the skull surface.
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Affiliation(s)
- Alice Segato
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Valentina Pieri
- Neuroradiology Unit and CERMAC, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Favaro
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Marco Riva
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy.,Unit of Oncological Neurosurgery, Humanitas Research Hospital, Rozzano, Italy
| | - Andrea Falini
- Neuroradiology Unit and CERMAC, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Antonella Castellano
- Neuroradiology Unit and CERMAC, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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6
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Quintero JE, Ai Y, Andersen AH, Hardy P, Grondin R, Guduru Z, Gash DM, Gerhardt GA, Zhang Z. Validations of apomorphine-induced BOLD activation correlations in hemiparkinsonian rhesus macaques. NEUROIMAGE-CLINICAL 2019; 22:101724. [PMID: 30822717 PMCID: PMC6396014 DOI: 10.1016/j.nicl.2019.101724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 02/08/2019] [Accepted: 02/16/2019] [Indexed: 11/27/2022]
Abstract
Identification of Parkinson's disease at the earliest possible stage of the disease may provide the best opportunity for the use of disease modifying treatments. However, diagnosing the disease during the pre-symptomatic period remains an unmet goal. To that end, we used pharmacological MRI (phMRI) to assess the function of the cortico-basal ganglia circuit in a non-human primate model of dopamine deficiency to determine the possible relationships between phMRI signals with behavioral, neurochemical, and histological measurements. Animals with unilateral treatments with the neurotoxin, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), that expressed stable, long-term hemiparkinsonism were challenged with the dopaminergic receptor agonist, apomorphine, and structure-specific phMRI blood oxygen level-dependent (BOLD) activation responses were measured. Behavioral, histopathological, and neurochemical measurements were obtained and correlated with phMRI activation of structures of the cortico-basal ganglia system. Greater phMRI activations in the basal ganglia and cortex were associated with slower movement speed, decreased daytime activity, or more pronounced parkinsonian features. Animals showed decreased stimulus-evoked dopamine release in the putamen and substantia nigra pars compacta and lower basal glutamate levels in the motor cortex on the MPTP-lesioned hemisphere compared to the contralateral hemisphere. The altered neurochemistry was significantly correlated with phMRI signals in the motor cortex and putamen. Finally, greater phMRI activations in the caudate nucleus correlated with fewer tyrosine hydroxylase-positive (TH+) nigral cells and decreased TH+ fiber density in the putamen. These results reveal the correlation of phMRI signals with the severity of the motor deficits and pathophysiological changes in the cortico-basal ganglia circuit. Apomorphine in hemiparkinsonian animals can evoke changes in functional MRI signals. Cortico-basal ganglia activation correlates to behavior, neurochemistry, histology Pharmacological MRI has potential to be biomarker for Parkinson's disease.
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Affiliation(s)
- J E Quintero
- Department of Neuroscience, University of Kentucky Chandler Medical Center, Lexington, KY 40536-0098, USA
| | - Yi Ai
- Department of Neuroscience, University of Kentucky Chandler Medical Center, Lexington, KY 40536-0098, USA
| | - A H Andersen
- Department of Neuroscience, University of Kentucky Chandler Medical Center, Lexington, KY 40536-0098, USA; Magnetic Resonance Imaging and Spectroscopy Center, University of Kentucky Chandler Medical Center, Lexington, KY 40536-0098, USA
| | - P Hardy
- Magnetic Resonance Imaging and Spectroscopy Center, University of Kentucky Chandler Medical Center, Lexington, KY 40536-0098, USA
| | - R Grondin
- Department of Neuroscience, University of Kentucky Chandler Medical Center, Lexington, KY 40536-0098, USA
| | - Z Guduru
- Department of Neurology, University of Kentucky Chandler Medical Center, Lexington, KY 40536-0098, USA
| | - D M Gash
- Department of Neuroscience, University of Kentucky Chandler Medical Center, Lexington, KY 40536-0098, USA
| | - G A Gerhardt
- Department of Neuroscience, University of Kentucky Chandler Medical Center, Lexington, KY 40536-0098, USA
| | - Z Zhang
- Department of Neuroscience, University of Kentucky Chandler Medical Center, Lexington, KY 40536-0098, USA.
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Landolt HP, Holst SC, Valomon A. Clinical and Experimental Human Sleep-Wake Pharmacogenetics. Handb Exp Pharmacol 2019; 253:207-241. [PMID: 30443785 DOI: 10.1007/164_2018_175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sleep and wakefulness are highly complex processes that are elegantly orchestrated by fine-tuned neurochemical changes among neuronal and non-neuronal ensembles, nuclei, and networks of the brain. Important neurotransmitters and neuromodulators regulating the circadian and homeostatic facets of sleep-wake physiology include melatonin, γ-aminobutyric acid, hypocretin, histamine, norepinephrine, serotonin, dopamine, and adenosine. Dysregulation of these neurochemical systems may cause sleep-wake disorders, which are commonly classified into insomnia disorder, parasomnias, circadian rhythm sleep-wake disorders, central disorders of hypersomnolence, sleep-related movement disorders, and sleep-related breathing disorders. Sleep-wake disorders can have far-reaching consequences on physical, mental, and social well-being and health and, thus, need be treated with effective and rational therapies. Apart from behavioral (e.g., cognitive behavioral therapy for insomnia), physiological (e.g., chronotherapy with bright light), and mechanical (e.g., continuous positive airway pressure treatment of obstructive sleep apnea) interventions, pharmacological treatments often are the first-line clinical option to improve disturbed sleep and wake states. Nevertheless, not all patients respond to pharmacotherapy in uniform and beneficial fashion, partly due to genetic differences. The improved understanding of the neurochemical mechanisms regulating sleep and wakefulness and the mode of action of sleep-wake therapeutics has provided a conceptual framework, to search for functional genetic variants modifying individual drug response phenotypes. This article will summarize the currently known genetic polymorphisms that modulate drug sensitivity and exposure, to partly determine individual responses to sleep-wake pharmacotherapy. In addition, a pharmacogenetic strategy will be outlined how based upon classical and opto-/chemogenetic strategies in animals, as well as human genetic associations, circuit mechanisms regulating sleep-wake functions in humans can be identified. As such, experimental human sleep-wake pharmacogenetics forms a bridge spanning basic research and clinical medicine and constitutes an essential step for the search and development of novel sleep-wake targets and therapeutics.
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Affiliation(s)
- Hans-Peter Landolt
- Institute of Pharmacology and Toxicology, University of Zürich, Zürich, Switzerland.
- Zürich Center for Interdisciplinary Sleep Research (ZiS), University of Zürich, Zürich, Switzerland.
| | - Sebastian C Holst
- Neurobiology Research Unit and Neuropharm, Department of Neurology, Rigshospitalet, Copenhagen, Denmark
| | - Amandine Valomon
- Wisconsin Institute for Sleep and Consciousness, University of Wisconsin Madison, Madison, WI, USA
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Pirker S, Perju-Dumbrava L, Kovacs GG, Traub-Weidinger T, Pirker W. Progressive Dopamine Transporter Binding Loss in Autopsy-Confirmed Corticobasal Degeneration. JOURNAL OF PARKINSONS DISEASE 2016; 5:907-12. [PMID: 26485425 DOI: 10.3233/jpd-150625] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Corticobasal degeneration (CBD) is characterized by neuronal and glial deposition of 4-repeat tau in the frontal and parietal cerebral cortex, white matter and striatum. There is neuronal loss in affected cortical regions and in the substantia nigra (SN). Recent single photon emission tomography (SPECT) studies have reported normal striatal dopamine transporter (DAT) binding in individual patients with CBD. OBJECTIVE To study the pattern and course of DAT binding loss in CBD. METHODS We retrospectively analyzed DAT SPECT studies in two patients presenting with a corticobasal syndrome in whom a diagnosis of CBD was later confirmed pathologically. RESULTS Baseline scans at 1.5 years after symptom onset revealed only mild abnormalities (reduced uptake in one putamen). Follow up scans at 4.5 years (Case 1) and 5 years (Case 2) after symptom onset showed a marked decline of striatal DAT binding. In both cases, there was a 37% binding reduction from the age-expected striatal binding value. Asymmetry of striatal DAT binding had increased from mild in the first SPECT studies to moderate at the time of their final imaging. CONCLUSION CBD patients can have delayed neuronal loss in the SN. Follow up DAT imaging may be of value in patients with possible CBD and a normal baseline scan.
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Affiliation(s)
- Susanne Pirker
- 2nd Neurological Department, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
| | | | - Gabor G Kovacs
- Institute of Neurology, Medical University of Vienna, Austria
| | - Tatiana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Walter Pirker
- Department of Neurology, Wilhelminenspital, Vienna, Austria
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Yang PH, Zhu JX, Huang YD, Zhang XY, Lei P, Bush AI, Xiang Q, Su ZJ, Zhang QH. Human Basic Fibroblast Growth Factor Inhibits Tau Phosphorylation via the PI3K/Akt-GSK3β Signaling Pathway in a 6-Hydroxydopamine-Induced Model of Parkinson's Disease. NEURODEGENER DIS 2016; 16:357-69. [PMID: 27228974 DOI: 10.1159/000445871] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/29/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Basic fibroblast growth factor (bFGF) has been increasingly investigated due to its neuroprotection in neurodegenerative disorders. Because there are still no cures for any of these disorders, it is crucial to identify new therapeutic targets and screen potential drugs. The increased phosphorylation of tau at Ser396 leads to intracellular tau accumulation, which forms neurofibrillary tangles in Parkinson's disease (PD). In this study, neuroprotection by bFGF was observed, and the mechanisms related to its regulation of phosphorylated tau were investigated. METHODS bFGF-loaded liposome carriers were intranasally administered to rats. The neuroprotective effects of bFGF were assessed in a PD model induced by 6-hydroxydopamine (6-OHDA) in vivo and in vitro. The phosphorylation of tau was measured, and the PI3K/Akt-GSK3β signaling pathway was investigated. RESULTS Our study demonstrated that liposomes markedly assisted in the delivery of bFGF to the striatum and substantia nigra of rats and enhanced the neuroprotective effects of bFGF on dopaminergic neurons. bFGF treatment significantly ameliorated the behavioral deficits induced by 6-OHDA, rescued the loss of tyrosine hydroxylase-positive neurons and increased the number of Nissl bodies. bFGF reduced the phosphorylation of tau and GSK3β and increased the phosphorylation of PI3K/Akt. CONCLUSION Liposomes markedly assisted in the delivery of bFGF to the brain and enhanced the neuroprotective effects of bFGF by inhibiting the phosphorylation of tau. bFGF down-regulated the phosphorylation of tau by increasing the phosphorylation of GSK3β via the PI3K/Akt signaling pathway. These findings provide a new vision of bFGF as a potential therapy for PD.
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Affiliation(s)
- Peng-Hui Yang
- Institute of Biomedicine and National Engineering Research Center of Genetic Medicine, Jinan University, Guangzhou, China
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Abstract
The difficulty to understand, diagnose, and treat neurological disorders stems from the great complexity of the central nervous system on different levels of physiological granularity. The individual components, their interactions, and dynamics involved in brain development and function can be represented as molecular, cellular, or functional networks, where diseases are perturbations of networks. These networks can become a useful research tool in investigating neurological disorders if they are properly tailored to reflect corresponding mechanisms. Here, we review approaches to construct networks specific for neurological disorders describing disease-related pathology on different scales: the molecular, cellular, and brain level. We also briefly discuss cross-scale network analysis as a necessary integrator of these scales.
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Rodriguez-Porcel F, Jamali S, Duker AP, Espay AJ. Dopamine transporter scanning in the evaluation of patients with suspected Parkinsonism: a case-based user’s guide. Expert Rev Neurother 2015; 16:23-9. [DOI: 10.1586/14737175.2015.1120160] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Abstract
Single photon emission computed tomography (SPECT) or positron emission computed tomography (PET) imaging agents for neurodegenerative diseases have a significant impact on clinical diagnosis and patient care. The examples of Parkinson's Disease (PD) and Alzheimer's Disease (AD) imaging agents described in this paper provide a general view on how imaging agents, i.e. radioactive drugs, are selected, chemically prepared and applied in humans. Imaging the living human brain can provide unique information on the pathology and progression of neurodegenerative diseases, such as AD and PD. The imaging method will also facilitate preclinical and clinical trials of new drugs offering specific information related to drug binding sites in the brain. In the future, chemists will continue to play important roles in identifying specific targets, synthesizing target-specific probes for screening and ultimately testing them by in vitro and in vivo assays.
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Affiliation(s)
- Lin Zhu
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.
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Shah M, Seibyl J, Cartier A, Bhatt R, Catafau AM. Molecular Imaging Insights into Neurodegeneration: Focus on α-Synuclein Radiotracers. J Nucl Med 2014; 55:1397-400. [DOI: 10.2967/jnumed.113.136515] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Louis ED. 'Essential tremor' or 'the essential tremors': is this one disease or a family of diseases? Neuroepidemiology 2013; 42:81-9. [PMID: 24335621 DOI: 10.1159/000356351] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 10/10/2013] [Indexed: 12/14/2022] Open
Abstract
There is accumulating evidence that the entity referred to as 'essential tremor' (ET) is not a single disease. It may be a family of diseases better referred to as 'the ETs'. This review will summarize the following evidence: (1) the presence of etiological heterogeneity; (2) the heterogeneity of findings in postmortem studies, thus suggesting several diseases; (3) the recent discussion that age of onset may be an important marker of disease heterogeneity; (4) the clinical expansion of the concept of ET in recent years to include a broader range of tremor phenomenology, other motor features (gait ataxia), other involuntary movements (dystonia), and nonmotor features (cognitive problems, psychiatric problems), some of which could be primary; (5) the heterogeneity of pharmacological response profiles and clinical progression, and (6) the association of ET with Parkinson's disease, Alzheimer's disease, and possibly progressive supranuclear palsy, with the possibility that some ET patients are more predisposed to develop one of these. © 2013 S. Karger AG, Basel.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, N.Y., USA
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Bajaj N, Hauser RA, Grachev ID. Clinical utility of dopamine transporter single photon emission CT (DaT-SPECT) with (123I) ioflupane in diagnosis of parkinsonian syndromes. J Neurol Neurosurg Psychiatry 2013; 84:1288-95. [PMID: 23486993 PMCID: PMC3812862 DOI: 10.1136/jnnp-2012-304436] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The diagnosis of movement disorders including Parkinson's disease (PD) and essential tremor is determined through clinical assessment. The difficulty with diagnosis of early PD has been highlighted in several recent clinical trials. Studies have suggested relatively high clinical diagnostic error rates for PD and essential tremor. This review was undertaken to clarify the utility of DaT-SPECT imaging with ((123)I)ioflupane (DaTSCAN or DaTscan or ((123)I)FP-CIT) in assisting practitioners in their clinical decision making by visualising the dopamine transporter in parkinsonian cases. In some patients with suspected parkinsonian syndromes, SPECT imaging with ((123)I)ioflupane is useful to assist in the diagnosis and to help guide prognosis and treatment decisions, including avoiding medications that are unlikely to provide benefit. Clinicians ordering ((123)I)ioflupane SPECT should be aware of its limitations and pitfalls and should order scans when there is diagnostic uncertainty or when the scan will be helpful in clinical decision making.
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Affiliation(s)
- Nin Bajaj
- Department of Clinical Neurology, National Parkinson's Foundation International Centre of Excellence, Nottingham University Hospitals NHS Trust and University of Nottingham, , Nottingham, UK
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Ramos-Cabrer P, Campos F. Liposomes and nanotechnology in drug development: focus on neurological targets. Int J Nanomedicine 2013; 8:951-60. [PMID: 23486739 PMCID: PMC3592553 DOI: 10.2147/ijn.s30721] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Neurological diseases represent a medical, social, and economic problem of paramount importance in developed countries. Although their etiology is generally known, developing therapeutic interventions for the central nervous system is challenging due to the impermeability of the blood-brain barrier. Thus, the fight against neurological diseases usually struggles "at the gates" of the brain. Flooding the bloodstream with drugs, where only a minor fraction reaches its target therapeutic site, is an inefficient, expensive, and dangerous procedure, because of the risk of side effects at nontargeted sites. Currently, advances in the field of nanotechnology have enabled development of a generation of multifunctional molecular platforms that are capable of transporting drugs across the blood-brain barrier, targeting specific cell types or functional states within the brain, releasing drugs in a controlled manner, and enabling visualization of processes in vivo using conventional imaging systems. The marriage between drug delivery and molecular imaging disciplines has resulted in a relatively new discipline, known as theranostics, which represents the basis of the concept of personalized medicine. In this study, we review the concepts of the blood-brain barrier and the strategies used to traverse/bypass it, the role of nanotechnology in theranostics, the wide range of nanoparticles (with emphasis on liposomes) that can be used as stealth drug carriers, imaging probes and targeting devices for the treatment of neurological diseases, and the targets and targeting strategies envisaged in the treatment of different types of brain pathology.
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Affiliation(s)
- Pedro Ramos-Cabrer
- Clinical Neurosciences Research Laboratory, Department of Neurology, Hospital Clínico Universitario de Santiago, University of Santiago de Compostela, Health Research Institute of Santiago, Santiago de Compostela, Spain.
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Mountz JM. Guest editorial: the future of nuclear medicine in the management of CNS diseases. Semin Nucl Med 2012; 42:354-5. [PMID: 23026358 DOI: 10.1053/j.semnuclmed.2012.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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