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Høilund-Carlsen PF, Alavi A. Aducanumab (Marketed as Aduhelm) Approval Is Likely Based on Misinterpretation of PET Imaging Data. J Alzheimers Dis 2021; 84:1457-1460. [PMID: 34657891 DOI: 10.3233/jad-215275] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
According to the FDA, aducanumab (Aduhelm), the recently approved anti-Alzheimer drug, reduces the level of cerebral amyloid plaques-a hallmark finding in patients with Alzheimer's disease-and this will result in a reduction in clinical decline. The authors of this article are not convinced that amyloid deposits are a hallmark of Alzheimer's disease and are of the opinion that the apparent reduction in amyloid accumulation following aducanumab treatment is likely instead a result of continued and advanced cerebral cell death and, thus, not a sign of improvement but of an even more advanced disease.
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Affiliation(s)
- Poul F Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Borja AJ, Hancin EC, Zhang V, Koa B, Bhattaru A, Rojulpote C, Detchou DK, Aly M, Kaghazchi F, Gerke O, Patil S, Gonuguntla K, Werner TJ, Revheim ME, Høilund-Carlsen PF, Alavi A. Global brain glucose uptake on 18F-FDG-PET/CT is influenced by chronic cardiovascular risk. Nucl Med Commun 2020; 42:444-450. [PMID: 33323870 DOI: 10.1097/mnm.0000000000001349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The goal of this study was to assess global cerebral glucose uptake in subjects with known cardiovascular risk factors by employing a quantitative 18F-fluorodeoxyglucose-PET/computed tomography (FDG-PET/CT) technique. We hypothesized that at-risk subjects would demonstrate decreased global brain glucose uptake compared to healthy controls. METHODS We compared 35 healthy male controls and 14 male subjects at increased risk for cardiovascular disease (CVD) as assessed by the systematic coronary risk evaluation (SCORE) tool. All subjects were grouped into two age-matched cohorts: younger (<50 years) and older (≥50 years). The global standardized uptake value mean (Avg SUVmean) was measured by mapping regions of interest of the entire brain across the supratentorial structures and cerebellum. Wilcoxon's rank-sum test was used to assess the differences in Avg SUVmean between controls and at-risk subjects. RESULTS Younger subjects demonstrated higher brain Avg SUVmean than older subjects. In addition, in both age strata, the 10-year risk for fatal CVD according to the SCORE tool was significantly greater in the at-risk groups than in healthy controls (younger: P = 0.0304; older: P = 0.0436). In the younger cohort, at-risk subjects demonstrated significantly lower brain Avg SUVmean than healthy controls (P = 0.0355). In the older cohort, at-risk subjects similarly had lower Avg SUVmean than controls (P = 0.0343). CONCLUSIONS Global brain glucose uptake appears to be influenced by chronic cardiovascular risk factors. Therefore, FDG-PET/CT may play a role in determining the importance of CVD on brain function and has potential for monitoring the efficacy of various therapeutic interventions.
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Affiliation(s)
- Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania.,Perelman School of Medicine, University of Pennsylvania
| | - Emily C Hancin
- Department of Radiology, Hospital of the University of Pennsylvania.,Lewis Katz School of Medicine, Temple University
| | - Vincent Zhang
- Department of Radiology, Hospital of the University of Pennsylvania
| | - Benjamin Koa
- Department of Radiology, Hospital of the University of Pennsylvania.,Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Abhijit Bhattaru
- Department of Radiology, Hospital of the University of Pennsylvania
| | | | - Donald K Detchou
- Department of Radiology, Hospital of the University of Pennsylvania.,Perelman School of Medicine, University of Pennsylvania
| | - Mahmoud Aly
- Department of Radiology, Hospital of the University of Pennsylvania
| | | | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital.,Department of Clinical Research, Research Unit of Clinical Physiology and Nuclear Medicine, University of Southern Denmark, Odense, Denmark
| | - Shivaraj Patil
- Department of Radiology, Hospital of the University of Pennsylvania.,Department of Medicine, University of Connecticut, Hartford, Connecticut, USA
| | - Karthik Gonuguntla
- Department of Radiology, Hospital of the University of Pennsylvania.,Department of Medicine, University of Connecticut, Hartford, Connecticut, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania
| | - Mona-Elisabeth Revheim
- Division of Radiology and Nuclear Medicine, Oslo University Hospital.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Poul F Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital.,Department of Clinical Research, Research Unit of Clinical Physiology and Nuclear Medicine, University of Southern Denmark, Odense, Denmark
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania
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Takahata K, Kimura Y, Sahara N, Koga S, Shimada H, Ichise M, Saito F, Moriguchi S, Kitamura S, Kubota M, Umeda S, Niwa F, Mizushima J, Morimoto Y, Funayama M, Tabuchi H, Bieniek KF, Kawamura K, Zhang MR, Dickson DW, Mimura M, Kato M, Suhara T, Higuchi M. PET-detectable tau pathology correlates with long-term neuropsychiatric outcomes in patients with traumatic brain injury. Brain 2020; 142:3265-3279. [PMID: 31504227 DOI: 10.1093/brain/awz238] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 12/14/2022] Open
Abstract
Tau deposits is a core feature of neurodegenerative disorder following traumatic brain injury (TBI). Despite ample evidence from post-mortem studies demonstrating exposure to both mild-repetitive and severe TBIs are linked to tau depositions, associations of topology of tau lesions with late-onset psychiatric symptoms due to TBI have not been explored. To address this issue, we assessed tau deposits in long-term survivors of TBI by PET with 11C-PBB3, and evaluated those associations with late-life neuropsychiatric outcomes. PET data were acquired from 27 subjects in the chronic stage following mild-repetitive or severe TBI and 15 healthy control subjects. Among the TBI patients, 14 were diagnosed as having late-onset symptoms based on the criteria of traumatic encephalopathy syndrome. For quantification of tau burden in TBI brains, we calculated 11C-PBB3 binding capacity (cm3), which is a summed voxel value of binding potentials (BP*ND) multiplied by voxel volume. Main outcomes of the present study were differences in 11C-PBB3 binding capacity between groups, and the association of regional 11C-PBB3 binding capacity with neuropsychiatric symptoms. To confirm 11C-PBB3 binding to tau deposits in TBI brains, we conducted in vitro PBB3 fluorescence and phospho-tau antibody immunofluorescence labelling of brain sections of chronic traumatic encephalopathy obtained from the Brain Bank. Our results showed that patients with TBI had higher 11C-PBB3 binding capacities in the neocortical grey and white matter segments than healthy control subjects. Furthermore, TBI patients with traumatic encephalopathy syndrome showed higher 11C-PBB3 binding capacity in the white matter segment than those without traumatic encephalopathy syndrome, and regional assessments revealed that subgroup difference was also significant in the frontal white matter. 11C-PBB3 binding capacity in the white matter segment correlated with the severity of psychosis. In vitro assays demonstrated PBB3-positive tau inclusions at the depth of neocortical sulci, confirming 11C-PBB3 binding to tau lesions. In conclusion, increased 11C-PBB3 binding capacity is associated with late-onset neuropsychiatric symptoms following TBI, and a close correlation was found between psychosis and 11C-PBB3 binding capacity in the white matter.
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Affiliation(s)
- Keisuke Takahata
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Kimura
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Naruhiko Sahara
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, USA
| | - Hitoshi Shimada
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Masanori Ichise
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Fumie Saito
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Sho Moriguchi
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Soichiro Kitamura
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Department of Psychiatry, Nara Medical University, Nara, Japan
| | - Manabu Kubota
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Satoshi Umeda
- Department of Psychology, Keio University, Tokyo, Japan
| | - Fumitoshi Niwa
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Jin Mizushima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yoko Morimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Michitaka Funayama
- Department of Psychiatry, Japanese Red Cross Ashikaga Hospital, Ashikaga, Tochigi, Japan
| | - Hajime Tabuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | | | | | - Ming-Rong Zhang
- Department of Radiopharmaceuticals Development, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | | | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Motoichiro Kato
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuya Suhara
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Makoto Higuchi
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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Alavi A, Werner TJ, Høilund-Carlsen PF. Reply to: Clinical brain PET research must embrace multi-centre collaboration and data sharing or risk its demise: emphasis should also be placed on the critical role of image analysis schemes. Eur J Nucl Med Mol Imaging 2020; 47:1806-1807. [PMID: 32200402 DOI: 10.1007/s00259-020-04765-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Poul F Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, 5000, Odense C, Denmark
- Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Abstract
Temporal lobe epilepsy (TLE) is a prevalent neurodegenerative disease associated with various neuropsychiatric disorders and decreased quality of life. Much has been said about the use of fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG-PET), magnetic resonance imaging (MRI), and computed tomography in the qualitative assessment of TLE. However, research into the applications of quantitative measurements to treat and diagnose TLE is severely lacking in the literature. Global quantitative analysis using 18F-FDG-PET is a powerful tool in the metabolic assessment of TLE, and can more accurately identify seizure lateralization and the potential effects of treatment as compared with visual assessments and traditional biopsy region-of-interest quantification. Therefore, there is a pressing need to introduce these novel methods to the treatment of TLE. Although 18F-FDG-PET is most commonly used for visual assessments, qualitative analysis is associated with high levels of interobserver and intraobserver variability. Semiquantitative analysis using standardized uptake value is a more consistently accurate measure of the hypometabolic patterns seen in TLE patients. Novel methods of global quantitative analysis developed in our laboratory have the potential to improve TLE assessment by limiting variability and correcting for the partial volume effect. It is of great importance to adopt these techniques into the mainstream diagnosis and treatment of TLE in order to improve patient care worldwide.
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