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Shokouhi S, Campbell D, Brill AB, Gwirtsman HE. Longitudinal Positron Emission Tomography in Preventive Alzheimer's Disease Drug Trials, Critical Barriers from Imaging Science Perspective. Brain Pathol 2018; 26:664-71. [PMID: 27327527 PMCID: PMC5958602 DOI: 10.1111/bpa.12399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/16/2016] [Indexed: 12/30/2022] Open
Abstract
Recent Alzheimer's trials have recruited cognitively normal people at risk for Alzheimer's dementia. Due to the lack of clinical symptoms in normal population, conventional clinical outcome measures are not suitable for these early trials. While several groups are developing new composite cognitive tests that could serve as potential outcome measures by detecting subtle cognitive changes in normal people, there is a need for longitudinal brain imaging techniques that can correlate with temporal changes in these new tests and provide additional objective measures of neuropathological changes in brain. Positron emission tomography (PET) is a nuclear medicine imaging procedure based on the measurement of annihilation photons after positron emission from radiolabeled molecules that allow tracking of biological processes in body, including the brain. PET is a well-established in vivo imaging modality in Alzheimer's disease diagnosis and research due to its capability of detecting abnormalities in three major hallmarks of this disease. These include (1) amyloid beta plaques; (2) neurofibrillary tau tangles and (3) decrease in neuronal activity due to loss of nerve cell connection and death. While semiquantitative PET imaging techniques are commonly used to set discrete cut-points to stratify abnormal levels of amyloid accumulation and neurodegeneration, they are suboptimal for detecting subtle longitudinal changes. In this study, we have identified and discussed four critical barriers in conventional longitudinal PET imaging that may be particularly relevant for early Alzheimer's disease studies. These include within and across subject heterogeneity of AD-affected brain regions, PET intensity normalization, neuronal compensations in early disease stages and cerebrovascular amyloid deposition.
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Affiliation(s)
- Sepideh Shokouhi
- Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center
| | - Desmond Campbell
- Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center
| | - Aaron B Brill
- Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center
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Hosokawa C, Ishii K, Kimura Y, Hyodo T, Hosono M, Sakaguchi K, Usami K, Shimamoto K, Yamazoe Y, Murakami T. Performance of 11C-Pittsburgh Compound B PET Binding Potential Images in the Detection of Amyloid Deposits on Equivocal Static Images. J Nucl Med 2015; 56:1910-5. [DOI: 10.2967/jnumed.115.156414] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 08/31/2015] [Indexed: 11/16/2022] Open
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Femminella GD, Edison P. Evaluation of neuroprotective effect of glucagon-like peptide 1 analogs using neuroimaging. Alzheimers Dement 2014; 10:S55-61. [PMID: 24529526 DOI: 10.1016/j.jalz.2013.12.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 12/05/2013] [Indexed: 11/16/2022]
Abstract
There is increasing evidence to suggest that glucagon-like peptide 1 (GLP1) analogs are neuroprotective in animal models. In transgenic mice, both insulin and GLP1 analogs reduced inflammation, increased stem cell proliferation, reduced apoptosis, and increased dendritic growth. Furthermore, insulin desensitization was also observed in these animals, and reduced glucose uptake in the brain, as shown on FDG-PET imaging. In this review we discussed the role of PET and MRI in evaluating the effect of GLP1 analogs in disease progression in both Alzheimer's and Parkinson's disease. We have also discussed the potential novel PET markers that will allow us to understand the mechanism by which GLP1 exerts its effects.
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Affiliation(s)
- Grazia D Femminella
- Neurology Imaging Unit, Imperial College London, Hammersmith Campus, London, UK
| | - Paul Edison
- Neurology Imaging Unit, Imperial College London, Hammersmith Campus, London, UK.
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Rinne JO, Frantzen J, Leinonen V, Lonnrot K, Laakso A, Virtanen KA, Solin O, Kotkansalo A, Koivisto A, Sajanti J, Karppinen A, Lehto H, Rummukainen J, Buckley C, Smith A, Jones PA, Sherwin P, Farrar G, McLain R, Kailajarvi M, Grachev ID. Prospective flutemetamol positron emission tomography and histopathology in normal pressure hydrocephalus. NEURODEGENER DIS 2013; 13:237-45. [PMID: 24296542 DOI: 10.1159/000355256] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/23/2013] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED BACKGOUND/OBJECTIVE: To determine the level of association between uptake of the amyloid positron emission tomography (PET) imaging agent [(18)F]flutemetamol and the level of amyloid-β measured by immunohistochemical and histochemical staining in a frontal cortical region biopsy site. METHODS Seventeen patients with probable normal pressure hydrocephalus (NPH) underwent prospective [(18)F]flutemetamol PET and subsequent frontal cortical brain biopsy during ventriculoperitoneal shunting. Tissue amyloid-β was evaluated using the monoclonal antibody 4G8, thioflavin S and Bielschowsky silver stain. RESULTS Four of the 17 patients (23.5%) had amyloid-β pathology based on the overall pathology read and also showed increased [(18)F]flutemetamol uptake. [(18)F]Flutemetamol standardized uptake values from the biopsy site were significantly associated with biopsy specimen amyloid-β levels (Pearson's r = 0.67; p = 0.006). There was also good correlation between the biopsy specimen amyloid-β level and uptake of [(18)F]flutemetamol in the region contralateral to the biopsy site (r = 0.67; p = 0.006), as well as with composite cortical [(18)F]flutemetamol uptake (r = 0.65; p = 0.008). The blinded visual read showed a high level of agreement between all readers (κ = 0.88). Two of 3 readers were in full agreement on all images; 1 reader disagreed on 1 of the 17 NPH cases. Blinded visual assessments of PET images by 1 reader were associated with 100% sensitivity to the overall pathology read, and assessments by the 2 others were associated with 75% sensitivity (overall sensitivity by majority read was 75%); specificity of all readers was 100%. CONCLUSIONS [(18)F]Flutemetamol detects brain amyloid-β in vivo and shows promise as a valuable tool to study and possibly facilitate diagnosis of Alzheimer's disease both in patients with suspected NPH and among the wider population.
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Affiliation(s)
- Juha O Rinne
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
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Chételat G, La Joie R, Villain N, Perrotin A, de La Sayette V, Eustache F, Vandenberghe R. Amyloid imaging in cognitively normal individuals, at-risk populations and preclinical Alzheimer's disease. Neuroimage Clin 2013; 2:356-65. [PMID: 24179789 PMCID: PMC3777672 DOI: 10.1016/j.nicl.2013.02.006] [Citation(s) in RCA: 253] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/10/2013] [Accepted: 02/23/2013] [Indexed: 01/18/2023]
Abstract
Recent developments of PET amyloid ligands have made it possible to visualize the presence of Aβ deposition in the brain of living participants and to assess the consequences especially in individuals with no objective sign of cognitive deficits. The present review will focus on amyloid imaging in cognitively normal elderly, asymptomatic at-risk populations, and individuals with subjective cognitive decline. It will cover the prevalence of amyloid-positive cases amongst cognitively normal elderly, the influence of risk factors for AD, the relationships to cognition, atrophy and prognosis, longitudinal amyloid imaging and ethical aspects related to amyloid imaging in cognitively normal individuals. Almost ten years of research have led to a few consensual and relatively consistent findings: some cognitively normal elderly have Aβ deposition in their brain, the prevalence of amyloid-positive cases increases in at-risk populations, the prognosis for these individuals is worse than for those with no Aβ deposition, and significant increase in Aβ deposition over time is detectable in cognitively normal elderly. More inconsistent findings are still under debate; these include the relationship between Aβ deposition and cognition and brain volume, the sequence and cause-to-effect relations between the different AD biomarkers, and the individual outcome associated with an amyloid positive versus negative scan. Preclinical amyloid imaging also raises important ethical issues. While amyloid imaging is definitely useful to understand the role of Aβ in early stages, to define at-risk populations for research or for clinical trial, and to assess the effects of anti-amyloid treatments, we are not ready yet to translate research results into clinical practice and policy. More researches are needed to determine which information to disclose from an individual amyloid imaging scan, the way of disclosing such information and the impact on individuals and on society.
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Affiliation(s)
- Gaël Chételat
- INSERM, U1077 Caen, France
- Université de Caen Basse-Normandie, UMR-S1077, Caen, France
- Ecole Pratique des Hautes Etudes, UMR-S1077, Caen, France
- CHU de Caen, U1077 Caen, France
| | - Renaud La Joie
- INSERM, U1077 Caen, France
- Université de Caen Basse-Normandie, UMR-S1077, Caen, France
- Ecole Pratique des Hautes Etudes, UMR-S1077, Caen, France
- CHU de Caen, U1077 Caen, France
| | - Nicolas Villain
- INSERM, U1077 Caen, France
- Université de Caen Basse-Normandie, UMR-S1077, Caen, France
- Ecole Pratique des Hautes Etudes, UMR-S1077, Caen, France
- CHU de Caen, U1077 Caen, France
| | - Audrey Perrotin
- INSERM, U1077 Caen, France
- Université de Caen Basse-Normandie, UMR-S1077, Caen, France
- Ecole Pratique des Hautes Etudes, UMR-S1077, Caen, France
- CHU de Caen, U1077 Caen, France
| | - Vincent de La Sayette
- INSERM, U1077 Caen, France
- Université de Caen Basse-Normandie, UMR-S1077, Caen, France
- Ecole Pratique des Hautes Etudes, UMR-S1077, Caen, France
- CHU de Caen, U1077 Caen, France
- CHU de Caen, Service de Neurologie, Caen, France
| | - Francis Eustache
- INSERM, U1077 Caen, France
- Université de Caen Basse-Normandie, UMR-S1077, Caen, France
- Ecole Pratique des Hautes Etudes, UMR-S1077, Caen, France
- CHU de Caen, U1077 Caen, France
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, University of Leuven, Belgium
- Neurology Department, University Hospitals Leuven, Belgium
- Alzheimer Research Centre KU Leuven, Leuven Institute of Neuroscience and Disease, University of Leuven, Belgium
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Leinonen V, Rinne JO, Virtanen KA, Eskola O, Rummukainen J, Huttunen J, von und zu Fraunberg M, Nerg O, Koivisto AM, Rinne J, Jääskeläinen JE, Buckley C, Smith A, Jones PA, Sherwin P, Farrar G, McLain R, Kailajärvi M, Heurling K, Grachev ID. Positron emission tomography with [18F]flutemetamol and [11C]PiB forin vivodetection of cerebral cortical amyloid in normal pressure hydrocephalus patients. Eur J Neurol 2013; 20:1043-52. [DOI: 10.1111/ene.12102] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 12/17/2012] [Indexed: 01/31/2023]
Affiliation(s)
- V. Leinonen
- Department of Neurosurgery; KUH NeuroCenter; Kuopio University Hospital and Neurosurgery; Institute of Clinical Medicine; University of Eastern Finland; Kuopio Finland
| | - J. O. Rinne
- Turku PET Centre; University of Turku; Turku University Hospital; Turku Finland
- Department of Neurology; Turku University Hospital; Turku Finland
| | - K. A. Virtanen
- Turku PET Centre; University of Turku; Turku University Hospital; Turku Finland
| | - O. Eskola
- Turku PET Centre; University of Turku; Turku University Hospital; Turku Finland
| | - J. Rummukainen
- Department of Pathology; Kuopio University Hospital; Kuopio Finland
| | - J. Huttunen
- Department of Neurosurgery; KUH NeuroCenter; Kuopio University Hospital and Neurosurgery; Institute of Clinical Medicine; University of Eastern Finland; Kuopio Finland
| | - M. von und zu Fraunberg
- Department of Neurosurgery; KUH NeuroCenter; Kuopio University Hospital and Neurosurgery; Institute of Clinical Medicine; University of Eastern Finland; Kuopio Finland
| | - O. Nerg
- Department of Neurology; KUH NeuroCenter; Kuopio University Hospital; Kuopio Finland
- Unit of Neurology; Institute of Clinical Medicine; University of Eastern Finland; Kuopio Finland
| | - A. M. Koivisto
- Department of Neurology; KUH NeuroCenter; Kuopio University Hospital; Kuopio Finland
- Unit of Neurology; Institute of Clinical Medicine; University of Eastern Finland; Kuopio Finland
| | - J. Rinne
- Department of Neurosurgery; KUH NeuroCenter; Kuopio University Hospital and Neurosurgery; Institute of Clinical Medicine; University of Eastern Finland; Kuopio Finland
| | - J. E. Jääskeläinen
- Department of Neurosurgery; KUH NeuroCenter; Kuopio University Hospital and Neurosurgery; Institute of Clinical Medicine; University of Eastern Finland; Kuopio Finland
| | - C. Buckley
- Medical Diagnostics; GE Healthcare; Amersham UK
| | - A. Smith
- Medical Diagnostics; GE Healthcare; Amersham UK
| | - P. A. Jones
- Medical Diagnostics; GE Healthcare; Amersham UK
| | - P. Sherwin
- Medical Diagnostics; GE Healthcare; Princeton NJ USA
| | - G. Farrar
- Medical Diagnostics; GE Healthcare; Amersham UK
| | - R. McLain
- PFP Statistical Consulting, LLC; Livonia MI USA
| | | | - K. Heurling
- Medical Diagnostics; GE Healthcare; Uppsala Sweden
| | - I. D. Grachev
- Medical Diagnostics; GE Healthcare; Princeton NJ USA
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[(18)F]Flutemetamol PET imaging and cortical biopsy histopathology for fibrillar amyloid β detection in living subjects with normal pressure hydrocephalus: pooled analysis of four studies. Acta Neuropathol 2012; 124:833-45. [PMID: 23053137 DOI: 10.1007/s00401-012-1051-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 09/26/2012] [Accepted: 09/28/2012] [Indexed: 02/03/2023]
Abstract
Molecular imaging techniques developed to 'visualize' amyloid in vivo represent a major achievement in Alzheimer's disease (AD) research. This pooled analysis of four studies determined the level of association between uptake of the fibrillar amyloid β positron emission tomography (PET) imaging agent [(18)F]flutemetamol (Pittsburgh Compound B analog with a 5.5 times longer half-life to enable it to be used in the clinical setting) and neuritic plaques and fibrillar amyloid β measured by pathologic staining of cortical region biopsy samples. Fifty-two patients with suspected normal pressure hydrocephalus underwent prospective (n = 30) or retrospective (n = 22) [(18)F]flutemetamol PET imaging for detection of cerebral cortical fibrillar amyloid β and cortical brain biopsy during intracranial pressure measurement or ventriculo-peritoneal shunting. [(18)F]Flutemetamol uptake was quantified using standardized uptake value ratio (SUVR) with cerebellar cortex as the reference region. Tissue fibrillar amyloid β was evaluated using immunohistochemical monoclonal antibody 4G8 and histochemical agents Thioflavin S and Bielschowsky silver stain, and an overall pathology result based on all available immunohistochemical and histochemical results. Biopsy site and contralateral [(18)F]flutemetamol SUVRs were significantly associated with neuritic plaque burden assessed with Bielschowsky silver stain (r (spearman's) = 0.61, p = 0.0001 for both), as was the composite SUVR with biopsy pathology (r (spearman's) = 0.74, p < 0.0001). SUVR and immunohistochemical results with 4G8 for detecting fibrillar amyloid β were similar. Blinded image evaluation showed strong agreement between readers (κ = 0.86). Overall sensitivity and specificity by majority read were 93 and 100 %. Noninvasive in vivo [(18)F]flutemetamol PET imaging demonstrates strong concordance with histopathology for brain fibrillar amyloid β, supporting its promise as a tool to assist physicians with earlier detection of the disease process and making diagnostic decisions about concomitant AD and other diseases associated with brain amyloidosis.
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