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Merkel H, Lindner D, Gaber K, Ziganshyna S, Jentzsch J, Mucha S, Gerhards T, Sari S, Stock A, Vothel F, Falter L, Quäschling U, Hoffmann KT, Meixensberger J, Halama D, Richter C. Standardized Classification of Cerebral Vasospasm after Subarachnoid Hemorrhage by Digital Subtraction Angiography. J Clin Med 2022; 11:jcm11072011. [PMID: 35407619 PMCID: PMC9000178 DOI: 10.3390/jcm11072011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 02/05/2023] Open
Abstract
Background: During the last decade, cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) was a current research focus without a standardized classification in digital subtraction angiography (DSA). This study was performed to investigate a device-independent visual cerebral vasospasm classification for endovascular treatment. Methods: The analyses are DSA based rather than multimodal. Ten defined points of intracranial arteries were measured in 45 patients suffering from cerebral vasospasm after SAH at three time points (hospitalization, before spasmolysis, control after six months). Mathematical clustering of vessel diameters was performed to generate four objective grades for comparison. Six interventional neuroradiologists in two groups scored 237 DSAs after a new visual classification (grade 0–3) developed on a segmental pattern of vessel contraction. For the second group, a threshold-based criterion was amended. Results: The raters had a reproducibility of 68.4% in the first group and 75.2% in the second group. The complementary threshold-based criterion increased the reproducibility by about 6.8%, while the rating deviated more from the mathematical clustering in all grades. Conclusions: The proposed visual classification scheme of cerebral vasospasm is suitable as a standard grading procedure for endovascular treatment. There is no advantage of a threshold-based criterion that compensates for the effort involved. Automated vessel analysis is superior to compare inter-group results in research settings.
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Affiliation(s)
- Helena Merkel
- Department of Neuroradiology, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany; (H.M.); (J.J.); (S.M.); (T.G.); (L.F.); (U.Q.); (K.-T.H.)
| | - Dirk Lindner
- Department of Neurosurgery, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany; (D.L.); (K.G.); (J.M.)
| | - Khaled Gaber
- Department of Neurosurgery, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany; (D.L.); (K.G.); (J.M.)
| | - Svitlana Ziganshyna
- Department of Anaesthesiology, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany;
| | - Jennifer Jentzsch
- Department of Neuroradiology, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany; (H.M.); (J.J.); (S.M.); (T.G.); (L.F.); (U.Q.); (K.-T.H.)
| | - Simone Mucha
- Department of Neuroradiology, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany; (H.M.); (J.J.); (S.M.); (T.G.); (L.F.); (U.Q.); (K.-T.H.)
| | - Thilo Gerhards
- Department of Neuroradiology, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany; (H.M.); (J.J.); (S.M.); (T.G.); (L.F.); (U.Q.); (K.-T.H.)
| | - Sabine Sari
- Department of Neuroradiology, Giessen University Hospital, Klinikstraße 33, 35392 Giessen, Germany;
| | - Annika Stock
- Department of Neuroradiology, Würzburg University Hospital, Josef-Schneider-Straße 2, 97080 Würzburg, Germany;
| | - Felicitas Vothel
- Department of Radiology and Neuroradiology, Sana Hospital Borna, Rudolf-Virchow-Straße 2, 04552 Borna, Germany;
| | - Lea Falter
- Department of Neuroradiology, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany; (H.M.); (J.J.); (S.M.); (T.G.); (L.F.); (U.Q.); (K.-T.H.)
| | - Ulf Quäschling
- Department of Neuroradiology, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany; (H.M.); (J.J.); (S.M.); (T.G.); (L.F.); (U.Q.); (K.-T.H.)
| | - Karl-Titus Hoffmann
- Department of Neuroradiology, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany; (H.M.); (J.J.); (S.M.); (T.G.); (L.F.); (U.Q.); (K.-T.H.)
| | - Jürgen Meixensberger
- Department of Neurosurgery, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany; (D.L.); (K.G.); (J.M.)
| | - Dirk Halama
- Department of Oral and Maxillofacial Surgery, Leipzig University Hospital, Liebigstraße 12, 04103 Leipzig, Germany;
| | - Cindy Richter
- Department of Neuroradiology, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany; (H.M.); (J.J.); (S.M.); (T.G.); (L.F.); (U.Q.); (K.-T.H.)
- Correspondence: ; Tel.: +49-341-97-20196
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Grachev ID, Meyer PM, Becker GA, Bronzel M, Marsteller D, Pastino G, Voges O, Rabinovich L, Knebel H, Zientek F, Rullmann M, Sattler B, Patt M, Gerhards T, Strauss M, Kluge A, Brust P, Savola JM, Gordon MF, Geva M, Hesse S, Barthel H, Hayden MR, Sabri O. Sigma-1 and dopamine D2/D3 receptor occupancy of pridopidine in healthy volunteers and patients with Huntington disease: a [ 18F] fluspidine and [ 18F] fallypride PET study. Eur J Nucl Med Mol Imaging 2020; 48:1103-1115. [PMID: 32995944 PMCID: PMC8041674 DOI: 10.1007/s00259-020-05030-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/07/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Pridopidine is an investigational drug for Huntington disease (HD). Pridopidine was originally thought to act as a dopamine stabilizer. However, pridopidine shows highest affinity to the sigma-1 receptor (S1R) and enhances neuroprotection via the S1R in preclinical studies. Using [18F] fluspidine and [18F] fallypride PET, the purpose of this study was to assess in vivo target engagement/receptor occupancy of pridopidine to the S1R and dopamine D2/D3 receptor (D2/D3R) at clinical relevant doses in healthy volunteers (HVs) and as proof-of-concept in a small number of patients with HD. METHODS Using [18F] fluspidine PET (300 MBq, 0-90 min), 11 male HVs (pridopidine 0.5 to 90 mg; six dose groups) and three male patients with HD (pridopidine 90 mg) were investigated twice, without and 2 h after single dose of pridopidine. Using [18F] fallypride PET (200 MBq, 0-210 min), four male HVs were studied without and 2 h following pridopidine administration (90 mg). Receptor occupancy was analyzed by the Lassen plot. RESULTS S1R occupancy as function of pridopidine dose (or plasma concentration) in HVs could be described by a three-parameter Hill equation with a Hill coefficient larger than one. A high degree of S1R occupancy (87% to 91%) was found throughout the brain at pridopidine doses ranging from 22.5 to 90 mg. S1R occupancy was 43% at 1 mg pridopidine. In contrast, at 90 mg pridopidine, the D2/D3R occupancy was only minimal (~ 3%). CONCLUSIONS Our PET findings indicate that at clinically relevant single dose of 90 mg, pridopidine acts as a selective S1R ligand showing near to complete S1R occupancy with negligible occupancy of the D2/D3R. The dose S1R occupancy relationship suggests cooperative binding of pridopidine to the S1R. Our findings provide significant clarification about pridopidine's mechanism of action and support further use of the 45-mg twice-daily dose to achieve full and selective targeting of the S1R in future clinical trials of neurodegenerative disorders. Clinical Trials.gov Identifier: NCT03019289 January 12, 2017; EUDRA-CT-Nr. 2016-001757-41.
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Affiliation(s)
- Igor D Grachev
- Teva Branded Pharmaceutical Products R&D, Inc, Malvern, PA, 19355, USA.,Guide Pharmaceutical Consulting, LLC, Millstone, NJ, 08535, USA
| | - Philipp M Meyer
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Georg A Becker
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Marcus Bronzel
- ABX-CRO Advanced Pharmaceutical Services Forschungsgesellschaft mbH, Dresden, Germany
| | - Doug Marsteller
- Teva Branded Pharmaceutical Products R&D, Inc, Frazer, PA, 19355, USA
| | - Gina Pastino
- Teva Branded Pharmaceutical Products R&D, Inc, Frazer, PA, 19355, USA
| | - Ole Voges
- ABX-CRO Advanced Pharmaceutical Services Forschungsgesellschaft mbH, Dresden, Germany
| | - Laura Rabinovich
- Teva Branded Pharmaceutical Products R&D, Inc, Frazer, PA, 19355, USA
| | - Helena Knebel
- Teva Branded Pharmaceutical Products R&D, Inc, Frazer, PA, 19355, USA
| | - Franziska Zientek
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Michael Rullmann
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Bernhard Sattler
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Marianne Patt
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Thilo Gerhards
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Maria Strauss
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Andreas Kluge
- ABX-CRO Advanced Pharmaceutical Services Forschungsgesellschaft mbH, Dresden, Germany
| | - Peter Brust
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Research Site Leipzig, Leipzig, Germany
| | - Juha-Matti Savola
- Teva Branded Pharmaceutical Products R&D, Inc, Frazer, PA, 19355, USA
| | - Mark F Gordon
- Teva Branded Pharmaceutical Products R&D, Inc, Frazer, PA, 19355, USA
| | - Michal Geva
- Prilenia Therapeutics Development Ltd., Herzliya, Israel
| | - Swen Hesse
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | | | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany.
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