The discovery of ketamine as a rapid and robust antidepressant marks the beginning of a new era i... more The discovery of ketamine as a rapid and robust antidepressant marks the beginning of a new era in the treatment of psychiatric disorders. Ketamine is thought to produce rapid and sustained antidepressant effects through restoration of lost synaptic connections. We investigated this hypothesis in humans for the first time using positron emission tomography (PET) and [11C]UCB-J – a radioligand that binds to the synaptic vesicle protein 2A (SV2A) and provides an index of axon terminal density. Overall, we did not find evidence of a measurable effect on SV2A density 24 hours after a single administration of ketamine in non-human primates, healthy controls (HCs), or individuals with major depressive disorder (MDD) and/or posttraumatic stress disorder (PTSD), despite a robust reduction in symptoms. A post-hoc, exploratory analysis suggests that patients with lower SV2A density at baseline may exhibit increased SV2A density 24 hours after ketamine and that this increase in SV2A was associated with a reduction in depression severity, as well as an increase in dissociative symptoms. These initial findings suggest that a restoration of synaptic connections in patients with lower SV2A at baseline may underlie ketamine’s therapeutic effects, however this needs replication in a larger sample. Further work is needed to build on these initial findings and further establish the nuanced pre- and post-synaptic mechanisms underpinning ketamine’s therapeutic effects.
The synaptic vesicle protein 2A (SV2A) is an integral 12-transmembrane domain glycoprotein locate... more The synaptic vesicle protein 2A (SV2A) is an integral 12-transmembrane domain glycoprotein located in the membrane of synaptic vesicles and widely distributed throughout the brain. In 2004, SV2A was shown to be the molecular target of the antiepileptic drug levetiracetam. High-affinity SV2A ligands have been described by the pharmaceutical company UCB more recently, and this enabled the rapid development of SV2A positron emission tomography (PET) radioligands. Because synaptic vesicle proteins, such as SV2A, have previously been used as biomarkers of synaptic density, PET imaging of SV2A may have broad utility across neuropathological diseases. In this chapter we review the current status of SV2A PET imaging.
The descending raphespinal serotonin (5-HT) system contributes to neural activities required for ... more The descending raphespinal serotonin (5-HT) system contributes to neural activities required for locomotion. The presynaptic serotonin transporter (SERT) is a marker of 5-HT innervation. In this study, we explored the use of PET imaging with the SERT radioligand [11C]AFM as a biomarker of 5-HT axon damage after spinal cord injury (SCI) in a rodent model and its translation to imaging SCI in humans. PET imaging with [11C]AFM was performed in healthy rats under baseline and citalopram blocking conditions and a mid-thoracic transection rat model of SCI. The lumbar-to-cervical activity (L/C) ratio was calculated for the healthy and SCI animals to assess SERT binding decrease after SCI. Finally, translation of [11C]AFM PET was attempted to explore its potential to image SCI in humans. Intense uptake in the brain and intact spinal cord was observed at 30–60 min post-injection of [11C]AFM in healthy rats. About 65% of [11C]AFM uptake in the spinal cord was blocked by citalopram. In the SCI rat model, the cervical uptake of [11C]AFM was similar to that in healthy rats, but the lumbar uptake was dramatically reduced, resulting in about half the L/C ratio in SCI rats compared to healthy rats. In contrast, [11C]AFM uptake in the human spinal cord showed no obvious decrease after treatment with citalopram. In the human subjects with SCI, decreases in [11C]AFM uptake were also not obvious in the section of spinal cord caudal to the injury point. [11C]AFM PET imaging of SERT provides a useful preclinical method to non-invasively visualize the rodent spinal cord and detect SERT changes in SCI rodent models. However, there appears to be little detectable specific binding signal for [11C]AFM in the human spinal cord. An SERT tracer with higher affinity and lower non-specific binding signal is needed to image the spinal cord in humans and to assess the axonal status in SCI patients.
Synaptic vesicle glycoprotein 2A (SV2A) is a 12-pass trans-membrane glycoprotein ubiquitously exp... more Synaptic vesicle glycoprotein 2A (SV2A) is a 12-pass trans-membrane glycoprotein ubiquitously expressed in presynaptic vesicles. In vivo imaging of SV2A using PET has potential applications in the diagnosis and prognosis of a variety of neuropsychiatric diseases, e.g., Alzheimer's disease, Parkin-son's disease, schizophrenia, multiple sclerosis, autism, epi-lepsy, stroke, traumatic brain injury, post-traumatic stress disorder, depression, etc. Herein, we report the synthesis and evaluation of a new 18F-labeled SV2A PET imaging probe, [18F]SynVesT-2, which possesses fast in vivo binding kinetics and high specific binding signals in nonhuman primate brain.
There is growing interest in developing a method to measure pancreatic beta-cell mass (BCM) so as... more There is growing interest in developing a method to measure pancreatic beta-cell mass (BCM) so as to: 1) monitor progression of beta cell changes in type 1 and type 2 diabetes; 2) identify therapies to preserve, restore or regenerate beta cells; and 3) monitor viability of islets after transplantation therapy. Given that beta cells and neurons have functional similarities, we tested the hypothesis that receptors, transporters, or proteins essential for signal detection and propagation, may be common to both cell types. Hence, we assessed if Positron Emission Tomography (PET) imaging ligands originally developed for neuroimaging may provide a means for imaging BCM as well. Previous studies have shown higher uptake of 11C-(+)-4-propyl-9-hydroxynaphthoxazine (PHNO), a dopamine D2/D3 agonist radioligand (D3-preferring), in the pancreatic tissue of healthy controls vs. T1DM in humans. In this study, we sought to determine whether 11C-PHNO, would be useful for measuring BCM. Eleven subjects (6 with T1DM, 4 males and 2 females, age 30.8 ± 11.4 years, BMI 24.4 ± 2.0, and 5 matched healthy controls, 3 males and 2 females, age 32.2 ± 11.4 years, BMI 26.4 ± 2.1) underwent abdominal PET/CT imaging using 11C-PHNO. Regions-of-interest (ROIs) were applied to the pancreas, liver, spleen, and kidney and time-activity curves (TACs) were produced and converted to standard uptake value (SUV) units. The distribution of activity between the head, body, and tail of the pancreas was also assessed. We observed that there was a 41% reduction in 11C-PHNO SUV in T1DM patients as compared to the healthy control group (p = 0.026). Moreover, there was a positive correlation between plasma c-peptide concentrations and 11C-PHNO SUV in the pancreas (r = 0.78), although this relationship did not reach statistical significance (p = 0.1), most likely due to the small sample size. These data suggest that dopamine D3 expression in pancreatic tissue might serve as a useful biomarker for assessing beta cell mass in diabetic humans. Disclosure E. Sanchez Rangel: None. J. Bini: None. N.B. Nabulsi: None. Y. Huang: None. K.C. Herold: None. R. Sherwin: Other Relationship; Self; QuintilesIMS, MannKind Corporation. Research Support; Self; Regeneron Pharmaceuticals, Inc.. Other Relationship; Self; ICON plc. R.E. Carson: Research Support; Self; Pfizer Inc., Bristol-Myers Squibb Company, Eli Lilly and Company, UCB, Inc., Siemens. G. Cline: None.
The discovery of ketamine as a rapid and robust antidepressant marks the beginning of a new era i... more The discovery of ketamine as a rapid and robust antidepressant marks the beginning of a new era in the treatment of psychiatric disorders. Ketamine is thought to produce rapid and sustained antidepressant effects through restoration of lost synaptic connections. We investigated this hypothesis in humans for the first time using positron emission tomography (PET) and [11C]UCB-J – a radioligand that binds to the synaptic vesicle protein 2A (SV2A) and provides an index of axon terminal density. Overall, we did not find evidence of a measurable effect on SV2A density 24 hours after a single administration of ketamine in non-human primates, healthy controls (HCs), or individuals with major depressive disorder (MDD) and/or posttraumatic stress disorder (PTSD), despite a robust reduction in symptoms. A post-hoc, exploratory analysis suggests that patients with lower SV2A density at baseline may exhibit increased SV2A density 24 hours after ketamine and that this increase in SV2A was associated with a reduction in depression severity, as well as an increase in dissociative symptoms. These initial findings suggest that a restoration of synaptic connections in patients with lower SV2A at baseline may underlie ketamine’s therapeutic effects, however this needs replication in a larger sample. Further work is needed to build on these initial findings and further establish the nuanced pre- and post-synaptic mechanisms underpinning ketamine’s therapeutic effects.
The synaptic vesicle protein 2A (SV2A) is an integral 12-transmembrane domain glycoprotein locate... more The synaptic vesicle protein 2A (SV2A) is an integral 12-transmembrane domain glycoprotein located in the membrane of synaptic vesicles and widely distributed throughout the brain. In 2004, SV2A was shown to be the molecular target of the antiepileptic drug levetiracetam. High-affinity SV2A ligands have been described by the pharmaceutical company UCB more recently, and this enabled the rapid development of SV2A positron emission tomography (PET) radioligands. Because synaptic vesicle proteins, such as SV2A, have previously been used as biomarkers of synaptic density, PET imaging of SV2A may have broad utility across neuropathological diseases. In this chapter we review the current status of SV2A PET imaging.
The descending raphespinal serotonin (5-HT) system contributes to neural activities required for ... more The descending raphespinal serotonin (5-HT) system contributes to neural activities required for locomotion. The presynaptic serotonin transporter (SERT) is a marker of 5-HT innervation. In this study, we explored the use of PET imaging with the SERT radioligand [11C]AFM as a biomarker of 5-HT axon damage after spinal cord injury (SCI) in a rodent model and its translation to imaging SCI in humans. PET imaging with [11C]AFM was performed in healthy rats under baseline and citalopram blocking conditions and a mid-thoracic transection rat model of SCI. The lumbar-to-cervical activity (L/C) ratio was calculated for the healthy and SCI animals to assess SERT binding decrease after SCI. Finally, translation of [11C]AFM PET was attempted to explore its potential to image SCI in humans. Intense uptake in the brain and intact spinal cord was observed at 30–60 min post-injection of [11C]AFM in healthy rats. About 65% of [11C]AFM uptake in the spinal cord was blocked by citalopram. In the SCI rat model, the cervical uptake of [11C]AFM was similar to that in healthy rats, but the lumbar uptake was dramatically reduced, resulting in about half the L/C ratio in SCI rats compared to healthy rats. In contrast, [11C]AFM uptake in the human spinal cord showed no obvious decrease after treatment with citalopram. In the human subjects with SCI, decreases in [11C]AFM uptake were also not obvious in the section of spinal cord caudal to the injury point. [11C]AFM PET imaging of SERT provides a useful preclinical method to non-invasively visualize the rodent spinal cord and detect SERT changes in SCI rodent models. However, there appears to be little detectable specific binding signal for [11C]AFM in the human spinal cord. An SERT tracer with higher affinity and lower non-specific binding signal is needed to image the spinal cord in humans and to assess the axonal status in SCI patients.
Synaptic vesicle glycoprotein 2A (SV2A) is a 12-pass trans-membrane glycoprotein ubiquitously exp... more Synaptic vesicle glycoprotein 2A (SV2A) is a 12-pass trans-membrane glycoprotein ubiquitously expressed in presynaptic vesicles. In vivo imaging of SV2A using PET has potential applications in the diagnosis and prognosis of a variety of neuropsychiatric diseases, e.g., Alzheimer's disease, Parkin-son's disease, schizophrenia, multiple sclerosis, autism, epi-lepsy, stroke, traumatic brain injury, post-traumatic stress disorder, depression, etc. Herein, we report the synthesis and evaluation of a new 18F-labeled SV2A PET imaging probe, [18F]SynVesT-2, which possesses fast in vivo binding kinetics and high specific binding signals in nonhuman primate brain.
There is growing interest in developing a method to measure pancreatic beta-cell mass (BCM) so as... more There is growing interest in developing a method to measure pancreatic beta-cell mass (BCM) so as to: 1) monitor progression of beta cell changes in type 1 and type 2 diabetes; 2) identify therapies to preserve, restore or regenerate beta cells; and 3) monitor viability of islets after transplantation therapy. Given that beta cells and neurons have functional similarities, we tested the hypothesis that receptors, transporters, or proteins essential for signal detection and propagation, may be common to both cell types. Hence, we assessed if Positron Emission Tomography (PET) imaging ligands originally developed for neuroimaging may provide a means for imaging BCM as well. Previous studies have shown higher uptake of 11C-(+)-4-propyl-9-hydroxynaphthoxazine (PHNO), a dopamine D2/D3 agonist radioligand (D3-preferring), in the pancreatic tissue of healthy controls vs. T1DM in humans. In this study, we sought to determine whether 11C-PHNO, would be useful for measuring BCM. Eleven subjects (6 with T1DM, 4 males and 2 females, age 30.8 ± 11.4 years, BMI 24.4 ± 2.0, and 5 matched healthy controls, 3 males and 2 females, age 32.2 ± 11.4 years, BMI 26.4 ± 2.1) underwent abdominal PET/CT imaging using 11C-PHNO. Regions-of-interest (ROIs) were applied to the pancreas, liver, spleen, and kidney and time-activity curves (TACs) were produced and converted to standard uptake value (SUV) units. The distribution of activity between the head, body, and tail of the pancreas was also assessed. We observed that there was a 41% reduction in 11C-PHNO SUV in T1DM patients as compared to the healthy control group (p = 0.026). Moreover, there was a positive correlation between plasma c-peptide concentrations and 11C-PHNO SUV in the pancreas (r = 0.78), although this relationship did not reach statistical significance (p = 0.1), most likely due to the small sample size. These data suggest that dopamine D3 expression in pancreatic tissue might serve as a useful biomarker for assessing beta cell mass in diabetic humans. Disclosure E. Sanchez Rangel: None. J. Bini: None. N.B. Nabulsi: None. Y. Huang: None. K.C. Herold: None. R. Sherwin: Other Relationship; Self; QuintilesIMS, MannKind Corporation. Research Support; Self; Regeneron Pharmaceuticals, Inc.. Other Relationship; Self; ICON plc. R.E. Carson: Research Support; Self; Pfizer Inc., Bristol-Myers Squibb Company, Eli Lilly and Company, UCB, Inc., Siemens. G. Cline: None.
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