Use of thallium transport to visualize functional olfactory nerve regeneration in vivo

Functional Olfactory Nerve Regeneration Demonstrated by Thallium-201 Olfacto-Scintigraphy in Patients with Traumatic Anosmia: A Case Report

Head trauma is one of the most common etiologies of olfactory dysfunction. It is difficult to use either the olfactory function test or magnetic resonance imaging to directly assess the course of damage to olfactory nerves. Thallium-201 (²⁰¹Tl) olfacto-scintigraphy has been shown to be an able means for objectively assessing the olfactory nerve transport function. It is expected to be used to evaluate olfactory nerve regeneration after damage to the olfactory nerves. However, no such result has been reported. We present a patient who lost his olfactory function after experiencing head trauma. When his olfactory function remained anosmic, a ²⁰¹Tl olfacto-scintigraphy showed no migration of ²⁰¹Tl from the nasal mucosa to the olfactory bulb. After treatment with medicines and olfactory training, his olfactory function improved. A second ²⁰¹Tl olfacto-scintigraphy showed an increased migration of ²⁰¹Tl from the nasal mucosa to the olfactory bulb.

Reduced nasal transport of insulin-like growth factor-1 to the mouse cerebrum with olfactory bulb resection

Although the olfactory nerve is involved in nasal transport of insulin-like growth factor-1 (IGF-1) to the brain, to our knowledge there have been no direct assessments of the effects of olfactory nerve damage on this transport. To determine whether olfactory bulb resection resulted in reduced transport of nasally administered human recombinant IGF-1 (hIGF-1) to the cerebrum, we measured the uptake of nasally administered iodine-125 hIGF-1 ((125)I-hIGF-1) in the cerebrum as a percentage of that in the blood in male ICR mice subjected to left olfactory bulb resection (model mice) and in sham-operated male ICR mice (control mice). Phosphorylated extracellular signal-regulated kinase (ERK) 1/2 (Thr202/Tyr204)/(Thr185/Tyr187) as a percentage of total ERK 1/2 in the left cerebrum was also assessed by using enzyme-linked immunosorbent assay after nasal administration of hIGF-1. Uptake of nasally administered (125)I-hIGF-1 in the cerebrum as a percentage of that in the blood was significantly lower in the model group than in the control group 30min after nasal administration of hIGF-1. Unilateral olfactory bulb resection prevented nasally administered hIGF-1 from increasing the phosphorylation of ERK 1/2 in the mouse cerebrum in vivo. These findings suggest that olfactory bulb damage reduces nasal transport of hIGF-1 to the brain in vivo.

Assessment of olfactory nerve by SPECT-MRI image with nasal thallium-201 administration in patients with olfactory impairments in comparison to healthy volunteers

Purpose

The aim of this study was to assess whether migration of thallium-201 (²⁰¹Tl) to the olfactory bulb were reduced in patients with olfactory impairments in comparison to healthy volunteers after nasal administration of ²⁰¹Tl.

Procedures

10 healthy volunteers and 21 patients enrolled in the study (19 males and 12 females; 26–71 years old). The causes of olfactory dysfunction in the patients were head trauma (n = 7), upper respiratory tract infection (n = 7), and chronic rhinosinusitis (n = 7). ²⁰¹TlCl was administered unilaterally to the olfactory cleft, and SPECT-CT was conducted 24 h later. Separate MRI images were merged with the SPECT images. ²⁰¹Tl olfactory migration was also correlated with the volume of the olfactory bulb determined from MRI images, as well as with odor recognition thresholds measured by using T&T olfactometry.

Results

Nasal ²⁰¹Tl migration to the olfactory bulb was significantly lower in the olfactory-impaired patients than in healthy volunteers. The migration of ²⁰¹Tl to the olfactory bulb was significantly correlated with odor recognition thresholds obtained with T&T olfactometry and correlated with the volume of the olfactory bulb determined from MRI images when all subjects were included.

Conclusions

Assessment of the ²⁰¹Tl migration to the olfactory bulb was the new method for the evaluation of the olfactory nerve connectivity in patients with impaired olfaction.

[Clinical diagnosis of the olfactory nerve transport function]

Nasal administration of macromolecular drugs (peptides, nanoparticles) has a possibility to enable a drug delivery system beyond the blood brain barrier via olfactory nerve transport. Basic research on nasal drug delivery to the brain has been well studied. However, evaluation of the olfactory nerve transport function in patients with olfactory disorders has yet to be done, although such an evaluation is important in selecting candidates for clinical trials. Current olfactory function tests are useful for the analysis of olfactory thresholds in olfaction-impaired patients. However, the usefulness of using the increase in olfactory thresholds in patients as an index for evaluating olfactory nerve damage has not been confirmed because of the difficulty in directly evaluating the viability of the peripheral olfactory nerves. Nasally administered thallium-201 migrates to the olfactory bulb, as has been shown in healthy volunteers. Furthermore, transection of olfactory nerve fibers in mice significantly decreases migration of nasally administered thallium-201 to the olfactory bulb. The migration of thallium-201 to the olfactory bulb is reduced in patients with impaired olfaction due to head trauma, upper respiratory tract infections, and chronic rhinosinusitis, relative to the values in healthy volunteers. Nasally administrating thallium-201 followed by single photon emission computed tomography, X-ray computed tomography and magnetic resonance imaging might be useful in choosing candidates for clinical trials of nasal drug delivery methods to the brain.