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Ilyas-Feldmann M, Asselin MC, Wang S, McMahon A, Anton-Rodriguez J, Brown G, Hinz R, Duncan JS, Sisodiya SM, Koepp M. P-glycoprotein overactivity in epileptogenic developmental lesions measured in vivo using (R)-[ 11 C]verapamil PET. Epilepsia 2020; 61:1472-1480. [PMID: 32627849 DOI: 10.1111/epi.16581] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Overexpression of the drug transporter P-glycoprotein (P-gp) is thought to be involved in drug-resistance in epilepsy by extrusion of antiepileptic drugs (AEDs). We used positron emission tomography (PET) and the P-gp substrate radiotracer (R)-[11 C]verapamil (VPM) together with the third-generation P-gp inhibitor tariquidar (TQD) to evaluate P-gp function in individuals with drug-resistant epileptogenic developmental lesions. METHODS Twelve healthy controls (7 male, median age 45, range 35-55 years), and two patients with epileptogenic developmental lesions (2 male, aged 24 and 62 years) underwent VPM-PET scans before and 60 minutes after a 30-minute infusion of 2 and 3 mg/kg TQD. The influx rate constant, VPM-K1 , was estimated from the first 10 minutes of dynamic data using a single-tissue compartment model with a VPM plasma input function. Statistical parametric mapping (SPM) analysis was used to compare individual patients with the healthy controls. RESULTS At baseline, SPM voxel-based analysis revealed significantly lower uptake of VPM corresponding to the area of the epileptogenic developmental lesion compared to 12 healthy controls (P < .048). This was accentuated following P-gp inhibition with TQD. After TQD, the uptake of VPM was significantly lower in the area of the epileptogenic developmental lesion compared to controls (P < .002). SIGNIFICANCE This study provides further evidence of P-gp overactivity in patients with drug-resistant epilepsy, irrespective of the type of lesion. Identifying P-gp overactivity as an underlying contributor to drug-resistance in individual patients will enable novel treatment strategies aimed at overcoming or reversing P-gp overactivity.
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Affiliation(s)
- Maria Ilyas-Feldmann
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Bucks, UK.,Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK.,Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Shaonan Wang
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK.,Global Pharmacometrics, Boehringer Ingelheim, Ingelheim am Rhein, Germany
| | - Adam McMahon
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | | | - Gavin Brown
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - Rainer Hinz
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Bucks, UK
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Bucks, UK
| | - Matthias Koepp
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Bucks, UK
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Herholz K, Haense C, Gerhard A, Jones M, Anton-Rodriguez J, Segobin S, Snowden JS, Thompson JC, Kobylecki C. Metabolic regional and network changes in Alzheimer's disease subtypes. J Cereb Blood Flow Metab 2018; 38:1796-1806. [PMID: 28675110 PMCID: PMC6168902 DOI: 10.1177/0271678x17718436] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/10/2017] [Accepted: 05/19/2017] [Indexed: 11/16/2022]
Abstract
Clinical variants of Alzheimer's disease (AD) include the common amnestic subtype as well as subtypes characterised by leading visual processing impairments or by multimodal neurocognitive deficits. We investigated regional metabolic patterns and networks between AD subtypes. The study comprised 9 age-matched controls and 25 patients with mild to moderate AD. Methods included clinical and neuropsychological assessment, high-resolution FDG PET and T1-weighted 3D MR imaging with PET-MR coregistration, grey matter segmentation, atlas-based regions-of-interest, linear mixed effects and regional correlation analysis. Regional metabolic patterns differed significantly between groups, but significant hypometabolism in the posterior cingulate cortex (PCC) was common to all subtypes. The most distinctive regional abnormality was occipital hypometabolism in the visual subtype. In controls, two large clusters of positive regional metabolic correlations were observed. The most pronounced breakdown of the normal correlation pattern was found in amnestic patients who, in contrast, showed the least regional focal metabolic deficits. The normal positive correlation between PCC and hippocampus was lost in all subtypes. In conclusion, PCC hypometabolism and metabolic correlation breakdown between PCC and hippocampus are the common functional core of all AD subtypes. Network alterations exceed focal regional impairment and are most prominent in the amnestic subtype.
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Affiliation(s)
- Karl Herholz
- Division of Informatics, Imaging and
Data Sciences, University of Manchester, Wolfson Molecular Imaging Centre,
Manchester, UK
- Division of Neuroscience and
Experimental Psychology, University of Manchester, Manchester, UK
| | - Cathleen Haense
- Division of Informatics, Imaging and
Data Sciences, University of Manchester, Wolfson Molecular Imaging Centre,
Manchester, UK
| | - Alex Gerhard
- Division of Informatics, Imaging and
Data Sciences, University of Manchester, Wolfson Molecular Imaging Centre,
Manchester, UK
- Division of Neuroscience and
Experimental Psychology, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust,
Salford, UK
- Department of Nuclear Medicine and
Lehrstuhl für Geriatrie, Universitätsklinikum Essen, Essen, Germany
| | - Matthew Jones
- Division of Neuroscience and
Experimental Psychology, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust,
Salford, UK
| | - José Anton-Rodriguez
- Division of Informatics, Imaging and
Data Sciences, University of Manchester, Wolfson Molecular Imaging Centre,
Manchester, UK
| | - Shailendra Segobin
- Division of Informatics, Imaging and
Data Sciences, University of Manchester, Wolfson Molecular Imaging Centre,
Manchester, UK
| | - Julie S Snowden
- Division of Neuroscience and
Experimental Psychology, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust,
Salford, UK
| | - Jennifer C Thompson
- Division of Neuroscience and
Experimental Psychology, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust,
Salford, UK
| | - Christopher Kobylecki
- Division of Neuroscience and
Experimental Psychology, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust,
Salford, UK
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Conen S, Matthews JC, Patel NK, Anton-Rodriguez J, Talbot PS. Acute and chronic changes in brain activity with deep brain stimulation for refractory depression. J Psychopharmacol 2018; 32:430-440. [PMID: 29228889 DOI: 10.1177/0269881117742668] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Deep brain stimulation is a potential option for patients with treatment-refractory depression. Deep brain stimulation benefits have been reported when targeting either the subgenual cingulate or ventral anterior capsule/nucleus accumbens. However, not all patients respond and optimum stimulation-site is uncertain. We compared deep brain stimulation of the subgenual cingulate and ventral anterior capsule/nucleus accumbens separately and combined in the same seven treatment-refractory depression patients, and investigated regional cerebral blood flow changes associated with acute and chronic deep brain stimulation. Deep brain stimulation-response was defined as reduction in Montgomery-Asberg Depression Rating Scale score from baseline of ≥50%, and remission as a Montgomery-Asberg Depression Rating Scale score ≤8. Changes in regional cerebral blood flow were assessed using [15O]water positron emission tomography. Remitters had higher relative regional cerebral blood flow in the prefrontal cortex at baseline and all subsequent time-points compared to non-remitters and non-responders, with prefrontal cortex regional cerebral blood flow generally increasing with chronic deep brain stimulation. These effects were consistent regardless of stimulation-site. Overall, no significant regional cerebral blood flow changes were apparent when deep brain stimulation was acutely interrupted. Deep brain stimulation improved treatment-refractory depression severity in the majority of patients, with consistent changes in local and distant brain regions regardless of target stimulation. Remission of depression was reached in patients with higher baseline prefrontal regional cerebral blood flow. Because of the small sample size these results are preliminary and further evaluation is necessary to determine whether prefrontal cortex regional cerebral blood flow could be a predictive biomarker of treatment response.
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Affiliation(s)
- Silke Conen
- 1 Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester Academic Health Science Centre, UK
| | - Julian C Matthews
- 2 Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester Academic Health Science Centre, UK
| | - Nikunj K Patel
- 3 Department of Neurosurgery, Frenchay Hospital, Bristol, UK
| | - José Anton-Rodriguez
- 2 Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester Academic Health Science Centre, UK
| | - Peter S Talbot
- 1 Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester Academic Health Science Centre, UK
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Kobylecki C, Haense C, Harris JM, Stopford CL, Segobin SH, Jones M, Richardson AMT, Gerhard A, Anton-Rodriguez J, Thompson JC, Herholz K, Snowden JS. Functional neuroanatomical associations of working memory in early-onset Alzheimer's disease. Int J Geriatr Psychiatry 2018; 33:176-184. [PMID: 28299814 DOI: 10.1002/gps.4703] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/08/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To characterize metabolic correlates of working memory impairment in clinically defined subtypes of early-onset Alzheimer's disease. BACKGROUND Established models of working memory suggest a key role for frontal lobe function, yet the association in Alzheimer's disease between working memory impairment and visuospatial and language symptoms suggests that temporoparietal neocortical dysfunction may be responsible. METHODS Twenty-four patients with predominantly early-onset Alzheimer's disease were clinically classified into groups with predominantly amnestic, multidomain or visual deficits. Patients underwent neuropsychological evaluation focused on the domains of episodic and working memory, T1-weighted magnetic resonance imaging and brain fluorodeoxyglucose positron emission tomography. Fluorodeoxyglucose positron emission tomography data were analysed by using a region-of-interest approach. RESULTS Patients with multidomain and visual presentations performed more poorly on tests of working memory compared with amnestic Alzheimer's disease. Working memory performance correlated with glucose metabolism in left-sided temporoparietal, but not frontal neocortex. Carriers of the apolipoprotein E4 gene showed poorer episodic memory and better working memory performance compared with noncarriers. CONCLUSIONS Our findings support the hypothesis that working memory changes in early-onset Alzheimer's disease are related to temporoparietal rather than frontal hypometabolism and show dissociation from episodic memory performance. They further support the concept of subtypes of Alzheimer's disease with distinct cognitive profiles due to prominent neocortical dysfunction early in the disease course. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Christopher Kobylecki
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Cathleen Haense
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Jennifer M Harris
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Cheryl L Stopford
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Shailendra H Segobin
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,INSERM-EPHE-Université de Caen de Basse-Normandie, Caen, France
| | - Matthew Jones
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Anna M T Richardson
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Medical School, University of Manchester, Manchester, UK
| | - Alexander Gerhard
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - José Anton-Rodriguez
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jennifer C Thompson
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Karl Herholz
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Julie S Snowden
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
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Feldmann M, Asselin MC, Liu J, Wang S, McMahon A, Anton-Rodriguez J, Walker M, Symms M, Brown G, Hinz R, Matthews J, Bauer M, Langer O, Thom M, Jones T, Vollmar C, Duncan JS, Sisodiya SM, Koepp MJ. P-glycoprotein expression and function in patients with temporal lobe epilepsy: a case-control study. Lancet Neurol 2013; 12:777-85. [PMID: 23786896 DOI: 10.1016/s1474-4422(13)70109-1] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Studies in rodent models of epilepsy suggest that multidrug efflux transporters at the blood-brain barrier, such as P-glycoprotein, might contribute to pharmacoresistance by reducing target-site concentrations of antiepileptic drugs. We assessed P-glycoprotein activity in vivo in patients with temporal lobe epilepsy. METHODS We selected 16 patients with pharmacoresistant temporal lobe epilepsy who had seizures despite treatment with at least two antiepileptic drugs, eight patients who had been seizure-free on antiepileptic drugs for at least a year after 3 or more years of active temporal lobe epilepsy, and 17 healthy controls. All participants had a baseline PET scan with the P-glycoprotein substrate (R)-[(11)C]verapamil. Pharmacoresistant patients and healthy controls then received a 30-min infusion of the P-glycoprotein-inhibitor tariquidar followed by another (R)-[(11)C]verapamil PET scan 60 min later. Seizure-free patients had a second scan on the same day, but without tariquidar infusion. Voxel-by-voxel, we calculated the (R)-[(11)C]verapamil plasma-to-brain transport rate constant, K1 (mL/min/cm(3)). Low baseline K1 and attenuated K1 increases after tariquidar correspond to high P-glycoprotein activity. FINDINGS Between October, 2008, and November, 2011, we completed (R)-[(11)C]verapamil PET studies in 14 pharmacoresistant patients, eight seizure-free patients, and 13 healthy controls. Voxel-based analysis revealed that pharmacoresistant patients had lower baseline K1, corresponding to higher baseline P-glycoprotein activity, than seizure-free patients in ipsilateral amygdala (0·031 vs 0·036 mL/min/cm(3); p=0·014), bilateral parahippocampus (0·032 vs 0·037; p<0·0001), fusiform gyrus (0·036 vs 0·041; p<0·0001), inferior temporal gyrus (0·035 vs 0·041; p<0·0001), and middle temporal gyrus (0·038 vs 0·044; p<0·0001). Higher P-glycoprotein activity was associated with higher seizure frequency in whole-brain grey matter (p=0·016) and the hippocampus (p=0·029). In healthy controls, we noted a 56·8% increase of whole-brain K1 after 2 mg/kg tariquidar, and 57·9% for 3 mg/kg; in patients with pharmacoresistant temporal lobe epilepsy, whole-brain K1 increased by only 21·9% for 2 mg/kg and 42·6% after 3 mg/kg. This difference in tariquidar response was most pronounced in the sclerotic hippocampus (mean 24·5% increase in patients vs mean 65% increase in healthy controls, p<0·0001). INTERPRETATION Our results support the hypothesis that there is an association between P-glycoprotein overactivity in some regions of the brain and pharmacoresistance in temporal lobe epilepsy. If this relation is confirmed, and P-glycoprotein can be identified as a contributor to pharmacoresistance, overcoming P-glycoprotein overactivity could be investigated as a potential treatment strategy. FUNDING EU-FP7 programme (EURIPIDES number 201380).
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Affiliation(s)
- Maria Feldmann
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
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