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Evans CD, Sparks J, Andersen SW, Brooks DA, Hauck PM, Mintun MA, Sims JR. APOE ε4's impact on response to amyloid therapies in early symptomatic Alzheimer's disease: Analyses from multiple clinical trials. Alzheimers Dement 2023; 19:5407-5417. [PMID: 37204338 DOI: 10.1002/alz.13128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Apolipoprotein E (APOE) ε4 may interact with response to amyloid-targeting therapies. METHODS Aggregate data from trials enrolling participants with amyloid-positive, early symptomatic Alzheimer's disease (AD) were analyzed for disease progression. RESULTS Pooled analysis of potentially efficacious antibodies lecanemab, aducanumab, solanezumab, and donanemab shows slightly better efficacy in APOE ε4 carriers than in non-carriers. Carrier and non-carrier mean (95% confidence interval) differences from placebo using Clinical Dementia Rating Scale-Sum of Boxes (CDR-SB) were -0.30 (-0.478, -0.106) and -0.20 (-0.435, 0.042) and AD Assessment Scale-Cognitive subscale (ADAS-Cog) values were -1.01 (-1.577, -0.456) and -0.80 (-1.627, 0.018), respectively. Decline in the APOE ε4 non-carrier placebo group was equal to or greater than that in carriers across multiple scales. Probability of study success increases as the representation of the carrier population increases. DISCUSSION We hypothesize that APOE ε4 carriers have same or better response than non-carriers to amyloid-targeting therapies and similar or less disease progression with placebo in amyloid-positive trials. HIGHLIGHTS Amyloid-targeting therapies had slightly greater efficacy in apolipoprotein E (APOE) ε4 carriers. Clinical decline is the same/slightly faster in amyloid-positive APOE ε4 non-carriers. Prevalence of non-carriers in trial populations could impact outcomes.
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Affiliation(s)
| | | | | | | | | | - Mark A Mintun
- Eli Lilly and Company, Indianapolis, Indiana, USA
- Avid Radiopharmaceuticals, a wholly owned subsidiary of Eli Lilly and Company, Philadelphia, Pennsylvania, USA
| | - John R Sims
- Eli Lilly and Company, Indianapolis, Indiana, USA
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Shcherbinin S, Morris A, Higgins IA, Tunali I, Lu M, Deveau C, Southekal S, Kotari V, Evans CD, Arora AK, Collins EC, Pontecorvo M, Mintun MA, Sims JR. Tau as a diagnostic instrument in clinical trials to predict amyloid in Alzheimer's disease. Alzheimers Dement (N Y) 2023; 9:e12415. [PMID: 37600216 PMCID: PMC10432878 DOI: 10.1002/trc2.12415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Alzheimer's disease (AD) is characterized by the presence of both amyloid and tau pathology. In vivo diagnosis can be made with amyloid and tau positron emission tomography (PET) imaging. Emergent evidence supports that amyloid and tau accumulation are associated and that amyloid accumulation may precede that of tau. This report further investigates the relationship between amyloid and tau to assess whether elevated cortical tau can predict elevated amyloid in participants with early symptomatic AD. METHODS Florbetapir F18 and flortaucipir F18 uptake were evaluated from baseline PET scans collected in three multi-center studies with cognitively impaired participants, including A05 (N = 306; NCT02016560), TB (N = 310; TRAILBLAZER-ALZ; NCT03367403), and TB2 (N = 1165; TRAILBLAZER-ALZ 2; NCT04437511). Images were assessed using visual and quantitative approaches to establish amyloid (A+) and tau (T+) positivity, as well as a combination method (tauVQ) to establish T+. Associations between global amyloid and tau were evaluated with positive and negative predictive values (PPV, NPV) and likelihood ratios (LR+, LR-). Predictive values within subgroups according to ethnicity, race, cognitive score, age, and sex were also evaluated. The relationship between regional tau (four target and two reference regions were tested) and global amyloid was investigated in A05 participant scans using receiver-operating characteristic (ROC) curves. RESULTS PPV for amyloid positivity was ≥93% for all three trials using various A+ and T+ definitions, including visual, quantitative, and combination methods. Population characteristics did not have an impact on A+ predictability. Regional analyses (early tau (Eτ) volume of interest (VOI), temporal, parietal, frontal) revealed significant area under the ROC curve in Eτ VOI compared to frontal region, regardless of reference region and consistent among visual and quantitative A+ definitions (p < 0.001). DISCUSSION These findings suggest that a positive tau PET scan is associated (≥93%) with amyloid positivity in individuals with early symptomatic AD, with the potential benefits of reducing clinical trial and health care expenses, radiation exposure, and participant time. Highlights Positron emission tomography (PET) evaluates candidates for Alzheimer's disease (AD) research. A positive tau PET scan is associated (≥93%) with amyloid positivity.A positive amyloid PET is not necessarily associated with tau positivity.Tau PET could be the sole diagnostic tool to confirm candidates for AD trials.
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Affiliation(s)
| | - Amanda Morris
- Eli Lilly and CompanyIndianapolisIndianaUSA
- Avid RadiopharmaceuticalsPhiladelphiaPennsylvaniaUSA
| | | | | | - Ming Lu
- Eli Lilly and CompanyIndianapolisIndianaUSA
- Avid RadiopharmaceuticalsPhiladelphiaPennsylvaniaUSA
| | | | - Sudeepti Southekal
- Eli Lilly and CompanyIndianapolisIndianaUSA
- Avid RadiopharmaceuticalsPhiladelphiaPennsylvaniaUSA
| | - Vikas Kotari
- Eli Lilly and CompanyIndianapolisIndianaUSA
- Avid RadiopharmaceuticalsPhiladelphiaPennsylvaniaUSA
| | | | - Anupa K. Arora
- Eli Lilly and CompanyIndianapolisIndianaUSA
- Avid RadiopharmaceuticalsPhiladelphiaPennsylvaniaUSA
| | - Emily C. Collins
- Eli Lilly and CompanyIndianapolisIndianaUSA
- Avid RadiopharmaceuticalsPhiladelphiaPennsylvaniaUSA
| | - Michael Pontecorvo
- Eli Lilly and CompanyIndianapolisIndianaUSA
- Avid RadiopharmaceuticalsPhiladelphiaPennsylvaniaUSA
| | - Mark A. Mintun
- Eli Lilly and CompanyIndianapolisIndianaUSA
- Avid RadiopharmaceuticalsPhiladelphiaPennsylvaniaUSA
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Kotari V, Southekal S, Navitsky M, Kennedy IA, Lu M, Morris A, Zimmer JA, Fleisher AS, Mintun MA, Devous MD, Pontecorvo MJ. Early tau detection in flortaucipir images: validation in autopsy-confirmed data and implications for disease progression. Alzheimers Res Ther 2023; 15:41. [PMID: 36855201 PMCID: PMC9972744 DOI: 10.1186/s13195-023-01160-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/01/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND There is an increasing interest in utilizing tau PET to identify patients early in Alzheimer's disease (AD). In this work, a temporal lobe composite (Eτ) volume of interest (VOI) was evaluated in a longitudinal flortaucipir cohort and compared to a previously described global neocortical VOI. In a separate autopsy-confirmed study, the sensitivity of the Eτ VOI for identifying intermediate (B2) neurofibrillary tangle (NFT) pathology was evaluated. METHODS A total of 427 subjects received flortaucipir, florbetapir, MRI, and cognitive evaluation at baseline and 18 months. In a separate autopsy study, 67 subjects received ante-mortem flortaucipir scans, and neuropathological findings were recorded according to NIA-AA recommendations by two experts. Two VOIs: Eτ comprising FreeSurfer volumes (bilateral entorhinal cortex, fusiform, parahippocampal, and inferior temporal gyri) transformed to MNI space and a previously published global AD signature-weighted neocortical VOI (ADsignature) (Devous et al., J Nucl Med 59:937-43, 2018), were used to calculate SUVr relative to a white matter reference region (PERSI) (Southekal et al., J Nucl Med Off Publ Soc Nucl Med 59:944-51, 2018). SUVr cutoffs for positivity were determined based on a cohort of young, cognitively normal subjects. Subjects were grouped based on positivity on both VOIs (Eτ+/ADsignature+; Eτ+/ADsignature-; Eτ-/ADsignature-). Groupwise comparisons were performed for baseline SUVr, 18-month changes in SUVr, neurodegeneration, and cognition. For the autopsy study, the sensitivity of Eτ in identifying intermediate Braak pathology (B2) subjects was compared to that of AD signature-weighted neocortical VOI. The average surface maps of subjects in the Eτ+/ADsignature- group and B2 NFT scores were created for visual evaluation of uptake. RESULTS Sixty-four out of 390 analyzable subjects were identified as Eτ+/ADsignature-: 84% were Aβ+, 100% were diagnosed as MCI or AD, and 59% were APOE ε4 carriers. Consistent with the hypothesis that Eτ+/ADsignature- status reflects an early stage of AD, Eτ+/ADsignature- subjects deteriorated significantly faster than Eτ-/ADsignature- subjects, but significantly slower than Eτ+/ADsignature+ subjects, on most measures (i.e., change in ADsignature SUVr, Eτ ROI cortical thickness, and MMSE). The ADsignature VOI was selective for subjects who came to autopsy with a B3 NFT score. In the autopsy study, 12/15 B2 subjects (including 10/11 Braak IV) were Eτ+/ADsignature-. Surface maps showed that flortaucipir uptake was largely captured by the Eτ VOI regions in B2 subjects. CONCLUSION The Eτ VOI identified subjects with elevated temporal but not global tau (Eτ+/ADsignature-) that were primarily Aβ+, APOE ε4 carriers, and diagnosed as MCI or AD. Eτ+/ADsignature- subjects had greater accumulation of tau, greater atrophy, and higher decline on MMSE in 18 months compared to Eτ-/ADsignature- subjects. Finally, the Eτ VOI identified the majority of the intermediate NFT score subjects in an autopsy-confirmed study. As far as we know, this is the first study that presents a visualization of ante-mortem FTP retention patterns that at a group level agree with the neurofibrillary tangle staging scheme proposed by Braak. These findings suggest that the Eτ VOI may be sensitive for detecting impaired subjects early in the course of Alzheimer's disease.
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Affiliation(s)
- Vikas Kotari
- Eli Lilly and Company, Indianapolis, IN, 46285, USA.
| | - Sudeepti Southekal
- grid.417540.30000 0000 2220 2544Eli Lilly and Company, Indianapolis, IN 46285 USA
| | - Michael Navitsky
- grid.417540.30000 0000 2220 2544Eli Lilly and Company, Indianapolis, IN 46285 USA
| | - Ian A. Kennedy
- grid.417540.30000 0000 2220 2544Eli Lilly and Company, Indianapolis, IN 46285 USA
| | - Ming Lu
- grid.417540.30000 0000 2220 2544Eli Lilly and Company, Indianapolis, IN 46285 USA
| | - Amanda Morris
- grid.417540.30000 0000 2220 2544Eli Lilly and Company, Indianapolis, IN 46285 USA
| | - Jennifer Ann Zimmer
- grid.417540.30000 0000 2220 2544Eli Lilly and Company, Indianapolis, IN 46285 USA
| | - Adam S. Fleisher
- grid.417540.30000 0000 2220 2544Eli Lilly and Company, Indianapolis, IN 46285 USA
| | - Mark A. Mintun
- grid.417540.30000 0000 2220 2544Eli Lilly and Company, Indianapolis, IN 46285 USA
| | - Michael D. Devous
- grid.417540.30000 0000 2220 2544Eli Lilly and Company, Indianapolis, IN 46285 USA
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Pontecorvo MJ, Lu M, Burnham SC, Schade AE, Dage JL, Shcherbinin S, Collins EC, Sims JR, Mintun MA. Association of Donanemab Treatment With Exploratory Plasma Biomarkers in Early Symptomatic Alzheimer Disease: A Secondary Analysis of the TRAILBLAZER-ALZ Randomized Clinical Trial. JAMA Neurol 2022; 79:1250-1259. [PMID: 36251300 PMCID: PMC9577883 DOI: 10.1001/jamaneurol.2022.3392] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Importance Plasma biomarkers of Alzheimer disease may be useful as minimally invasive pharmacodynamic measures of treatment outcomes. Objective To analyze the association of donanemab treatment with plasma biomarkers associated with Alzheimer disease. Design, Setting, and Participants TRAILBLAZER-ALZ was a randomized, double-blind, placebo-controlled clinical trial conducted from December 18, 2017, to December 4, 2020, across 56 sites in the US and Canada. Exploratory biomarkers were prespecified with the post hoc addition of plasma glial fibrillary acidic protein and amyloid-β. Men and women aged 60 to 85 years with gradual and progressive change in memory function for at least 6 months were included. A total of 1955 participants were assessed for eligibility. Key eligibility criteria include Mini-Mental State Examination scores of 20 to 28 and elevated amyloid and intermediate tau levels. Interventions Randomized participants received donanemab or placebo every 4 weeks for up to 72 weeks. The first 3 doses of donanemab were given at 700 mg and then increased to 1400 mg with blinded dose reductions as specified based on amyloid reduction. Main Outcomes and Measures Change in plasma biomarker levels after donanemab treatment. Results In TRAILBLAZER-ALZ, 272 participants (mean [SD] age, 75.2 [5.5] years; 145 [53.3%] female) were randomized. Plasma levels of phosphorylated tau217 (pTau217) and glial fibrillary acidic protein were significantly lower with donanemab treatment compared with placebo as early as 12 weeks after the start of treatment (least square mean change difference vs placebo, -0.04 [95% CI, -0.07 to -0.02]; P = .002 and -0.04 [95% CI, -0.07 to -0.01]; P = .01, respectively). No significant differences in plasma levels of amyloid-β 42/40 and neurofilament light chain were observed between treatment arms at the end of treatment. Changes in plasma pTau217 and glial fibrillary acidic protein were significantly correlated with the Centiloid percent change in amyloid (Spearman rank correlation coefficient [R] = 0.484 [95% CI, 0.359-0.592]; P < .001 and R = 0.453 [95% CI, 0.306-0.579]; P < .001, respectively) following treatment. Additionally, plasma levels of pTau217 and glial fibrillary acidic protein were significantly correlated at baseline and following treatment (R = 0.399 [95% CI, 0.278-0.508], P < .001 and R = 0.393 [95% CI, 0.254-0.517]; P < .001, respectively). Conclusions and Relevance Significant reductions in plasma biomarkers pTau217 and glial fibrillary acidic protein compared with placebo were observed following donanemab treatment in patients with early symptomatic Alzheimer disease. These easily accessible plasma biomarkers might provide additional evidence of Alzheimer disease pathology change through anti-amyloid therapy. Usefulness in assessing treatment response will require further evaluation. Trial Registration ClinicalTrials.gov Identifier: NCT03367403.
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Affiliation(s)
- Michael J. Pontecorvo
- Avid Radiopharmaceuticals, Philadelphia, Pennsylvania,Eli Lilly and Company, Indianapolis, Indiana
| | - Ming Lu
- Avid Radiopharmaceuticals, Philadelphia, Pennsylvania,Eli Lilly and Company, Indianapolis, Indiana
| | - Samantha C. Burnham
- Avid Radiopharmaceuticals, Philadelphia, Pennsylvania,Eli Lilly and Company, Indianapolis, Indiana
| | | | - Jeffrey L. Dage
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis
| | | | - Emily C. Collins
- Avid Radiopharmaceuticals, Philadelphia, Pennsylvania,Eli Lilly and Company, Indianapolis, Indiana
| | | | - Mark A. Mintun
- Avid Radiopharmaceuticals, Philadelphia, Pennsylvania,Eli Lilly and Company, Indianapolis, Indiana
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Shcherbinin S, Evans CD, Lu M, Andersen SW, Pontecorvo MJ, Willis BA, Gueorguieva I, Hauck PM, Brooks DA, Mintun MA, Sims JR. Association of Amyloid Reduction After Donanemab Treatment With Tau Pathology and Clinical Outcomes: The TRAILBLAZER-ALZ Randomized Clinical Trial. JAMA Neurol 2022; 79:1015-1024. [PMID: 36094645 PMCID: PMC9468959 DOI: 10.1001/jamaneurol.2022.2793] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Question Is donanemab-induced amyloid reduction associated with slowing of tau pathology and clinical decline in individuals with Alzheimer disease? Findings In early symptomatic Alzheimer disease, donanemab induced a robust decrease in amyloid plaque levels by 24 weeks, with baseline plaque directly associated with magnitude of amyloid reduction and inversely associated with probability of complete clearance. In individuals with amyloid clearance, post hoc modeling suggests that amyloid levels would remain below the positivity threshold for almost 4 years without treatment; in treated patients, greater plaque clearance was associated with slower progression of tau positron emission tomography and slower clinical decline (in apolipoprotein E ε4 carriers only). Meaning Exploratory post hoc analyses of the Study of LY3002813 in Participants With Early Symptomatic Alzheimer’s Disease (TRAILBLAZER-ALZ) identified potential associations between amyloid lowering, tau pathology, and clinical outcomes. Importance β-amyloid plaques and neurofibrillary tau deposits biologically define Alzheimer disease. Objective To perform post hoc analyses of amyloid reduction after donanemab treatment and assess its association with tau pathology and clinical measures. Design, Setting, and Participants The Study of LY3002813 in Participants With Early Symptomatic Alzheimer’s Disease (TRAILBLAZER-ALZ) was a phase 2, placebo-controlled, randomized clinical trial conducted from December 18, 2017, to December 4, 2020, with a double-blind period of up to 76 weeks and a 48-week follow-up period. The study was conducted at 56 centers in the US and Canada. Enrolled were participants from 60 to 85 years of age with gradual and progressive change in memory function for 6 months or more, early symptomatic Alzheimer disease, elevated amyloid, and intermediate tau levels. Interventions Donanemab (an antibody specific for the N-terminal pyroglutamate β-amyloid epitope) dosing was every 4 weeks: 700 mg for the first 3 doses, then 1400 mg for up to 72 weeks. Blinded dose-reduction evaluations occurred at 24 and 52 weeks based on amyloid clearance. Main Outcomes and Measures Change in amyloid, tau, and clinical decline after donanemab treatment. Results The primary study randomized 272 participants (mean [SD] age, 75.2 [5.5] years; 145 female participants [53.3%]). The trial excluded 1683 of 1955 individuals screened. The rate of donanemab-induced amyloid reduction at 24 weeks was moderately correlated with the amount of baseline amyloid (Spearman correlation coefficient r, −0.54; 95% CI, −0.66 to −0.39; P < .001). Modeling provides a hypothesis that amyloid would not reaccumulate to the 24.1-centiloid threshold for 3.9 years (95% prediction interval, 1.9-8.3 years) after discontinuing donanemab treatment. Donanemab slowed tau accumulation in a region-dependent manner as measured using neocortical and regional standardized uptake value ratios with cerebellar gray reference region. A disease-progression model found a significant association between percentage amyloid reduction and change on the integrated Alzheimer Disease Rating Scale only in apolipoprotein E (APOE) ε4 carriers (95% CI, 24%-59%; P < .001). Conclusions and Relevance Results of post hoc analyses for donanemab-treated participants suggest that baseline amyloid levels were directly associated with the magnitude of amyloid reduction and inversely associated with the probability of achieving complete amyloid clearance. The donanemab-induced slowing of tau was more pronounced in those with complete amyloid clearance and in brain regions identified later in the pathologic sequence. Data from other trials will be important to confirm aforementioned observations, particularly treatment response by APOE ε4 status. Trial Registration ClinicalTrials.gov Identifier: NCT03367403
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Affiliation(s)
| | | | - Ming Lu
- Eli Lilly and Company, Indianapolis, Indiana.,Avid Radiopharmaceuticals, a wholly owned subsidiary of Eli Lilly and Company, Philadelphia, Pennsylvania
| | | | - Michael J Pontecorvo
- Eli Lilly and Company, Indianapolis, Indiana.,Avid Radiopharmaceuticals, a wholly owned subsidiary of Eli Lilly and Company, Philadelphia, Pennsylvania
| | - Brian A Willis
- Eli Lilly and Company, Indianapolis, Indiana.,Now with Eisai Inc, Nutley, New Jersey
| | | | | | | | - Mark A Mintun
- Eli Lilly and Company, Indianapolis, Indiana.,Avid Radiopharmaceuticals, a wholly owned subsidiary of Eli Lilly and Company, Philadelphia, Pennsylvania
| | - John R Sims
- Eli Lilly and Company, Indianapolis, Indiana
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Wang Q, Chen G, Schindler SE, Christensen J, McKay NS, Liu J, Wang S, Sun Z, Hassenstab J, Su Y, Flores S, Hornbeck R, Cash L, Cruchaga C, Fagan AM, Tu Z, Morris JC, Mintun MA, Wang Y, Benzinger TL. Baseline Microglial Activation Correlates With Brain Amyloidosis and Longitudinal Cognitive Decline in Alzheimer Disease. Neurol Neuroimmunol Neuroinflamm 2022; 9:e1152. [PMID: 35260470 PMCID: PMC8906187 DOI: 10.1212/nxi.0000000000001152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/06/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES This study aims to quantify microglial activation in individuals with Alzheimer disease (AD) using the 18-kDa translocator protein (TSPO) PET imaging in the hippocampus and precuneus, the 2 AD-vulnerable regions, and to evaluate the association of baseline neuroinflammation with amyloidosis, tau, and longitudinal cognitive decline. METHODS Twenty-four participants from the Knight Alzheimer Disease Research Center (Knight ADRC) were enrolled and classified into stable cognitively normal, progressor, and symptomatic AD groups based on clinical dementia rating (CDR) at 2 or more clinical assessments. The baseline TSPO radiotracer [11C]PK11195 was used to image microglial activation. Baseline CSF concentrations of Aβ42, Aβ42/Aβ40 ratio, tau phosphorylated at position 181 (p-tau181), and total tau (t-tau) were measured. Clinical and cognitive decline were examined with longitudinal CDR and cognitive composite scores (Global and Knight ADRC-Preclinical Alzheimer Cognitive Composite [Knight ADRC-PACC] Score). RESULTS Participants in the progressor and symptomatic AD groups had significantly elevated [11C]PK11195 standard uptake value ratios (SUVRs) in the hippocampus but not in the precuneus region. In the subcohort with CSF biomarkers (16 of the 24), significant negative correlations between CSF Aβ42 or Aβ42/Aβ40 and [11C]PK11195 SUVR were observed in the hippocampus and precuneus. No correlations were observed between [11C]PK11195 SUVR and CSF p-tau181 or t-tau at baseline in those regions. Higher baseline [11C]PK11195 SUVR averaged in the whole cortical regions predicted longitudinal decline on cognitive tests. DISCUSSION Microglial activation is increased in individuals with brain amyloidosis and predicts worsening cognition in AD. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with AD, higher baseline [11C]PK11195 SUVR averaged in the whole cortical regions was associated with longitudinal decline on cognitive tests.
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Affiliation(s)
- Qing Wang
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Gengsheng Chen
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Suzanne E. Schindler
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Jon Christensen
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Nicole S. McKay
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Jingxia Liu
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Sicheng Wang
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Zhexian Sun
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Jason Hassenstab
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Yi Su
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Shaney Flores
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Russ Hornbeck
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Lisa Cash
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Carlos Cruchaga
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Anne M. Fagan
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Zhude Tu
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - John C. Morris
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Mark A. Mintun
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Yong Wang
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
| | - Tammie L.S. Benzinger
- From the Mallinckrodt Institute of Radiology (Q.W., G.C., J.C., S.F., R.H., Z.T., Y.W., T.L.S.B.), Washington University School of Medicine; Knight Alzheimer Disease Research Center (Q.W., G.C., S.E.S., J.H., L.C., A.M.F., J.C.M., T.L.S.B.), Washington University School of Medicine; Department of Neurology (S.E.S., J.H., C.C., A.M.F., J.C.M.), Washington University School of Medicine; Department of Surgery (J.L.), Washington University School of Medicine; Department of Electrical and System Engineering (S.W., Y.W.), Washington University School of Med-icine; Department of Biomedical Engineering (Z.S., Y.W.), Washington University School of Medicine, St. Louis, MO; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (Y.S.), Phoenix, AZ; Department of Psychiatry (C.C.), Washington University School of Medicine, St. Louis, MO; Avid Radiopharmaceuticals (M.A.M.), Philadelphia, PA; Department of Obstetrics and Gynecology (Y.W.), Washington University School of Medicine; and Department of Neurosurgery (T.L.S.B.), Washington University School of Medicine, St. Louis, MO
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Jansen WJ, Janssen O, Tijms BM, Vos SJB, Ossenkoppele R, Visser PJ, Aarsland D, Alcolea D, Altomare D, von Arnim C, Baiardi S, Baldeiras I, Barthel H, Bateman RJ, Van Berckel B, Binette AP, Blennow K, Boada M, Boecker H, Bottlaender M, den Braber A, Brooks DJ, Van Buchem MA, Camus V, Carill JM, Cerman J, Chen K, Chételat G, Chipi E, Cohen AD, Daniels A, Delarue M, Didic M, Drzezga A, Dubois B, Eckerström M, Ekblad LL, Engelborghs S, Epelbaum S, Fagan AM, Fan Y, Fladby T, Fleisher AS, Van der Flier WM, Förster S, Fortea J, Frederiksen KS, Freund-Levi Y, Frings L, Frisoni GB, Fröhlich L, Gabryelewicz T, Gertz HJ, Gill KD, Gkatzima O, Gómez-Tortosa E, Grimmer T, Guedj E, Habeck CG, Hampel H, Handels R, Hansson O, Hausner L, Hellwig S, Heneka MT, Herukka SK, Hildebrandt H, Hodges J, Hort J, Huang CC, Iriondo AJ, Itoh Y, Ivanoiu A, Jagust WJ, Jessen F, Johannsen P, Johnson KA, Kandimalla R, Kapaki EN, Kern S, Kilander L, Klimkowicz-Mrowiec A, Klunk WE, Koglin N, Kornhuber J, Kramberger MG, Kuo HC, Van Laere K, Landau SM, Landeau B, Lee DY, de Leon M, Leyton CE, Lin KJ, Lleó A, Löwenmark M, Madsen K, Maier W, Marcusson J, Marquié M, Martinez-Lage P, Maserejian N, Mattsson N, de Mendonça A, Meyer PT, Miller BL, Minatani S, Mintun MA, Mok VCT, Molinuevo JL, Morbelli SD, Morris JC, Mroczko B, Na DL, Newberg A, Nobili F, Nordberg A, Olde Rikkert MGM, de Oliveira CR, Olivieri P, Orellana A, Paraskevas G, Parchi P, Pardini M, Parnetti L, Peters O, Poirier J, Popp J, Prabhakar S, Rabinovici GD, Ramakers IH, Rami L, Reiman EM, Rinne JO, Rodrigue KM, Rodríguez-Rodriguez E, Roe CM, Rosa-Neto P, Rosen HJ, Rot U, Rowe CC, Rüther E, Ruiz A, Sabri O, Sakhardande J, Sánchez-Juan P, Sando SB, Santana I, Sarazin M, Scheltens P, Schröder J, Selnes P, Seo SW, Silva D, Skoog I, Snyder PJ, Soininen H, Sollberger M, Sperling RA, Spiru L, Stern Y, Stomrud E, Takeda A, Teichmann M, Teunissen CE, Thompson LI, Tomassen J, Tsolaki M, Vandenberghe R, Verbeek MM, Verhey FRJ, Villemagne V, Villeneuve S, Vogelgsang J, Waldemar G, Wallin A, Wallin ÅK, Wiltfang J, Wolk DA, Yen TC, Zboch M, Zetterberg H. Prevalence Estimates of Amyloid Abnormality Across the Alzheimer Disease Clinical Spectrum. JAMA Neurol 2022; 79:228-243. [PMID: 35099509 DOI: 10.1001/jamaneurol.2021.5216] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE One characteristic histopathological event in Alzheimer disease (AD) is cerebral amyloid aggregation, which can be detected by biomarkers in cerebrospinal fluid (CSF) and on positron emission tomography (PET) scans. Prevalence estimates of amyloid pathology are important for health care planning and clinical trial design. OBJECTIVE To estimate the prevalence of amyloid abnormality in persons with normal cognition, subjective cognitive decline, mild cognitive impairment, or clinical AD dementia and to examine the potential implications of cutoff methods, biomarker modality (CSF or PET), age, sex, APOE genotype, educational level, geographical region, and dementia severity for these estimates. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, individual-participant pooled study included participants from 85 Amyloid Biomarker Study cohorts. Data collection was performed from January 1, 2013, to December 31, 2020. Participants had normal cognition, subjective cognitive decline, mild cognitive impairment, or clinical AD dementia. Normal cognition and subjective cognitive decline were defined by normal scores on cognitive tests, with the presence of cognitive complaints defining subjective cognitive decline. Mild cognitive impairment and clinical AD dementia were diagnosed according to published criteria. EXPOSURES Alzheimer disease biomarkers detected on PET or in CSF. MAIN OUTCOMES AND MEASURES Amyloid measurements were dichotomized as normal or abnormal using cohort-provided cutoffs for CSF or PET or by visual reading for PET. Adjusted data-driven cutoffs for abnormal amyloid were calculated using gaussian mixture modeling. Prevalence of amyloid abnormality was estimated according to age, sex, cognitive status, biomarker modality, APOE carrier status, educational level, geographical location, and dementia severity using generalized estimating equations. RESULTS Among the 19 097 participants (mean [SD] age, 69.1 [9.8] years; 10 148 women [53.1%]) included, 10 139 (53.1%) underwent an amyloid PET scan and 8958 (46.9%) had an amyloid CSF measurement. Using cohort-provided cutoffs, amyloid abnormality prevalences were similar to 2015 estimates for individuals without dementia and were similar across PET- and CSF-based estimates (24%; 95% CI, 21%-28%) in participants with normal cognition, 27% (95% CI, 21%-33%) in participants with subjective cognitive decline, and 51% (95% CI, 46%-56%) in participants with mild cognitive impairment, whereas for clinical AD dementia the estimates were higher for PET than CSF (87% vs 79%; mean difference, 8%; 95% CI, 0%-16%; P = .04). Gaussian mixture modeling-based cutoffs for amyloid measures on PET scans were similar to cohort-provided cutoffs and were not adjusted. Adjusted CSF cutoffs resulted in a 10% higher amyloid abnormality prevalence than PET-based estimates in persons with normal cognition (mean difference, 9%; 95% CI, 3%-15%; P = .004), subjective cognitive decline (9%; 95% CI, 3%-15%; P = .005), and mild cognitive impairment (10%; 95% CI, 3%-17%; P = .004), whereas the estimates were comparable in persons with clinical AD dementia (mean difference, 4%; 95% CI, -2% to 9%; P = .18). CONCLUSIONS AND RELEVANCE This study found that CSF-based estimates using adjusted data-driven cutoffs were up to 10% higher than PET-based estimates in people without dementia, whereas the results were similar among people with dementia. This finding suggests that preclinical and prodromal AD may be more prevalent than previously estimated, which has important implications for clinical trial recruitment strategies and health care planning policies.
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Affiliation(s)
- Willemijn J Jansen
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Banner Alzheimer's Institute, Phoenix, Arizona
| | - Olin Janssen
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Betty M Tijms
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center (UMC), Amsterdam, the Netherlands
| | - Stephanie J B Vos
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Rik Ossenkoppele
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center (UMC), Amsterdam, the Netherlands.,Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Pieter Jelle Visser
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center (UMC), Amsterdam, the Netherlands.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Dag Aarsland
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden.,Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Daniel Alcolea
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Memory Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Daniele Altomare
- Laboratory Alzheimer's Neuroimaging and Epidemiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fatebenefratelli, Brescia, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Christine von Arnim
- Division of Geriatrics, University of Goettingen Medical School, Goettingen, Germany.,Clinic for Neurogeriatrics and Neurological Rehabilitation, University and Rehabilitation Hospital Ulm, Ulm, Germany
| | - Simone Baiardi
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Spain
| | - Ines Baldeiras
- Center for Neuroscience and Cell Biology (CIBB), University of Coimbra, Coimbra, Portugal.,Neurology Department and Laboratory of Neurochemistry, Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
| | - Henryk Barthel
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Randall J Bateman
- Department of Neurology and the Alzheimer's Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Bart Van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alexa Pichet Binette
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Department of Neuroscience and Physiology, Sahlgren's University Hospital, Mölndal, Sweden
| | - Merce Boada
- Research Center and Memory Clinic of Fundació Alzheimer Centre Educacional, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | - Henning Boecker
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Bonn, Germany
| | - Michel Bottlaender
- Université Paris-Saclay, Service Hospitalier Frédéric Joliot (CEA), French National Centre for Scientific Research (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), BioMaps, Service Hospitalier Frederic Joliot, Orsay, France
| | - Anouk den Braber
- Department of Neurology, Alzheimer Centre Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - David J Brooks
- Translational and Clinical Research Institute, University of Newcastle upon Tyne, United Kingdom.,Department of Nuclear Medicine, Positron Emission Tomography Centre, Aarhus University, Aarhus, Denmark.,Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Mark A Van Buchem
- Department of Neurology, University Hospital Leiden, Leiden, the Netherlands
| | - Vincent Camus
- Unite Mixte de Recherche, INSERM U930, French National Centre for Scientific Research (CNRS) ERL, Tours, France
| | - Jose Manuel Carill
- Nuclear Medicine Department, University Hospital Marqués de Valdecilla, Molecular Imaging, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), University of Cantabria, Santander, Spain
| | - Jiri Cerman
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Kewei Chen
- Banner Alzheimer's Institute, Phoenix, Arizona
| | - Gaël Chételat
- Normandie University, University of Caen Normandie (UNICAEN), INSERM, U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institut Blood and Brain at Caen-Normandie, Cyceron, Caen, France
| | - Elena Chipi
- Centro Disturbi della Memoria, Laboratorio di Neurochimica Clinica, Clinica Neurologica, Università di Perugia, Perugia, Italy
| | - Ann D Cohen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alisha Daniels
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Marion Delarue
- Normandie University, University of Caen Normandie (UNICAEN), INSERM, U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institut Blood and Brain at Caen-Normandie, Cyceron, Caen, France
| | - Mira Didic
- Assistance Publique Hôpitaux de Marseille (AP-HM), Timone, Service de Neurologie et Neuropsychologie, Hôpital Timone Adultes, Marseille, France.,Aix Marseille Univ, INSERM, Institut de Neurosciences des Systèmes (INS), Marseille, France
| | - Alexander Drzezga
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Bonn, Germany.,Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - Bruno Dubois
- Department of Neurology, Institut de la Mémoire et de la Maladie d'Alzheimer, Centre de Référence Démences Rares, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Marie Eckerström
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | | | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), University of Antwerp, Antwerp, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stéphane Epelbaum
- Department of Neurology, Institut de la Mémoire et de la Maladie d'Alzheimer, Centre de Référence Démences Rares, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne M Fagan
- Department of Neurology and the Alzheimer's Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Yong Fan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tormod Fladby
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway
| | | | - Wiesje M Van der Flier
- Department of Neurology, Alzheimer Centre Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Stefan Förster
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Department of Nuclear Medicine, Klinikum Bayreuth, Bayreuth, Germany
| | - Juan Fortea
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Memory Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Kristian Steen Frederiksen
- Danish Dementia Research Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Yvonne Freund-Levi
- School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet Center for Alzheimer Research, Stockholm, Sweden.,Department of Old Age Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Lars Frings
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Giovanni B Frisoni
- Memory Clinic, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Lutz Fröhlich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Tomasz Gabryelewicz
- Department of Neurodegenerative Disorders, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Hermann-Josef Gertz
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Kiran Dip Gill
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Olymbia Gkatzima
- Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | | | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Eric Guedj
- Aix Marseille University, AP-HM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, Centre Européen de Recherche en Imagerie Médicale (CERIMED), Nuclear Medicine Department, Marseille, France
| | - Christian G Habeck
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York
| | - Harald Hampel
- Sorbonne University, Clinical Research Group no. 21, Alzheimer Precision Medicine, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Ron Handels
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Lucrezia Hausner
- Universität Heidelberg, Abteilung Gerontopsychiatrie, Zentralinstitut für Seelische Gesundheit Mannheim, Mannheim, Germany
| | - Sabine Hellwig
- Department of Psychiatry and Psychotherapy Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael T Heneka
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital of Bonn, Bonn, Germany.,Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester
| | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Helmut Hildebrandt
- Klinikum Bremen-Ost, University of Oldenburg, Institute of Psychology, Oldenburg, Germany
| | - John Hodges
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jakub Hort
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | | | - Ane Juaristi Iriondo
- Center for Research and Advanced Therapies, Centro de Investigación y Ciencias Avanzadas-Alzheimer Foundation, Donostia-San Sebastian, Spain
| | - Yoshiaki Itoh
- Department of Neurology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Adrian Ivanoiu
- Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - William J Jagust
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley.,Division of Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley National Laboratory, Berkeley, California
| | - Frank Jessen
- Department of Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany.,Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,DZNE, Bonn, Germany
| | - Peter Johannsen
- Memory Disorder Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Keith A Johnson
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Ramesh Kandimalla
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Department of Radiation Oncology, Emory University, Atlanta, Georgia.,Applied Biology, Council of Scientific and Industrial Research (CSIR)-Indian Institute of Chemical Technology, Uppal Road, Tarnaka, Hyderabad, Telangana State, India.,Department of Biochemistry, Kakatiya Medical College/Mahatma Gandhi Memorial Hospital, Warangal, Telangana State, India
| | - Elisabeth N Kapaki
- National and Kapodistrian University of Athens, School of Medicine, 1st Department of Neurology, Eginition Hospital, Athens, Greece
| | - Silke Kern
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Aleksandra Klimkowicz-Mrowiec
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - William E Klunk
- Department of Psychiatry, Massachusetts General Hospital, Boston.,Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Milica G Kramberger
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Hung-Chou Kuo
- Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Koen Van Laere
- Division of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Susan M Landau
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley
| | - Brigitte Landeau
- Normandie University, University of Caen Normandie (UNICAEN), INSERM, U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institut Blood and Brain at Caen-Normandie, Cyceron, Caen, France
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Mony de Leon
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Cristian E Leyton
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Kun-Ju Lin
- Healthy Aging Research Center and Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nuclear Medicine and Molecular Imaging Center, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Alberto Lleó
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Memory Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Malin Löwenmark
- Memory Clinic, Department of Geriatrics, Uppsala University Hospital, Uppsala, Sweden
| | - Karine Madsen
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Wolfgang Maier
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - Jan Marcusson
- Acute Internal Medicine and Geriatrics, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marta Marquié
- Research Center and Memory Clinic of Fundació Alzheimer Centre Educacional, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | - Pablo Martinez-Lage
- Center for Research and Advanced Therapies, CITA-Alzheimer Foundation, Donostia-San Sebastian, Spain
| | | | - Niklas Mattsson
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | | | - Philipp T Meyer
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Shinobu Minatani
- Department of Neurology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Mark A Mintun
- Avid Radiopharmaceuticals, Philadelphia, Pennsylvania
| | - Vincent C T Mok
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China.,BrainNow Research Institute, Guangdong Province, Shenzhen, China
| | - Jose Luis Molinuevo
- Alzheimer's Disease and Other Cognitive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Clinic University Hospital, Barcelona, Spain
| | - Silvia Daniela Morbelli
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - John C Morris
- Department of Neurology and the Alzheimer's Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Barbara Mroczko
- Department of Neurodegeneration Diagnostics, Medical University of Białystok, Białystok, Poland.,Department of Biochemical Diagnostics, University Hospital of Białystok, Białystok, Poland
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Andrew Newberg
- Myrna Brind Center of Integrative Medicine, Thomas Jefferson University and Hospital, Philadelphia, Pennsylvania
| | - Flavio Nobili
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Agneta Nordberg
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden.,Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Pauline Olivieri
- Department of Neurology of Memory and Language, Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences, Hôpital Sainte Anne, F-75014, Paris, France.,Université de Paris, Paris, Université Paris-Saclay, BioMaps, CEA, CNRS, INSERM, Orsay, France
| | - Adela Orellana
- Research Center and Memory Clinic of Fundació Alzheimer Centre Educacional, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | - George Paraskevas
- National and Kapodistrian University of Athens, School of Medicine, 1st Department of Neurology, Eginition Hospital, Athens, Greece
| | - Piero Parchi
- Istituto delle Scienze Neurologiche di Bologna, IRCCS, Bologna, Italy.,DIMES, University of Bologna, Bologna, Italy
| | | | - Lucilla Parnetti
- Centro Disturbi della Memoria, Laboratorio di Neurochimica Clinica, Clinica Neurologica, Università di Perugia, Perugia, Italy
| | - Oliver Peters
- Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin-CBF, Berlin, Deutschland
| | - Judes Poirier
- Studies on Prevention of Alzheimer's Disease (StOP-AD) Centre, Montreal, Quebec, Canada
| | - Julius Popp
- Department of Geriatric Psychiatry, University Hospital of Psychiatry Zürich and University of Zürich, Zürich, Switzerland.,Old Age Psychiatry, Department of Psychiatry, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Sudesh Prabhakar
- Department of Neurology, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Inez H Ramakers
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Lorena Rami
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic of Barcelona, IDIBAPS, Barcelona, Spain
| | | | | | - Karen M Rodrigue
- Center for Vital Longevity, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas
| | | | - Catherine M Roe
- Department of Neurology and the Alzheimer's Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Pedro Rosa-Neto
- Studies on Prevention of Alzheimer's Disease (StOP-AD) Centre, Montreal, Quebec, Canada
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Uros Rot
- Department of Neurology, Medical Center, Zaloska 7, Ljubljana, Slovenia
| | - Christopher C Rowe
- Department of Molecular Imaging, Austin Health, Melbourne, Victoria, Australia.,Florey Department of Neuroscience, University of Melbourne, Melbourne, Victoria, Australia
| | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August University, Göttingen, Germany
| | - Agustín Ruiz
- Research Center and Memory Clinic of Fundació Alzheimer Centre Educacional, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Jayant Sakhardande
- Cognitive Neuroscience Division, Department of Neurology and the Taub Institute, Columbia University, New York, New York
| | - Pascual Sánchez-Juan
- Service of Neurology, University Hospital Marqués de Valdecilla-IDIVAL, CIBERNED, Santander, Spain
| | - Sigrid Botne Sando
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology, University Hospital of Trondheim, Trondheim, Norway
| | - Isabel Santana
- Center for Neuroscience and Cell Biology (CIBB), University of Coimbra, Coimbra, Portugal.,Neurology Department and Laboratory of Neurochemistry, Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
| | - Marie Sarazin
- Department of Neurology of Memory and Language, Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences, Hôpital Sainte Anne, F-75014, Paris, France.,Université de Paris, Paris, Université Paris-Saclay, BioMaps, CEA, CNRS, INSERM, Orsay, France
| | - Philip Scheltens
- Department of Neurology, Alzheimer Centre Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Johannes Schröder
- Section for Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Per Selnes
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway
| | - Sang Won Seo
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Dina Silva
- Faculty of Medicine, University of Lisboa, Lisboa, Portugal
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Peter J Snyder
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, The University of Rhode Island, Kingston
| | - Hilkka Soininen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurocenter, Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Marc Sollberger
- Memory Clinic, University Department of Geriatric Medicine, Felix Platter-Hospital, Basel, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Reisa A Sperling
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Harvard Aging Brain Study, Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Luisa Spiru
- Geriatrics, Gerontology and Old Age Psychiatry Clinical Department, Carol Davila University of Medicine and Pharmacy-Elias, Emergency Clinical Hospital, Bucharest, Romania.,Memory Clinic and Longevity Medicine, Ana Aslan International Foundation, Bucharest, Romania
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology and the Taub Institute, Columbia University, New York, New York
| | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Akitoshi Takeda
- Department of Neurology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Marc Teichmann
- Department of Neurology, Institut de la Mémoire et de la Maladie d'Alzheimer, Centre de Référence Démences Rares, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Centre de Référence Démences Rares, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Charlotte E Teunissen
- Department of Neurology, Alzheimer Centre Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Louisa I Thompson
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jori Tomassen
- Department of Neurology, Alzheimer Centre Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Magda Tsolaki
- Aristotle University of Thessaloniki, Memory and Dementia Center, 3rd Department of Neurology, George Papanicolau General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, University of Leuven, Leuven, Belgium.,Neurology Department, University Hospitals Leuven, Leuven, Belgium
| | - Marcel M Verbeek
- Departments of Neurology and Laboratory Medicine, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Nijmegen, the Netherlands
| | - Frans R J Verhey
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Victor Villemagne
- Department of Molecular Imaging, Austin Health, Melbourne, Victoria, Australia.,Molecular Biomarkers in Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sylvia Villeneuve
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada.,McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Jonathan Vogelgsang
- Translational Neuroscience Laboratory, McLean Hospital, Harvard Medical School, Belmont, Massachusetts
| | - Gunhild Waldemar
- Danish Dementia Research Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders Wallin
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Åsa K Wallin
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany.,Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - David A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia
| | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan.,Healthy Aging Research Center and Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Marzena Zboch
- Research-Scientific-Didactic Centre of Dementia-Related Diseases in Scinawa, Medical University of Wroclaw, Wroclaw, Poland
| | - Henrik Zetterberg
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, University College London (UCL) Queen Square Institute of Neurology, Queen Square, London, United Kingdom.,UK Dementia Research Institute, London, United Kingdom.,Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
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8
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Shcherbinin S, Andersen SW, Evans CD, Lo AC, Lu M, Navitsky M, Collins EC, Sims JR, Brooks DA, Mintun MA. TRAILBLAZER‐ALZ Study: Dynamics of amyloid reduction after donanemab treatment. Alzheimers Dement 2021. [DOI: 10.1002/alz.057492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | | | | | | | - Ming Lu
- Avid Radiopharmaceuticals Philadelphia PA USA
| | | | - Emily C Collins
- Eli Lilly and Company Indianapolis IN USA
- Avid Radiopharmaceuticals Philadelphia PA USA
| | | | | | - Mark A Mintun
- Eli Lilly and Company Indianapolis IN USA
- Avid Radiopharmaceuticals Philadelphia PA USA
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9
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Sparks J, Lo AC, Evans CD, Chatterjee S, Andersen SW, Sims JR, Brys M, Mintun MA. Reproducibility of applying multiple statistical analyses to data from the TRAILBLAZER‐ALZ clinical trial of donanemab in early symptomatic Alzheimer's disease. Alzheimers Dement 2021. [DOI: 10.1002/alz.057700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | | | | | | | - Mirek Brys
- Eli Lilly and Company Indianapolis IN USA
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10
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Pontecorvo MJ, Devous MD, Lu M, Fleisher AS, Collins EC, Mintun MA. Methods and future directions for evaluation of Tau PET signal. Alzheimers Dement 2021. [DOI: 10.1002/alz.049678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Ming Lu
- Avid Radiopharmaceuticals Philadelphia PA USA
| | | | | | - Mark A. Mintun
- Avid Radiopharmaceuticals Philadelphia PA USA
- Eli Lilly and Company Indianapolis IN USA
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11
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Munsie LM, Lo AC, Fleisher AS, Andersen SW, Shcherbinin S, Sims JR, Brys M, Mintun MA. Novel use of tau imaging to enrich for pathological homogeneity within the PERISCOPE‐ALZ study of zagotenemab. Alzheimers Dement 2021. [DOI: 10.1002/alz.050173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | | | | | | | - Mirek Brys
- Eli Lilly and Company Indianapolis IN USA
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12
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Mintun MA, Lo AC, Duggan Evans C, Wessels AM, Ardayfio PA, Andersen SW, Shcherbinin S, Sparks J, Sims JR, Brys M, Apostolova LG, Salloway SP, Skovronsky DM. Donanemab in Early Alzheimer's Disease. N Engl J Med 2021; 384:1691-1704. [PMID: 33720637 DOI: 10.1056/nejmoa2100708] [Citation(s) in RCA: 549] [Impact Index Per Article: 183.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND A hallmark of Alzheimer's disease is the accumulation of amyloid-β (Aβ) peptide. Donanemab, an antibody that targets a modified form of deposited Aβ, is being investigated for the treatment of early Alzheimer's disease. METHODS We conducted a phase 2 trial of donanemab in patients with early symptomatic Alzheimer's disease who had tau and amyloid deposition on positron-emission tomography (PET). Patients were randomly assigned in a 1:1 ratio to receive donanemab (700 mg for the first three doses and 1400 mg thereafter) or placebo intravenously every 4 weeks for up to 72 weeks. The primary outcome was the change from baseline in the score on the Integrated Alzheimer's Disease Rating Scale (iADRS; range, 0 to 144, with lower scores indicating greater cognitive and functional impairment) at 76 weeks. Secondary outcomes included the change in scores on the Clinical Dementia Rating Scale-Sum of Boxes (CDR-SB), the 13-item cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-Cog13), the Alzheimer's Disease Cooperative Study-Instrumental Activities of Daily Living Inventory (ADCS-iADL), and the Mini-Mental State Examination (MMSE), as well as the change in the amyloid and tau burden on PET. RESULTS A total of 257 patients were enrolled; 131 were assigned to receive donanemab and 126 to receive placebo. The baseline iADRS score was 106 in both groups. The change from baseline in the iADRS score at 76 weeks was -6.86 with donanemab and -10.06 with placebo (difference, 3.20; 95% confidence interval, 0.12 to 6.27; P = 0.04). The results for most secondary outcomes showed no substantial difference. At 76 weeks, the reductions in the amyloid plaque level and the global tau load were 85.06 centiloids and 0.01 greater, respectively, with donanemab than with placebo. Amyloid-related cerebral edema or effusions (mostly asymptomatic) occurred with donanemab. CONCLUSIONS In patients with early Alzheimer's disease, donanemab resulted in a better composite score for cognition and for the ability to perform activities of daily living than placebo at 76 weeks, although results for secondary outcomes were mixed. Longer and larger trials are necessary to study the efficacy and safety of donanemab in Alzheimer's disease. (Funded by Eli Lilly; TRAILBLAZER-ALZ ClinicalTrials.gov number, NCT03367403.).
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Affiliation(s)
- Mark A Mintun
- From Eli Lilly (M.A.M., A.C.L., C.D.E., A.M.W., P.A.A., S.W.A., S.S., J.S., J.R.S., M.B., D.M.S.) and the Departments of Neurology, of Radiology and Imaging Sciences, and of Medical and Molecular Genetics and the Indiana Alzheimer Disease Center, Indiana University School of Medicine (L.G.A.) - both in Indianapolis; and the Departments of Psychiatry and Human Behavior and of Neurology, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI (S.P.S.)
| | - Albert C Lo
- From Eli Lilly (M.A.M., A.C.L., C.D.E., A.M.W., P.A.A., S.W.A., S.S., J.S., J.R.S., M.B., D.M.S.) and the Departments of Neurology, of Radiology and Imaging Sciences, and of Medical and Molecular Genetics and the Indiana Alzheimer Disease Center, Indiana University School of Medicine (L.G.A.) - both in Indianapolis; and the Departments of Psychiatry and Human Behavior and of Neurology, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI (S.P.S.)
| | - Cynthia Duggan Evans
- From Eli Lilly (M.A.M., A.C.L., C.D.E., A.M.W., P.A.A., S.W.A., S.S., J.S., J.R.S., M.B., D.M.S.) and the Departments of Neurology, of Radiology and Imaging Sciences, and of Medical and Molecular Genetics and the Indiana Alzheimer Disease Center, Indiana University School of Medicine (L.G.A.) - both in Indianapolis; and the Departments of Psychiatry and Human Behavior and of Neurology, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI (S.P.S.)
| | - Alette M Wessels
- From Eli Lilly (M.A.M., A.C.L., C.D.E., A.M.W., P.A.A., S.W.A., S.S., J.S., J.R.S., M.B., D.M.S.) and the Departments of Neurology, of Radiology and Imaging Sciences, and of Medical and Molecular Genetics and the Indiana Alzheimer Disease Center, Indiana University School of Medicine (L.G.A.) - both in Indianapolis; and the Departments of Psychiatry and Human Behavior and of Neurology, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI (S.P.S.)
| | - Paul A Ardayfio
- From Eli Lilly (M.A.M., A.C.L., C.D.E., A.M.W., P.A.A., S.W.A., S.S., J.S., J.R.S., M.B., D.M.S.) and the Departments of Neurology, of Radiology and Imaging Sciences, and of Medical and Molecular Genetics and the Indiana Alzheimer Disease Center, Indiana University School of Medicine (L.G.A.) - both in Indianapolis; and the Departments of Psychiatry and Human Behavior and of Neurology, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI (S.P.S.)
| | - Scott W Andersen
- From Eli Lilly (M.A.M., A.C.L., C.D.E., A.M.W., P.A.A., S.W.A., S.S., J.S., J.R.S., M.B., D.M.S.) and the Departments of Neurology, of Radiology and Imaging Sciences, and of Medical and Molecular Genetics and the Indiana Alzheimer Disease Center, Indiana University School of Medicine (L.G.A.) - both in Indianapolis; and the Departments of Psychiatry and Human Behavior and of Neurology, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI (S.P.S.)
| | - Sergey Shcherbinin
- From Eli Lilly (M.A.M., A.C.L., C.D.E., A.M.W., P.A.A., S.W.A., S.S., J.S., J.R.S., M.B., D.M.S.) and the Departments of Neurology, of Radiology and Imaging Sciences, and of Medical and Molecular Genetics and the Indiana Alzheimer Disease Center, Indiana University School of Medicine (L.G.A.) - both in Indianapolis; and the Departments of Psychiatry and Human Behavior and of Neurology, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI (S.P.S.)
| | - JonDavid Sparks
- From Eli Lilly (M.A.M., A.C.L., C.D.E., A.M.W., P.A.A., S.W.A., S.S., J.S., J.R.S., M.B., D.M.S.) and the Departments of Neurology, of Radiology and Imaging Sciences, and of Medical and Molecular Genetics and the Indiana Alzheimer Disease Center, Indiana University School of Medicine (L.G.A.) - both in Indianapolis; and the Departments of Psychiatry and Human Behavior and of Neurology, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI (S.P.S.)
| | - John R Sims
- From Eli Lilly (M.A.M., A.C.L., C.D.E., A.M.W., P.A.A., S.W.A., S.S., J.S., J.R.S., M.B., D.M.S.) and the Departments of Neurology, of Radiology and Imaging Sciences, and of Medical and Molecular Genetics and the Indiana Alzheimer Disease Center, Indiana University School of Medicine (L.G.A.) - both in Indianapolis; and the Departments of Psychiatry and Human Behavior and of Neurology, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI (S.P.S.)
| | - Miroslaw Brys
- From Eli Lilly (M.A.M., A.C.L., C.D.E., A.M.W., P.A.A., S.W.A., S.S., J.S., J.R.S., M.B., D.M.S.) and the Departments of Neurology, of Radiology and Imaging Sciences, and of Medical and Molecular Genetics and the Indiana Alzheimer Disease Center, Indiana University School of Medicine (L.G.A.) - both in Indianapolis; and the Departments of Psychiatry and Human Behavior and of Neurology, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI (S.P.S.)
| | - Liana G Apostolova
- From Eli Lilly (M.A.M., A.C.L., C.D.E., A.M.W., P.A.A., S.W.A., S.S., J.S., J.R.S., M.B., D.M.S.) and the Departments of Neurology, of Radiology and Imaging Sciences, and of Medical and Molecular Genetics and the Indiana Alzheimer Disease Center, Indiana University School of Medicine (L.G.A.) - both in Indianapolis; and the Departments of Psychiatry and Human Behavior and of Neurology, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI (S.P.S.)
| | - Stephen P Salloway
- From Eli Lilly (M.A.M., A.C.L., C.D.E., A.M.W., P.A.A., S.W.A., S.S., J.S., J.R.S., M.B., D.M.S.) and the Departments of Neurology, of Radiology and Imaging Sciences, and of Medical and Molecular Genetics and the Indiana Alzheimer Disease Center, Indiana University School of Medicine (L.G.A.) - both in Indianapolis; and the Departments of Psychiatry and Human Behavior and of Neurology, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI (S.P.S.)
| | - Daniel M Skovronsky
- From Eli Lilly (M.A.M., A.C.L., C.D.E., A.M.W., P.A.A., S.W.A., S.S., J.S., J.R.S., M.B., D.M.S.) and the Departments of Neurology, of Radiology and Imaging Sciences, and of Medical and Molecular Genetics and the Indiana Alzheimer Disease Center, Indiana University School of Medicine (L.G.A.) - both in Indianapolis; and the Departments of Psychiatry and Human Behavior and of Neurology, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI (S.P.S.)
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13
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Gupta HV, Beach TG, Mehta SH, Shill HA, Driver-Dunckley E, Sabbagh MN, Belden CM, Liebsack C, Dugger BN, Serrano GE, Sue LI, Siderowf A, Pontecorvo MJ, Mintun MA, Joshi AD, Adler CH. Clinicopathological Correlation: Dopamine and Amyloid PET Imaging with Neuropathology in Three Subjects Clinically Diagnosed with Alzheimer's Disease or Dementia with Lewy Bodies. J Alzheimers Dis 2021; 80:1603-1612. [PMID: 33720879 PMCID: PMC10109539 DOI: 10.3233/jad-200323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Imaging biomarkers have the potential to distinguish between different brain pathologies based on the type of ligand used with PET. AV-45 PET (florbetapir, Amyvid™) is selective for the neuritic plaque amyloid of Alzheimer's disease (AD), while AV-133 PET (florbenazine) is selective for VMAT2, which is a dopaminergic marker. OBJECTIVE To report the clinical, AV-133 PET, AV-45 PET, and neuropathological findings of three clinically diagnosed dementia patients who were part of the Avid Radiopharmaceuticals AV133-B03 study as well as the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND). METHODS Three subjects who had PET imaging with both AV-133 and AV-45 as well as a standardized neuropathological assessment were included. The final clinical, PET scan, and neuropathological diagnoses were compared. RESULTS The clinical and neuropathological diagnoses were made blinded to PET scan results. The first subject had a clinical diagnosis of dementia with Lewy bodies (DLB); AV-133 PET showed bilateral striatal dopaminergic degeneration, and AV-45 PET was positive for amyloid. The final clinicopathological diagnosis was DLB and AD. The second subject was diagnosed clinically with probable AD; AV-45 PET was positive for amyloid, while striatal AV-133 PET was normal. The final clinicopathological diagnosis was DLB and AD. The third subject had a clinical diagnosis of DLB. Her AV-45 PET was positive for amyloid and striatal AV-133 showed dopaminergic degeneration. The final clinicopathological diagnosis was multiple system atrophy and AD. CONCLUSION PET imaging using AV-133 for the assessment of striatal VMAT2 density may help distinguish between AD and DLB. However, some cases of DLB with less-pronounced nigrostriatal dopaminergic neuronal loss may be missed.
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Affiliation(s)
- Harsh V Gupta
- Department of Neurology, The University of Kansas Health System, Kansas City, KS, USA
| | | | - Shyamal H Mehta
- Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA
| | | | | | | | | | | | - Brittany N Dugger
- Department of Pathology and Laboratory Medicine, University of California-Davis School of Medicine, Sacramento, CA, USA
| | | | - Lucia I Sue
- Banner Sun Health Research Institute, Sun City, AZ, USA
| | - Andrew Siderowf
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA
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14
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Devous MD, Fleisher AS, Pontecorvo MJ, Lu M, Siderowf A, Navitsky M, Kennedy I, Southekal S, Harris TS, Mintun MA. Relationships Between Cognition and Neuropathological Tau in Alzheimer's Disease Assessed by 18F Flortaucipir PET. J Alzheimers Dis 2021; 80:1091-1104. [PMID: 33682705 DOI: 10.3233/jad-200808] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Tau neurofibrillary tangle burden increases with Alzheimer's disease (AD) stage and correlates with degree of cognitive impairment. Tau PET imaging could facilitate understanding the relationship between tau pathology and cognitive impairment. OBJECTIVE Evaluate the relationship between 18F flortaucipir uptake patterns and cognition across multiple cognitive domains. METHODS We acquired flortaucipir PET scans in 84 amyloid-positive control, mild cognitive impairment (MCI), and AD subjects. Flortaucipir standardized uptake value ratio (SUVr) values were obtained from a neocortical volume of interest (VOI), a precuneus VOI, and VOIs defined by the correlation between flortaucipir SUVr images and domain-specific cognitive tests. Cognitive assessments included Mini-Mental State Exam (MMSE), Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), and a neuropsychological test battery (i.e., Wechsler Memory Scale-Revised Logical Memory (WMS-R), Trail Making Test, Boston Naming Test, Digit Symbol Substitution Test, Animal List Generation, WMS-R Digit Span, American National Adult Reading Test, Clock Drawing Test, Judgment of Line Orientation, and WMS-R Logical Memory II (Delayed Recall)) and the Functional Activities Questionnaire (FAQ). Correlation analyses compared regional and voxel-wise VOIs to cognitive scores. RESULTS Subjects included 5 controls, 47 MCI, and 32 AD subjects. Significant correlations were seen between both flortaucipir and florbetapir SUVrs and MMSE, ADAS-Cog, and FAQ. Cognitive impairment was associated with increased flortaucipir uptake in regionally specific patterns consistent with the neuroanatomy underlying specific cognitive tests. CONCLUSION Flortaucipir SUVr values demonstrated significant inverse correlations with cognitive scores in domain-specific patterns. Findings support the hypothesis that PET imaging of neuropathologic tau deposits may reflect underlying neurodegeneration in AD.
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Affiliation(s)
| | | | | | - Ming Lu
- Avid Radiopharmaceuticals, Inc., Philadelphia, PA, USA
| | - Andrew Siderowf
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ian Kennedy
- Avid Radiopharmaceuticals, Inc., Philadelphia, PA, USA
| | | | | | - Mark A Mintun
- Avid Radiopharmaceuticals, Inc., Philadelphia, PA, USA
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15
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Lu M, Pontecorvo MJ, Devous MD, Arora AK, Galante N, McGeehan A, Devadanam C, Salloway SP, Doraiswamy PM, Curtis C, Truocchio SP, Flitter M, Locascio T, Devine M, Zimmer JA, Fleisher AS, Mintun MA. Aggregated Tau Measured by Visual Interpretation of Flortaucipir Positron Emission Tomography and the Associated Risk of Clinical Progression of Mild Cognitive Impairment and Alzheimer Disease: Results From 2 Phase III Clinical Trials. JAMA Neurol 2021; 78:445-453. [PMID: 33587110 PMCID: PMC7885097 DOI: 10.1001/jamaneurol.2020.5505] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Questions What is the association between flortaucipir positron emission tomography (PET) imaging
visual classification using a clinically applicable and US Food and Drug
Administration–approved method and 18-month cognitive and functional decline in
patients with clinically diagnosed mild cognitive impairment and dementia owing to
Alzheimer disease (AD)? Findings In this analysis of 2 open-label clinical trials, visual read of an advanced
flortaucipir PET AD pattern was associated with an increased risk of 18-month cognitive
and functional decline compared with other scan patterns. Meaning Clinically applicable visual reads of flortaucipir PET scans may provide valuable
information regarding the risk of near-term clinical deterioration among patients with
clinically diagnosed mild cognitive impairment or dementia owing to AD. Importance Flortaucipir positron emission tomography (PET) scans, rated with a novel, US Food and
Drug Administration–approved, clinically applicable visual interpretation method,
provide valuable information regarding near-term clinical progression of patients with
Alzheimer disease (AD) or mild cognitive impairment (MCI). Objective To evaluate the association between flortaucipir PET visual interpretation and
patients’ near-term clinical progression. Design/Setting/Participants Two prospective, open-label, longitudinal studies were conducted from December 2014 to
September 2019. Study 1 screened 298 patients and enrolled 160 participants who had a
flortaucipir scan at baseline visit. Study 2 selected 205 participants from the AMARANTH
trial, which was terminated after futility analysis. Out of the 2218 AMARANTH
participants, 424 had a flortaucipir scan around randomization, but 219 did not complete
18-month clinical dementia rating (CDR) assessments and thus were excluded. In both
studies, all participants were diagnosed as clinically impaired, and they were
longitudinally followed up for approximately 18 months after baseline. Main Outcomes and Measures Flortaucipir scans were rated as either advanced or nonadvanced AD pattern using a
predetermined visual interpretation method. The CDR sum of box (CDR-SB) score was used
as primary clinical end point measurement in both studies. Results Of the 364 study participants who had readable scans, 48% were female
(n = 174 of 364), and the mean (SD) age was 71.8 (8.7) years. Two hundred
forty participants were rated as having an advanced AD pattern. At 18 months follow-up,
70% of those with an advanced AD pattern (n = 147 of 210) had 1 point or
more increase in CDR-SB, an event predefined as clinically meaningful deterioration. In
contrast, only 46% of those with a nonadvanced AD pattern scan (n = 48 of
105) experienced the same event (risk ratio [RR], 1.40; 95% CI, 1.11-1.76;
P = .005). The adjusted mean CDR-SB changes were 2.28 and
0.98 for advanced and nonadvanced AD pattern groups, respectively
(P < .001). Analyses with other clinical end point
assessments, as well as analyses with each individual study’s data, consistently
indicated a higher risk of clinical deterioration associated with an advanced AD scan
pattern. Conclusions and Relevance These results suggest that flortaucipir PET scans, when interpreted with an US Food and
Drug Administration–approved, clinically applicable visual interpretation method,
may provide valuable information regarding the risk of clinical deterioration over 18
months among patients with AD and MCI. Trial Registration ClinicalTrials.gov Identifier: NCT02016560
and NCT03901105
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Affiliation(s)
- Ming Lu
- Avid Radiopharmaceuticals, A Wholly Owned Subsidiary of Eli Lilly and Co, Philadelphia, Pennsylvania
| | - Michael J Pontecorvo
- Avid Radiopharmaceuticals, A Wholly Owned Subsidiary of Eli Lilly and Co, Philadelphia, Pennsylvania
| | - Michael D Devous
- Avid Radiopharmaceuticals, A Wholly Owned Subsidiary of Eli Lilly and Co, Philadelphia, Pennsylvania
| | - Anupa K Arora
- Avid Radiopharmaceuticals, A Wholly Owned Subsidiary of Eli Lilly and Co, Philadelphia, Pennsylvania
| | - Nicholas Galante
- Avid Radiopharmaceuticals, A Wholly Owned Subsidiary of Eli Lilly and Co, Philadelphia, Pennsylvania
| | - Anne McGeehan
- Avid Radiopharmaceuticals, A Wholly Owned Subsidiary of Eli Lilly and Co, Philadelphia, Pennsylvania
| | - Catherine Devadanam
- Avid Radiopharmaceuticals, A Wholly Owned Subsidiary of Eli Lilly and Co, Philadelphia, Pennsylvania
| | - Stephen P Salloway
- Butler Hospital, Providence, Rhode Island.,Brown University, Providence, Rhode Island
| | - P Murali Doraiswamy
- Duke University School of Medicine and the Duke Institute of Brian Science Center, Durham, North Carolina
| | | | - Stephen P Truocchio
- Avid Radiopharmaceuticals, A Wholly Owned Subsidiary of Eli Lilly and Co, Philadelphia, Pennsylvania
| | - Matthew Flitter
- Avid Radiopharmaceuticals, A Wholly Owned Subsidiary of Eli Lilly and Co, Philadelphia, Pennsylvania
| | - Tricia Locascio
- Avid Radiopharmaceuticals, A Wholly Owned Subsidiary of Eli Lilly and Co, Philadelphia, Pennsylvania
| | - Marybeth Devine
- Avid Radiopharmaceuticals, A Wholly Owned Subsidiary of Eli Lilly and Co, Philadelphia, Pennsylvania
| | | | | | - Mark A Mintun
- Avid Radiopharmaceuticals, A Wholly Owned Subsidiary of Eli Lilly and Co, Philadelphia, Pennsylvania.,Eli Lilly and Company, Indianapolis, Indiana
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Bateman RJ, Aschenbrenner AJ, Benzinger TL, Clifford D, Coalier K, Cruchaga C, Fagan AM, Farlow MR, Goate AM, Gordon BA, Hassenstab J, Jack CR, Koeppe RA, McDade E, Mills S, Morris JC, Salloway SP, Santacruz A, Snyder PJ, Wang G, Xiong C, Snider BJ, Mummery CJ, Surti GM, Hannequin D, Wallon D, Berman S, Lah JJ, Jiménez‐Velazquez IZ, Roberson ED, Dyck CH, Honig LS, Sanchez‐Valle R, Brooks WS, Gauthier S, Masters CL, Galasko DR, Brosch JR, Hsiung GR, Jayadev S, Formaglio M, Masellis M, Clarnette R, Pariente J, Dubois B, Pasquier F, Andersen SW, Holdridge KC, Mintun MA, Sims JR, Yaari R, Baudler M, Delmar P, Doody R, Fontoura P, Kerchner GA. Overview of dominantly inherited AD and top‐line DIAN‐TU results of solanezumab and gantenerumab. Alzheimers Dement 2020. [DOI: 10.1002/alz.041129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Randall J Bateman
- Washington University in St. Louis School of Medicine St. Louis MO USA
| | | | | | - David Clifford
- Washington University in St. Louis School of Medicine St. Louis MO USA
| | | | - Carlos Cruchaga
- Hope Center for Neurological Disorders Washington University School of Medicine St. Louis MO USA
| | - Anne M. Fagan
- Washington University School of Medicine St. Louis MO USA
| | - Martin R. Farlow
- Department of Neurology Indiana University School of Medicine Indianapolis IN USA
| | - Alison M. Goate
- Ronald M. Loeb Center for Alzheimer’s Disease New York NY USA
| | | | - Jason Hassenstab
- Washington University in St. Louis School of Medicine St. Louis MO USA
| | | | | | - Eric McDade
- Knight Alzheimer Disease Research Center St. Louis MO USA
| | - Susan Mills
- Washington University in St. Louis School of Medicine St. Louis MO USA
| | - John C. Morris
- Knight Alzheimer Disease Research Center St. Louis MO USA
| | | | - Anna Santacruz
- Washington University in St. Louis School of Medicine St. Louis MO USA
| | | | - Guoqiao Wang
- Washington University in St. Louis School of Medicine St. Louis MO USA
| | - Chengjie Xiong
- Washington University in St. Louis School of Medicine St. Louis MO USA
| | | | | | | | | | | | - Sarah Berman
- University of Pittsburgh School of Medicine Pittsburgh PA USA
| | - James J. Lah
- Emory University School of Medicine Atlanta GA USA
| | | | | | | | | | | | | | - Serge Gauthier
- McGill University Research Centre for Studies in Aging Montreal QC Canada
| | - Colin L. Masters
- The Florey Institute of Neuroscience and Mental Health, Melbourne VIC Australia
| | | | | | | | | | | | - Mario Masellis
- Hurvitz Brain Sciences Program Sunnybrook Research Institute Toronto ON Canada
| | | | | | - Bruno Dubois
- Institute of Memory and Alzheimer's Disease (IM2A) Department of Neurology Pitié‐Salpêtrière Hospital, AP‐HP, l'Hôpital Paris France
| | | | | | | | | | | | - Roy Yaari
- Eli Lilly and Company Indianapolis IN USA
| | - Monika Baudler
- Roche/Genentech Product Development, Neuroscience Basel Switzerland
| | | | - Rachelle Doody
- Roche Pharma Research and Early Development Basel Switzerland
| | - Paulo Fontoura
- Roche/Genentech Product Development, Neuroscience Basel Switzerland
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Farlow MR, Bateman RJ, Aschenbrenner AJ, Benzinger TL, Clifford D, Coalier K, Cruchaga C, Fagan AM, Goate AM, Gordon BA, Hassenstab J, Jack CR, Koeppe RA, McDade E, Mills S, Morris JC, Salloway SP, Santacruz A, Snyder PJ, Wang G, Xiong C, Snider BJ, Mummery CJ, Surti GM, Hannequin D, Wallon D, Berman S, Lah JJ, Jiménez‐Velazquez IZ, Roberson ED, van Dyck CH, Honig LS, Sanchez‐Valle R, Brooks WS, Gauthier S, Masters CL, Galasko DR, Brosch JR, Hsiung GR, Jayadev S, Formaglio M, Masellis M, Clarnette R, Pariente J, Dubois B, Pasquier F, Andersen SW, Holdridge KC, Mintun MA, Sims JR, Yaari R. Solanezumab in‐depth outcomes. Alzheimers Dement 2020. [DOI: 10.1002/alz.038028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Martin R. Farlow
- Department of Neurology Indiana University School of Medicine Indianapolis IN USA
| | | | | | | | - David Clifford
- Washington University in St. Louis School of Medicine St. Louis MO USA
| | | | - Carlos Cruchaga
- Hope Center for Neurological Disorders Washington University School of Medicine St. Louis MO USA
| | - Anne M. Fagan
- Washington University School of Medicine St. Louis MO USA
| | - Alison M. Goate
- Ronald M. Loeb Center for Alzheimer's Disease New York NY USA
| | | | - Jason Hassenstab
- Washington University in St. Louis School of Medicine St. Louis MO USA
| | | | | | - Eric McDade
- Knight Alzheimer Disease Research Center St. Louis MO USA
| | - Susan Mills
- Washington University in St. Louis School of Medicine St. Louis MO USA
| | - John C. Morris
- Washington University School of Medicine St. Louis MO USA
| | | | - Anna Santacruz
- Washington University in St. Louis School of Medicine St. Louis MO USA
| | | | - Guoqiao Wang
- Washington University in St. Louis School of Medicine St. Louis MO USA
| | - Chengjie Xiong
- Washington University in St. Louis School of Medicine St. Louis MO USA
| | | | | | | | - Didier Hannequin
- Normandie Univ, UNIROUEN, INSERM U1245 and Rouen University Hospital Department of Neurology and CNR‐MAJ, F 76000, Normandy Center for Genomic and Personalized Medicine Rouen France
| | - David Wallon
- Normandie Univ, UNIROUEN, INSERM U1245 and Rouen University Hospital Department of Neurology and CNR‐MAJ, F 76000, Normandy Center for Genomic and Personalized Medicine Rouen France
| | - Sarah Berman
- University of Pittsburgh School of Medicine Pittsburgh PA USA
| | - James J. Lah
- Emory University School of Medicine Atlanta GA USA
| | | | | | | | | | | | | | - Serge Gauthier
- McGill University Research Centre for Studies in Aging Montreal QC Canada
| | - Colin L. Masters
- The Florey Institute of Neuroscience and Mental Health Melbourne VIC Australia
| | | | | | | | | | | | | | | | | | - Bruno Dubois
- Institute of Memory and Alzheimer's Disease (IM2A) Department of Neurology Pitié‐Salpêtrière Hospital, AP‐HP Paris France
| | | | | | | | | | | | - Roy Yaari
- Eli Lilly and Company Indianapolis IN USA
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18
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Beach TG, Montine TJ, Serrano GE, Sue LI, Intorcia AJ, Fleisher AS, Pontecorvo MJ, Devous MD, Lu M, Mintun MA. Neuropathological diagnoses of subjects autopsied in the phase 3 clinicopathological study of flortaucipir F18 PET imaging. Alzheimers Dement 2020. [DOI: 10.1002/alz.040458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Lucia I. Sue
- Banner Sun Health Research Institute Sun City AZ USA
| | | | | | | | | | - Ming Lu
- Avid Radiopharmaceuticals Philadelphia PA USA
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19
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Damasceno PF, La Joie R, Shcherbinin S, Southekal S, Kotari V, Higgins IA, Collins EC, Rabinovici GD, Mintun MA, Raj A. Network diffusion model enhances predictions of future tau‐PET burden in Alzheimer’s patients. Alzheimers Dement 2020. [DOI: 10.1002/alz.039480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Pablo F. Damasceno
- Department of Radiology University of California San Francisco San Francisco CA USA
| | - Renaud La Joie
- Memory and Aging Center UCSF Weill Institute for Neurosciences University of California, San Francisco San Francisco CA USA
| | | | | | | | | | | | - Gil D. Rabinovici
- Memory and Aging Center UCSF Weill Institute for Neurosciences University of California, San Francisco San Francisco CA USA
| | | | - Ashish Raj
- Department of Radiology University of California San Francisco San Francisco CA USA
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20
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Fleisher AS, Pontecorvo MJ, Devous MD, Lu M, Arora AK, Truocchio SP, Aldea P, Flitter M, Locascio T, Devine M, Siderowf A, Beach TG, Montine TJ, Serrano GE, Curtis C, Perrin A, Salloway S, Daniel M, Wellman C, Joshi AD, Irwin DJ, Lowe VJ, Seeley WW, Ikonomovic MD, Masdeu JC, Kennedy I, Harris T, Navitsky M, Southekal S, Mintun MA. Positron Emission Tomography Imaging With [18F]flortaucipir and Postmortem Assessment of Alzheimer Disease Neuropathologic Changes. JAMA Neurol 2020; 77:829-839. [PMID: 32338734 PMCID: PMC7186920 DOI: 10.1001/jamaneurol.2020.0528] [Citation(s) in RCA: 208] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/10/2020] [Indexed: 01/05/2023]
Abstract
Importance Positron emission tomography (PET) may increase the diagnostic accuracy and confirm the underlying neuropathologic changes of Alzheimer disease (AD). Objective To determine the accuracy of antemortem [18F]flortaucipir PET images for predicting the presence of AD-type tau pathology at autopsy. Design, Setting, and Participants This diagnostic study (A16 primary cohort) was conducted from October 2015 to June 2018 at 28 study sites (27 in US sites and 1 in Australia). Individuals with a terminal illness who were older than 50 years and had a projected life expectancy of less than 6 months were enrolled. All participants underwent [18F]flortaucipir PET imaging, and scans were interpreted by 5 independent nuclear medicine physicians or radiologists. Supplemental autopsy [18F]flortaucipir images and pathological samples were also collected from 16 historically collected cases. A second study (FR01 validation study) was conducted from March 26 to April 26, 2019, in which 5 new readers assessed the original PET images for comparison to autopsy. Main Outcomes and Measures [18F]flortaucipir PET images were visually assessed and compared with immunohistochemical tau pathology. An AD tau pattern of flortaucipir retention was assessed for correspondence with a postmortem B3-level (Braak stage V or VI) pathological pattern of tau accumulation and to the presence of amyloid-β plaques sufficient to meet the criteria for high levels of AD neuropathological change. Success was defined as having at least 3 of the 5 readers above the lower bounds of the 95% CI for both sensitivity and specificity of 50% or greater. Results A total of 156 patients were enrolled in the A16 study and underwent [18F]flortaucipir PET imaging. Of these, 73 died during the study, and valid autopsies were performed for 67 of these patients. Three autopsies were evaluated as test cases and removed from the primary cohort (n = 64). Of the 64 primary cohort patients, 34 (53%) were women and 62 (97%) were white; mean (SD) age was 82.5 (9.6) years; and 49 (77%) had dementia, 1 (2%) had mild cognitive impairment, and 14 (22%) had normal cognition. Prespecified success criteria were met for the A16 primary cohort. The flortaucipir PET scans predicted a B3 level of tau pathology, with sensitivity ranging from 92.3% (95% CI, 79.7%-97.3%) to 100.0% (95% CI, 91.0%-100.0%) and specificity ranging from 52.0% (95% CI, 33.5%-70.0%) to 92.0% (95% CI, 75.0%-97.8%). A high level of AD neuropathological change was predicted with sensitivity of 94.7% (95% CI, 82.7%-98.5%) to 100.0% (95% CI, 90.8%-100.0%) and specificity of 50.0% (95% CI, 32.1%-67.9%) to 92.3% (95% CI, 75.9%-97.9%). The FR01 validation study also met prespecified success criteria. Addition of the supplemental autopsy data set and 3 test cases, which comprised a total of 82 patients and autopsies for both the A16 and FR01 studies, resulted in improved specificity and comparable overall accuracy. Among the 156 enrolled participants, 14 (9%) experienced at least 1 treatment-emergent adverse event. Conclusions and Relevance This study's findings suggest that PET imaging with [18F]flortaucipir could be used to identify the density and distribution of AD-type tau pathology and the presence of high levels of AD neuropathological change, supporting a neuropathological diagnosis of AD.
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Affiliation(s)
| | | | | | - Ming Lu
- Avid Radiopharmaceuticals, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Joseph C. Masdeu
- Houston Methodist Institute for Academic Medicine, Houston, Texas
| | - Ian Kennedy
- Avid Radiopharmaceuticals, Philadelphia, Pennsylvania
| | - Thomas Harris
- Avid Radiopharmaceuticals, Philadelphia, Pennsylvania
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21
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Pontecorvo MJ, Keene CD, Beach TG, Montine TJ, Arora AK, Devous MD, Navitsky M, Kennedy I, Joshi AD, Lu M, Serrano GE, Sue LI, Intorcia AJ, Rose SE, Wilson A, Hellstern L, Coleman N, Flitter M, Aldea P, Fleisher AS, Mintun MA, Siderowf A. Comparison of regional flortaucipir PET with quantitative tau immunohistochemistry in three subjects with Alzheimer's disease pathology: a clinicopathological study. EJNMMI Res 2020; 10:65. [PMID: 32542468 PMCID: PMC7295920 DOI: 10.1186/s13550-020-00653-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 12/13/2019] [Accepted: 06/03/2020] [Indexed: 01/16/2023] Open
Abstract
Background The objective of this study was to make a quantitative comparison of flortaucipir PET retention with pathological tau and β-amyloid across a range of brain regions at autopsy. Methods Patients with dementia (two with clinical diagnosis of AD, one undetermined), nearing the end of life, underwent 20-min PET, beginning 80 min after an injection of ~370 mBq flortaucipir [18F]. Neocortical, basal ganglia, and limbic tissue samples were obtained bilaterally from 19 regions at autopsy and subject-specific PET regions of interest corresponding to the 19 sampled target tissue regions in each hemisphere were hand drawn on the PET images. SUVr values were calculated for each region using a cerebellar reference region. Abnormally phosphorylated tau (Ptau) and amyloid-β (Aβ) tissue concentrations were measured for each tissue region with an antibody capture assay (Histelide) using AT8 and H31L21 antibodies respectively. Results The imaging-to-autopsy interval ranged from 4–29 days. All three subjects had intermediate to high levels of AD neuropathologic change at autopsy. Mean cortical SUVr averaged across all three subjects correlated significantly with the Ptau immunoassay (Pearson r = 0.81; p < 0.0001). When Ptau and Aβ1-42 were both included in the model, the Ptau correlation with flortaucipir SUVr was preserved but there was no correlation of Aβ1-42 with flortaucipir. There was also a modest correlation between limbic (hippocampal/entorhinal and amygdala) flortaucipir SUVr and Ptau (Pearson r = 0.52; p < 0.080). There was no significant correlation between SUVr and Ptau in basal ganglia. Conclusions The results of this pilot study support a quantitative relationship between cortical flortaucipir SUVr values and quantitative measures of Ptau at autopsy. Additional research including more cases is needed to confirm the generalizability of these results. Trial registration, NIH Clinicaltrials.gov NCT # 02516046. Registered August 27, 2015. https://clinicaltrials.gov/ct2/show/NCT02516046?term=02516046&draw=2&rank=1
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Affiliation(s)
- Michael J Pontecorvo
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA.
| | - C Dirk Keene
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Thomas G Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Phoenix, AZ, USA
| | | | - Anupa K Arora
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Michael D Devous
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Michael Navitsky
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Ian Kennedy
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Abhinay D Joshi
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA.,Present Address: Medpace Holdings, Inc., Cincinnati, Ohio, USA
| | - Ming Lu
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Geidy E Serrano
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Phoenix, AZ, USA
| | - Lucia I Sue
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Phoenix, AZ, USA
| | - Anthony J Intorcia
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Phoenix, AZ, USA
| | - Shannon E Rose
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Angela Wilson
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Leanne Hellstern
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Natalie Coleman
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Matthew Flitter
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Patricia Aldea
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Adam S Fleisher
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Mark A Mintun
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA
| | - Andrew Siderowf
- Avid Radiopharmaceuticals, 3711 Market St., 7th floor, Philadelphia, PA, 19104, USA.,Present Address: Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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22
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Pontecorvo MJ, Devous MD, Kennedy I, Navitsky M, Lu M, Galante N, Salloway S, Doraiswamy PM, Southekal S, Arora AK, McGeehan A, Lim NC, Xiong H, Truocchio SP, Joshi AD, Shcherbinin S, Teske B, Fleisher AS, Mintun MA. A multicentre longitudinal study of flortaucipir (18F) in normal ageing, mild cognitive impairment and Alzheimer's disease dementia. Brain 2020; 142:1723-1735. [PMID: 31009046 PMCID: PMC6536847 DOI: 10.1093/brain/awz090] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [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: 09/12/2018] [Revised: 01/11/2019] [Accepted: 02/06/2019] [Indexed: 01/20/2023] Open
Abstract
The advent of tau-targeted PET tracers such as flortaucipir (18F) (flortaucipir, also known as 18F-AV-1451 or 18F-T807) have made it possible to investigate the sequence of development of tau in relationship to age, amyloid-β, and to the development of cognitive impairment due to Alzheimer's disease. Here we report a multicentre longitudinal evaluation of the relationships between baseline tau, tau change and cognitive change, using flortaucipir PET imaging. A total of 202 participants 50 years old or older, including 57 cognitively normal subjects, 97 clinically defined mild cognitive impairment and 48 possible or probable Alzheimer's disease dementia patients, received flortaucipir PET scans of 20 min in duration beginning 80 min after intravenous administration of 370 MBq flortaucipir (18F). On separate days, subjects also received florbetapir amyloid PET imaging, and underwent a neuropsychological test battery. Follow-up flortaucipir scans and neuropsychological battery assessments were also performed at 9 and 18 months. Fifty-five amyloid-β+ and 90 amyloid-β- subjects completed the baseline and 18-month study visits and had valid quantifiable flortaucipir scans at both time points. There was a statistically significant increase in the global estimate of cortical tau burden as measured by standardized uptake value ratio (SUVr) from baseline to 18 months in amyloid-β+ but not amyloid-β- subjects (least squared mean change in flortaucipir SUVr : 0.0524 ± 0.0085, P < 0.0001 and 0.0007 ± 0.0024 P = 0.7850, respectively), and a significant association between magnitude of SUVr increase and baseline tau burden. Voxel-wise evaluations further suggested that the regional pattern of change in flortaucipir PET SUVr over the 18-month study period (i.e. which regions exhibited the greatest change) also varied as a function of baseline global estimate of tau burden. In subjects with lower global SUVr, temporal lobe regions showed the greatest flortaucipir retention, whereas in subjects with higher baseline SUVr, parietal and frontal regions were increasingly affected. Finally, baseline flortaucipir and change in flortaucipir SUVr were both significantly (P < 0.0001) associated with changes in cognitive performance. Taken together, these results provide a preliminary characterization of the longitudinal spread of tau in Alzheimer's disease and suggest that the amount and location of tau may have implications both for the spread of tau and the cognitive deterioration that may occur over an 18-month period.
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Affiliation(s)
| | | | - Ian Kennedy
- Avid Radiopharmaceuticals, Philadelphia, PA, USA
| | | | - Ming Lu
- Avid Radiopharmaceuticals, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | - Hui Xiong
- Avid Radiopharmaceuticals, Philadelphia, PA, USA
| | | | | | | | | | | | - Mark A Mintun
- Avid Radiopharmaceuticals, Philadelphia, PA, USA.,Eli Lilly and Company, Indianapolis IN, USA
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23
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Golla SSV, Wolters EE, Timmers T, Ossenkoppele R, van der Weijden CWJ, Scheltens P, Schwarte L, Mintun MA, Devous Sr MD, Schuit RC, Windhorst AD, Lammertsma AA, Yaqub M, van Berckel BNM, Boellaard R. Parametric methods for [ 18F]flortaucipir PET. J Cereb Blood Flow Metab 2020; 40:365-373. [PMID: 30569813 PMCID: PMC7044757 DOI: 10.1177/0271678x18820765] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 12/22/2022]
Abstract
[18F]Flortaucipir is a PET tau tracer used to visualize tau binding in Alzheimer's disease (AD) in vivo. The present study evaluated the performance of several methods to obtain parametric images of [18F]flortaucipir. One hundred and thirty minutes dynamic PET scans were performed in 10 AD patients and 10 controls. Parametric images were generated using different linearization and basis function approaches. Regional binding potential (BPND) and volume of distribution (VT) values obtained from the parametric images were compared with corresponding values derived using the reversible two-tissue compartment model (2T4k_VB). Performance of SUVr parametric images was assessed by comparing values with distribution volume ratio (DVR) and SRTM-derived BPND estimates obtained using non-linear regression (NLR). Spectral analysis (SA) (r2 = 0.92; slope = 0.99) derived VT correlated well with NLR-derived VT. RPM (r2 = 0.95; slope = 0.98) derived BPND correlated well with NLR-derived DVR. Although SUVr80-100 min correlated well with NLR-derived DVR (r2 = 0.91; slope = 1.09), bias in SUVr appeared to depend on uptake time and underlying level of specific binding. In conclusion, RPM and SA provide parametric images comparable to the NLR estimates. Individual SUVr values are biased compared with DVR and this bias requires further study in a larger dataset in order to understand its consequences.
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Affiliation(s)
- Sandeep SV Golla
- Department of Radiology and Nuclear
Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The
Netherlands
| | - Emma E Wolters
- Department of Radiology and Nuclear
Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The
Netherlands
- Alzheimer Center and Department of
Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The
Netherlands
| | - Tessa Timmers
- Department of Radiology and Nuclear
Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The
Netherlands
- Alzheimer Center and Department of
Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The
Netherlands
| | - Rik Ossenkoppele
- Department of Radiology and Nuclear
Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The
Netherlands
- Alzheimer Center and Department of
Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The
Netherlands
| | - Chris WJ van der Weijden
- Department of Radiology and Nuclear
Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The
Netherlands
- Alzheimer Center and Department of
Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The
Netherlands
| | - Philip Scheltens
- Alzheimer Center and Department of
Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The
Netherlands
| | - Lothar Schwarte
- Department of Anaesthesiology, Amsterdam
Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | - Robert C Schuit
- Department of Radiology and Nuclear
Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The
Netherlands
| | - Albert D Windhorst
- Department of Radiology and Nuclear
Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The
Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear
Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The
Netherlands
| | - Maqsood Yaqub
- Department of Radiology and Nuclear
Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The
Netherlands
| | - Bart NM van Berckel
- Department of Radiology and Nuclear
Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The
Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear
Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The
Netherlands
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24
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Charil A, Schwarz AJ, Southekal S, Kotari V, Navitsky M, Kennedy I, Lu M, Shcherbinin S, Mintun MA, Devous MD, Pontecorvo MJ. P3-322: RELATIONSHIPS BETWEEN FLORTAUCIPIR TAU BINDING AND REGIONAL BRAIN ATROPHY IN AMYLOID POSITIVE SUBJECTS ACROSS THE ALZHEIMER'S DISEASE SPECTRUM. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | | | | | | | - Ian Kennedy
- Avid Radiopharmaceuticals; Philadelphia PA USA
| | - Ming Lu
- Avid Radiopharmaceuticals; Philadelphia PA USA
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25
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Navitsky M, Kotari V, Southekal S, Kennedy I, Harris T, Lu M, Mintun MA, Fleisher AS, Pontecorvo MJ, Devous MD. O3-02-03: ASSOCIATION BETWEEN APOE ISOFORM AND 18-MONTH TAU ACCUMULATION. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | | | - Ian Kennedy
- Avid Radiopharmaceuticals; Philadelphia PA USA
| | | | - Ming Lu
- Avid Radiopharmaceuticals; Philadelphia PA USA
| | - Mark A. Mintun
- Avid Radiopharmaceuticals; Philadelphia PA USA
- Eli Lilly and Company; Indianapolis IN USA
| | - Adam S. Fleisher
- Avid Radiopharmaceuticals; Philadelphia PA USA
- Eli Lilly and Company; Indianapolis IN USA
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26
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Southekal S, Kotari V, Devous MD, Navitsky M, Kennedy I, Beach TG, Montine TJ, Arora A, Flitter ML, Fleisher AS, Pontecorvo MJ, Mintun MA. DT-01-05: TEMPORAL LOBE QUANTITATION OF FLORTAUCIPIR PET IMAGES MAY IMPROVE DETECTION OF INTERMEDIATE NEUROFIBRILLARY TANGLE PATHOLOGY IN AUTOPSY-VALIDATED CASES. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | | | | | - Ian Kennedy
- Avid Radiopharmaceuticals; Philadelphia PA USA
| | | | | | - Anupa Arora
- Avid Radiopharmaceuticals; Philadelphia PA USA
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27
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Shcherbinin S, Jaeger R, Charil A, Holdridge KC, Longley H, Yaari R, Sims JR, Mintun MA. P4-290: IMAGING BIOMARKER TRAJECTORIES OF THE MILD AD DEMENTIA POPULATION IN THE EXPEDITION3 TRIAL. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Ralf Jaeger
- Eli Lilly and Company; Windlesham United Kingdom
| | | | | | | | - Roy Yaari
- Eli Lilly and Company; Indianapolis IN USA
| | | | - Mark A. Mintun
- Eli Lilly and Company; Indianapolis IN USA
- Avid Radiopharmaceuticals; Philadelphia PA USA
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28
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Shcherbinin S, Hesterman J, Devous MD, Natanegara F, You W, Evans CD, Collins EC, Lo A, Sims JR, Mintun MA. P3-026: IMPLEMENTATION OF DUAL-PHASE FLORBETAPIR PET IN THE MULTICENTER PHASE 2 NAVIGATE-AD CLINICAL TRIAL. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | | | - Wenqi You
- Eli Lilly and Company; Indianapolis IN USA
| | | | - Emily C. Collins
- Eli Lilly and Company; Indianapolis IN USA
- Avid Radiopharmaceuticals; Philadelphia PA USA
| | - Albert Lo
- Eli Lilly and Company; Indianapolis IN USA
| | | | - Mark A. Mintun
- Eli Lilly and Company; Indianapolis IN USA
- Avid Radiopharmaceuticals; Philadelphia PA USA
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29
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Kotari V, Navitsky M, Southekal S, Kennedy I, Harris T, Lu M, Mintun MA, Fleisher AS, Pontecorvo MJ, Devous MD. O5‐01‐06: EARLY TAU DETECTION AND IMPLICATIONS FOR DISEASE PROGRESSION. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | | | - Ian Kennedy
- Avid Radiopharmaceuticals Philadelphia PA USA
| | | | - Ming Lu
- Avid Radiopharmaceuticals Philadelphia PA USA
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30
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Charil A, Schwarz AJ, Southekal S, Kotari V, Navitsky M, Kennedy I, Lu M, Shcherbinin S, Mintun MA, Devous MD, Pontecorvo MJ. IC-P-162: RELATIONSHIPS BETWEEN FLORTAUCIPIR TAU BINDING AND REGIONAL BRAIN ATROPHY IN AMYLOID POSITIVE SUBJECTS ACROSS THE ALZHEIMER'S DISEASE SPECTRUM. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | | | | | | | - Ian Kennedy
- Avid Radiopharmaceuticals; Philadelphia PA USA
| | - Ming Lu
- Avid Radiopharmaceuticals; Philadelphia PA USA
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31
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Stern RA, Adler CH, Chen K, Navitsky M, Luo J, Dodick DW, Alosco ML, Tripodis Y, Goradia DD, Martin B, Mastroeni D, Fritts NG, Jarnagin J, Devous MD, Mintun MA, Pontecorvo MJ, Shenton ME, Reiman EM. Tau Positron-Emission Tomography in Former National Football League Players. N Engl J Med 2019; 380:1716-1725. [PMID: 30969506 PMCID: PMC6636818 DOI: 10.1056/nejmoa1900757] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that has been associated with a history of repetitive head impacts. The neuropathological diagnosis is based on a specific pattern of tau deposition with minimal amyloid-beta deposition that differs from other disorders, including Alzheimer's disease. The feasibility of detecting tau and amyloid deposition in the brains of living persons at risk for CTE has not been well studied. METHODS We used flortaucipir positron-emission tomography (PET) and florbetapir PET to measure deposition of tau and amyloid-beta, respectively, in the brains of former National Football League (NFL) players with cognitive and neuropsychiatric symptoms and in asymptomatic men with no history of traumatic brain injury. Automated image-analysis algorithms were used to compare the regional tau standardized uptake value ratio (SUVR, the ratio of radioactivity in a cerebral region to that in the cerebellum as a reference) between the two groups and to explore the associations of SUVR with symptom severity and with years of football play in the former-player group. RESULTS A total of 26 former players and 31 controls were included in the analysis. The mean flortaucipir SUVR was higher among former players than among controls in three regions of the brain: bilateral superior frontal (1.09 vs. 0.98; adjusted mean difference, 0.13; 95% confidence interval [CI], 0.06 to 0.20; P<0.001), bilateral medial temporal (1.23 vs. 1.12; adjusted mean difference, 0.13; 95% CI, 0.05 to 0.21; P<0.001), and left parietal (1.12 vs. 1.01; adjusted mean difference, 0.12; 95% CI, 0.05 to 0.20; P = 0.002). In exploratory analyses, the correlation coefficients in these three regions between the SUVRs and years of play were 0.58 (95% CI, 0.25 to 0.79), 0.45 (95% CI, 0.07 to 0.71), and 0.50 (95% CI, 0.14 to 0.74), respectively. There was no association between tau deposition and scores on cognitive and neuropsychiatric tests. Only one former player had levels of amyloid-beta deposition similar to those in persons with Alzheimer's disease. CONCLUSIONS A group of living former NFL players with cognitive and neuropsychiatric symptoms had higher tau levels measured by PET than controls in brain regions that are affected by CTE and did not have elevated amyloid-beta levels. Further studies are needed to determine whether elevated CTE-associated tau can be detected in individual persons. (Funded by Avid Radiopharmaceuticals and others.).
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Affiliation(s)
- Robert A Stern
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
| | - Charles H Adler
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
| | - Kewei Chen
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
| | - Michael Navitsky
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
| | - Ji Luo
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
| | - David W Dodick
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
| | - Michael L Alosco
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
| | - Yorghos Tripodis
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
| | - Dhruman D Goradia
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
| | - Brett Martin
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
| | - Diego Mastroeni
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
| | - Nathan G Fritts
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
| | - Johnny Jarnagin
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
| | - Michael D Devous
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
| | - Mark A Mintun
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
| | - Michael J Pontecorvo
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
| | - Martha E Shenton
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
| | - Eric M Reiman
- From the Boston University School of Medicine (R.A.S., M.L.A., N.G.F., J.J.), Boston University School of Public Health (Y.T., B.M.), Brigham and Women's Hospital (M.E.S.), Harvard Medical School (M.E.S.), and the Veterans Affairs Boston Healthcare System (M.E.S.) - all in Boston; Mayo Clinic Arizona, Scottsdale (C.H.A., D.W.D.), Banner Alzheimer's Institute, Phoenix (K.C., J.L., D.D.G., E.M.R.), and Arizona State University, Tempe (D.M.) - all in Arizona; and Avid Radiopharmaceuticals, Philadelphia (M.N., M.D.D., M.A.M., M.J.P.)
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Gordon BA, Blazey TM, Christensen J, Dincer A, Flores S, Keefe S, Chen C, Su Y, McDade EM, Wang G, Li Y, Hassenstab J, Aschenbrenner A, Hornbeck R, Jack CR, Ances BM, Berman SB, Brosch JR, Galasko D, Gauthier S, Lah JJ, Masellis M, van Dyck CH, Mintun MA, Klein G, Ristic S, Cairns NJ, Marcus DS, Xiong C, Holtzman DM, Raichle ME, Morris JC, Bateman RJ, Benzinger TLS. Tau PET in autosomal dominant Alzheimer's disease: relationship with cognition, dementia and other biomarkers. Brain 2019; 142:1063-1076. [PMID: 30753379 PMCID: PMC6439328 DOI: 10.1093/brain/awz019] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/12/2018] [Accepted: 12/01/2018] [Indexed: 01/01/2023] Open
Abstract
Tauopathy is a hallmark pathology of Alzheimer's disease with a strong relationship with cognitive impairment. As such, understanding tau may be a key to clinical interventions. In vivo tauopathy has been measured using cerebrospinal fluid assays, but these do not provide information about where pathology is in the brain. The introduction of PET ligands that bind to paired helical filaments provides the ability to measure the amount and distribution of tau pathology. The heritability of the age of dementia onset tied to the specific mutations found in autosomal dominant Alzheimer's disease families provides an elegant model to study the spread of tau across the course of the disease as well as the cross-modal relationship between tau and other biomarkers. To better understand the pathobiology of Alzheimer's disease we measured levels of tau PET binding in individuals with dominantly inherited Alzheimer's disease using data from the Dominantly Inherited Alzheimer Network (DIAN). We examined cross-sectional measures of amyloid-β, tau, glucose metabolism, and grey matter degeneration in 15 cognitively normal mutation non-carriers, 20 asymptomatic carriers, and 15 symptomatic mutation carriers. Linear models examined the association of pathology with group, estimated years to symptom onset, as well as cross-modal relationships. For comparison, tau PET was acquired on 17 older adults with sporadic, late onset Alzheimer disease. Tau PET binding was starkly elevated in symptomatic DIAN individuals throughout the cortex. The brain areas demonstrating elevated tau PET binding overlapped with those seen in sporadic Alzheimer's disease, but with a greater cortical involvement and greater levels of binding despite similar cognitive impairment. Tau PET binding was elevated in the temporal lobe, but the most prominent loci of pathology were in the precuneus and lateral parietal regions. Symptomatic mutation carriers also demonstrated elevated tau PET binding in the basal ganglia, consistent with prior work with amyloid-β. The degree of tau tracer binding in symptomatic individuals was correlated to other biomarkers, particularly markers of neurodegeneration. In addition to the differences seen with tau, amyloid-β was increased in both asymptomatic and symptomatic groups relative to non-carriers. Glucose metabolism showed decline primarily in the symptomatic group. MRI indicated structural degeneration in both asymptomatic and symptomatic cohorts. We demonstrate that tau PET binding is elevated in symptomatic individuals with dominantly inherited Alzheimer's disease. Tau PET uptake was tied to the onset of cognitive dysfunction, and there was a higher amount, and different regional pattern of binding compared to late onset, non-familial Alzheimer's disease.
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Affiliation(s)
- Brian A Gordon
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
- Knight Alzheimer’s Disease Research Center, Washington University in St. Louis MO, USA
- The Hope Center for Neurological Disorders, St. Louis, MO, USA
- Department of Psychological and Brain Sciences, Washington University in St. Louis MO, USA
| | - Tyler M Blazey
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - Jon Christensen
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - Aylin Dincer
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - Shaney Flores
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - Sarah Keefe
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - Charles Chen
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - Yi Su
- Banner Health, Phoenix AZ, USA
| | - Eric M McDade
- Knight Alzheimer’s Disease Research Center, Washington University in St. Louis MO, USA
- Department of Neurology, Washington University in St. Louis MO, USA
| | - Guoqiao Wang
- Department of Neurology, Washington University in St. Louis MO, USA
| | - Yan Li
- Department of Neurology, Washington University in St. Louis MO, USA
| | - Jason Hassenstab
- Knight Alzheimer’s Disease Research Center, Washington University in St. Louis MO, USA
- Department of Psychological and Brain Sciences, Washington University in St. Louis MO, USA
- Department of Neurology, Washington University in St. Louis MO, USA
| | - Andrew Aschenbrenner
- Knight Alzheimer’s Disease Research Center, Washington University in St. Louis MO, USA
- Department of Neurology, Washington University in St. Louis MO, USA
| | - Russ Hornbeck
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | | | - Beau M Ances
- Knight Alzheimer’s Disease Research Center, Washington University in St. Louis MO, USA
- The Hope Center for Neurological Disorders, St. Louis, MO, USA
- Department of Neurology, Washington University in St. Louis MO, USA
| | - Sarah B Berman
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jared R Brosch
- Department of Neurology, Indiana University, Indianapolis, IN, USA
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Serge Gauthier
- Departments of Psychiatry, Neurology and Neurosurgery, and Medicine, McGill University, Montreal, Canada
| | - James J Lah
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Mario Masellis
- Division of Neurology, Sunnybrook Health Sciences Centre; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher H van Dyck
- Alzheimer’s Disease Research Unit, Yale University School of Medicine, New Haven, CT, USA
| | - Mark A Mintun
- Avid Radiopharmaceuticals (A Wholly Owned Subsidiary of Eli Lilly and Company), Philadelphia, PA, USA
| | - Gregory Klein
- Roche Pharma Research and Early Development, Basel, Switzerland
| | - Smiljana Ristic
- Roche/Genentech Product Development, Neuroscience, Basel, Switzerland
| | - Nigel J Cairns
- Knight Alzheimer’s Disease Research Center, Washington University in St. Louis MO, USA
- The Hope Center for Neurological Disorders, St. Louis, MO, USA
- Department of Neurology, Washington University in St. Louis MO, USA
| | - Daniel S Marcus
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - Chengjie Xiong
- Knight Alzheimer’s Disease Research Center, Washington University in St. Louis MO, USA
- Department of Biostatistics, Washington University in St. Louis, MO, USA
| | - David M Holtzman
- Knight Alzheimer’s Disease Research Center, Washington University in St. Louis MO, USA
- The Hope Center for Neurological Disorders, St. Louis, MO, USA
- Department of Neurology, Washington University in St. Louis MO, USA
| | - Marcus E Raichle
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
- The Hope Center for Neurological Disorders, St. Louis, MO, USA
- Department of Neurology, Washington University in St. Louis MO, USA
| | - John C Morris
- Knight Alzheimer’s Disease Research Center, Washington University in St. Louis MO, USA
- Department of Neurology, Washington University in St. Louis MO, USA
| | - Randall J Bateman
- Knight Alzheimer’s Disease Research Center, Washington University in St. Louis MO, USA
- The Hope Center for Neurological Disorders, St. Louis, MO, USA
- Department of Neurology, Washington University in St. Louis MO, USA
| | - Tammie L S Benzinger
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
- Knight Alzheimer’s Disease Research Center, Washington University in St. Louis MO, USA
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Golla SSV, Timmers T, Ossenkoppele R, Groot C, Verfaillie S, Scheltens P, van der Flier WM, Schwarte L, Mintun MA, Devous M, Schuit RC, Windhorst AD, Lammertsma AA, Boellaard R, van Berckel BNM, Yaqub M. Quantification of Tau Load Using [ 18F]AV1451 PET. Mol Imaging Biol 2018; 19:963-971. [PMID: 28374171 PMCID: PMC5662681 DOI: 10.1007/s11307-017-1080-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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] [Indexed: 12/19/2022]
Abstract
Purpose The tau tracer [18F]AV1451, also known as flortaucipir, is a promising ligand for imaging tau accumulation in Alzheimer’s disease (AD). Most of the previous studies have quantified tau load using standardized uptake value ratios (SUVr) derived from a static [18F]AV1451 scan. SUVr may, however, be flow dependent and, especially for longitudinal studies, should be validated against a fully quantitative approach. The objective of this study was to identify the optimal tracer kinetic model for measuring tau load using [18F]AV1451. Procedures Following intravenous injection of 225 ± 16 MBq [18F]AV1451, 130 min dynamic PET scans were performed in five biomarker confirmed AD patients and five controls. Arterial blood sampling was performed to obtain a metabolite-corrected plasma input function. Next, regional time–activity curves were generated using PVElab software. These curves were analysed using several pharmacokinetic models. Results The reversible single tissue compartment model (1T2k_VB) was the preferred model for all but one control. For AD patients, however, model preference shifted towards a reversible two tissue compartmental model (2T4k_VB). The simplified reference tissue model (SRTM) derived binding potential (BPND) showed good correlation (AD: r2 = 0.87, slope = 1.06; controls: r2 = 0.87, slope = 0.86) with indirect plasma input binding (distribution volume ratio-1). Standardized uptake value ratios (80–100 min) correlated well with DVR (r2 = 0.93, slope = 1.07) and SRTM-derived BPND (r2 = 0.84, slope = 0.95). In addition, regional differences in tracer binding between subject groups in different tau-specific regions were observed. Conclusions Model preference of [18F]AV1451 appears to depend on subject status and, in particular, VT. The relationship between model preference and VT suggests that (higher) tau load may be reflected by a second tissue compartment. Nevertheless, consistent results can be obtained using a 2T4k_VB model. In addition, SRTM can be used to derive BPND. Electronic supplementary material The online version of this article (doi:10.1007/s11307-017-1080-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sandeep S V Golla
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands.
| | - Tessa Timmers
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands.,Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam, Netherlands
| | - Rik Ossenkoppele
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands.,Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam, Netherlands
| | - Colin Groot
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - Sander Verfaillie
- Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam, Netherlands
| | - Philip Scheltens
- Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam, Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam, Netherlands.,Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Lothar Schwarte
- Department of Anaesthesiology, VU University Medical center, Amsterdam, Netherlands
| | | | | | - Robert C Schuit
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - Albert D Windhorst
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands.,Department of Nuclear Medicine & Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands.,Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam, Netherlands
| | - Maqsood Yaqub
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands
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34
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Navitsky M, Joshi AD, Kennedy I, Klunk WE, Rowe CC, Wong DF, Pontecorvo MJ, Mintun MA, Devous MD. Standardization of amyloid quantitation with florbetapir standardized uptake value ratios to the Centiloid scale. Alzheimers Dement 2018; 14:1565-1571. [PMID: 30006100 DOI: 10.1016/j.jalz.2018.06.1353] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [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: 08/30/2017] [Revised: 05/17/2018] [Accepted: 06/03/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Klunk et al. recently proposed a means of standardizing quantitation of amyloid burden from positron emission tomography scans to a common Centiloid scale, and we have applied that method to florbetapir. METHODS Florbetapir and Pittsburgh compound B scans were acquired for 46 mixed clinical presentation subjects within 18 ± 20 days. Florbetapir and Pittsburgh compound B cortical standardized uptake value ratio (SUVr) values were well correlated for both standard Centiloid (R2 = 0.894) and Avid (R2 = 0.901) volume of interests (VOIs). The methods of Klunk et al. were applied to establish a conversion first from florbetapir SUVr values obtained using standard Centiloid VOIs to Centiloids and then from Avid VOIs (Joshi et al.) to Centiloids. RESULTS The equation for conversion of florbetapir SUVr from Avid VOIs to the Centiloid scale was as follows: Florbetapir Centiloids = 183 × SUVrAvid - 177. The threshold that discriminated neuropathologically verified none or sparse versus moderate to frequent plaques in autopsy-confirmed data is 24.1 Centiloids. DISCUSSION These findings may allow improved tracer-independent amyloid quantitation.
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Affiliation(s)
| | | | - Ian Kennedy
- Avid Radiopharmaceuticals, Philadelphia, PA, USA
| | - William E Klunk
- Departments of Neurology and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christopher C Rowe
- Department of Molecular Imaging and Therapy, Austin Health and Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Dean F Wong
- Radiology, Psychiatry, Neuroscience, Neurology, Environmental Health Sciences, and Carey Business School, Johns Hopkins University, Section of High Resolution Brain PET Imaging, Division of Nuclear Medicine, Baltimore, MD, USA
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35
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Flores S, Su Y, Wang G, Hornbeck RC, Speidel B, Vlassenko AG, Gordon BA, Mintun MA, Koeppe RA, Klunk WE, Xiong C, Morris JC, Bateman RJ, Benzinger TL. P3‐440: COMPARING THE CENTILOID SCALE FOR PITTSBURGH COMPOUND B AND FLORBETAPIR IN LONGITUDINAL PET STUDIES OF SPORADIC AD. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Shaney Flores
- Washington University in St. Louis School of MedicineSt. LouisMOUSA
| | - Yi Su
- Washington University in St. Louis School of MedicineSt. LouisMOUSA
| | - Guoqiao Wang
- Washington University in St. LouisSt. LouisMOUSA
| | | | - Ben Speidel
- Washington University School of MedicineSaint LouisMOUSA
| | | | - Brian A. Gordon
- Washington University in St. Louis School of MedicineSt. LouisMOUSA
| | | | | | | | - Chengjie Xiong
- Knight Alzheimer's Disease Research CenterSt. LouisMOUSA
| | - John C. Morris
- Knight Alzheimer's Disease Research CenterSaint LouisMOUSA
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36
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Shcherbinin S, Liu P, Fleisher AS, Sundell KL, Charil A, Lu M, Devous MD, Pontecorvo MJ, Mintun MA, Siemers ER, Irizarry MC, Schwarz AJ. IC‐P‐216: LOBAR CLASSIFICATION OF TAU PET IMAGES IN THE EXPEDITION‐3 TRIAL. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Peng Liu
- Eli Lilly and CompanyIndianapolisINUSA
| | | | | | | | - Ming Lu
- Avid RadiopharmaceuticalsPhiladelphiaPAUSA
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37
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Shcherbinin S, Liu P, Fleisher AS, Sundell KL, Charil A, Lu M, Devous MD, Pontecorvo MJ, Mintun MA, Siemers ER, Irizarry MC, Schwarz AJ. O3‐13‐02: LOBAR CLASSIFICATION OF TAU PET IMAGES IN THE EXPEDITION‐3 TRIAL. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Peng Liu
- Eli Lilly and CompanyIndianapolisINUSA
| | | | | | | | - Ming Lu
- Avid RadiopharmaceuticalsPhiladelphiaPAUSA
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38
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Flores S, Su Y, Wang G, Hornbeck RC, Speidel B, Vlassenko AG, Gordon BA, Mintun MA, Koeppe RA, Klunk WE, Xiong C, Morris JC, Bateman RJ, Benzinger TL. IC‐P‐009: COMPARING THE CENTILOID SCALE FOR PITTSBURGH COMPOUND B AND FLORBETAPIR IN LONGITUDINAL PET STUDIES OF SPORADIC AD. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Shaney Flores
- Washington University in St. LouisSchool of MedicineSt. LouisMOUSA
| | - Yi Su
- Washington University in St. LouisSchool of MedicineSt. LouisMOUSA
| | - Guoqiao Wang
- Washington University in St. LouisSt. LouisMOUSA
| | | | - Ben Speidel
- Washington UniversitySchool of MedicineSaint LouisMOUSA
| | | | - Brian A. Gordon
- Washington University in St. LouisSchool of MedicineSt. LouisMOUSA
| | | | | | | | - Chengjie Xiong
- Department of BiostatisticsWashington UniversitySt. LouisMOUSA
| | - John C. Morris
- Knight Alzheimer's Disease Research CenterSaint LouisMOUSA
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39
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Johnson KA, Schultz AP, Raman R, Donohue MC, Sun CK, Jacobs HIL, Marek K, Seibyl J, Mintun MA, Shcherbinin S, Pontecorvo MJ, Mormino BC, Rowe CC, Dyck CH, Salloway S, Jack CR, Yaari R, Holdridge KC, Aisen PS, Sperling RA. P4‐321: TAU PET IN A4: PRELIMINARY REPORT. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.07.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Keith A. Johnson
- Department of Radiology, Division of Molecular Imaging and Nuclear MedicineMassachusetts General HospitalBostonMAUSA
| | | | - Rema Raman
- University of Southern CaliforniaSan DiegoCAUSA
| | | | | | - Heidi IL. Jacobs
- Alzheimer Center LimburgMaastricht UniversityMaastrichtNetherlands
| | - Kenneth Marek
- Molecular NeuroimagingA Division of inviCRONew HavenCTUSA
| | | | | | | | | | | | | | | | | | | | - Roy Yaari
- Lilly Research LaboratoriesIndianapolisINUSA
| | | | - Paul S. Aisen
- Alzheimer's Therapeutic Research InstituteSan DiegoCAUSA
| | - Reisa A. Sperling
- Center for Alzheimer Research and Treatment, Brigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
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40
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Hou C, Hsieh CJ, Li S, Lee H, Graham TJ, Xu K, Weng CC, Doot RK, Chu W, Chakraborty SK, Dugan LL, Mintun MA, Mach RH. Development of a Positron Emission Tomography Radiotracer for Imaging Elevated Levels of Superoxide in Neuroinflammation. ACS Chem Neurosci 2018; 9:578-586. [PMID: 29099578 PMCID: PMC5865080 DOI: 10.1021/acschemneuro.7b00385] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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] [Indexed: 11/29/2022] Open
Abstract
![]()
Reactive oxygen species
(ROS) are believed to play a major role in the proinflammatory, M1-polarized
form of neuroinflammation. However, it has been difficult to assess
the role of ROS and their role in neuroinflammation in animal models
of disease because of the absence of probes capable of measuring their
presence with the functional imaging technique positron emission tomography
(PET). This study describes the synthesis and in vivo evaluation of
[18F]ROStrace, a radiotracer for imaging superoxide in
vivo with PET, in an LPS model of neuroinflammation. [18F]ROStrace was found to rapidly cross the blood–brain barrier
(BBB) and was trapped in the brain of LPS-treated animals but not
the control group. [18F]ox-ROStrace, the
oxidized form of [18F]ROStrace, did not cross the BBB.
These data suggest that [18F]ROStrace is a suitable radiotracer
for imaging superoxide levels in the central nervous system with PET.
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Affiliation(s)
- Catherine Hou
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Chia-Ju Hsieh
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Shihong Li
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Hsiaoju Lee
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Thomas J. Graham
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Kuiying Xu
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Chi-Chang Weng
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Robert K. Doot
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Wenhua Chu
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110-1016, United States
| | - Subhasish K. Chakraborty
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
| | - Laura L. Dugan
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
| | - Mark A. Mintun
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110-1016, United States
| | - Robert H. Mach
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
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41
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Jansen WJ, Ossenkoppele R, Tijms BM, Fagan AM, Hansson O, Klunk WE, van der Flier WM, Villemagne VL, Frisoni GB, Fleisher AS, Lleó A, Mintun MA, Wallin A, Engelborghs S, Na DL, Chételat G, Molinuevo JL, Landau SM, Mattsson N, Kornhuber J, Sabri O, Rowe CC, Parnetti L, Popp J, Fladby T, Jagust WJ, Aalten P, Lee DY, Vandenberghe R, Resende de Oliveira C, Kapaki E, Froelich L, Ivanoiu A, Gabryelewicz T, Verbeek MM, Sanchez-Juan P, Hildebrandt H, Camus V, Zboch M, Brooks DJ, Drzezga A, Rinne JO, Newberg A, de Mendonça A, Sarazin M, Rabinovici GD, Madsen K, Kramberger MG, Nordberg A, Mok V, Mroczko B, Wolk DA, Meyer PT, Tsolaki M, Scheltens P, Verhey FRJ, Visser PJ, Aarsland D, Alcolea D, Alexander M, Almdahl IS, Arnold SE, Baldeiras I, Barthel H, van Berckel BNM, Blennow K, van Buchem MA, Cavedo E, Chen K, Chipi E, Cohen AD, Förster S, Fortea J, Frederiksen KS, Freund-Levi Y, Gkatzima O, Gordon MF, Grimmer T, Hampel H, Hausner L, Hellwig S, Herukka SK, Johannsen P, Klimkowicz-Mrowiec A, Köhler S, Koglin N, van Laere K, de Leon M, Lisetti V, Maier W, Marcusson J, Meulenbroek O, Møllergård HM, Morris JC, Nordlund A, Novak GP, Paraskevas GP, Perera G, Peters O, Ramakers IHGB, Rami L, Rodríguez-Rodríguez E, Roe CM, Rot U, Rüther E, Santana I, Schröder J, Seo SW, Soininen H, Spiru L, Stomrud E, Struyfs H, Teunissen CE, Vos SJB, van Waalwijk van Doorn LJC, Waldemar G, Wallin ÅK, Wiltfang J, Zetterberg H. Association of Cerebral Amyloid-β Aggregation With Cognitive Functioning in Persons Without Dementia. JAMA Psychiatry 2018; 75:84-95. [PMID: 29188296 PMCID: PMC5786156 DOI: 10.1001/jamapsychiatry.2017.3391] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Cerebral amyloid-β aggregation is an early event in Alzheimer disease (AD). Understanding the association between amyloid aggregation and cognitive manifestation in persons without dementia is important for a better understanding of the course of AD and for the design of prevention trials. OBJECTIVE To investigate whether amyloid-β aggregation is associated with cognitive functioning in persons without dementia. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 2908 participants with normal cognition and 4133 with mild cognitive impairment (MCI) from 53 studies in the multicenter Amyloid Biomarker Study. Normal cognition was defined as having no cognitive concerns for which medical help was sought and scores within the normal range on cognitive tests. Mild cognitive impairment was diagnosed according to published criteria. Study inclusion began in 2013 and is ongoing. Data analysis was performed in January 2017. MAIN OUTCOMES AND MEASURES Global cognitive performance as assessed by the Mini-Mental State Examination (MMSE) and episodic memory performance as assessed by a verbal word learning test. Amyloid aggregation was measured with positron emission tomography or cerebrospinal fluid biomarkers and dichotomized as negative (normal) or positive (abnormal) according to study-specific cutoffs. Generalized estimating equations were used to examine the association between amyloid aggregation and low cognitive scores (MMSE score ≤27 or memory z score≤-1.28) and to assess whether this association was moderated by age, sex, educational level, or apolipoprotein E genotype. RESULTS Among 2908 persons with normal cognition (mean [SD] age, 67.4 [12.8] years), amyloid positivity was associated with low memory scores after age 70 years (mean difference in amyloid positive vs negative, 4% [95% CI, 0%-7%] at 72 years and 21% [95% CI, 10%-33%] at 90 years) but was not associated with low MMSE scores (mean difference, 3% [95% CI, -1% to 6%], P = .16). Among 4133 patients with MCI (mean [SD] age, 70.2 [8.5] years), amyloid positivity was associated with low memory (mean difference, 16% [95% CI, 12%-20%], P < .001) and low MMSE (mean difference, 14% [95% CI, 12%-17%], P < .001) scores, and this association decreased with age. Low cognitive scores had limited utility for screening of amyloid positivity in persons with normal cognition and those with MCI. In persons with normal cognition, the age-related increase in low memory score paralleled the age-related increase in amyloid positivity with an intervening period of 10 to 15 years. CONCLUSIONS AND RELEVANCE Although low memory scores are an early marker of amyloid positivity, their value as a screening measure for early AD among persons without dementia is limited.
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Affiliation(s)
- Willemijn J. Jansen
- Department of Psychiatry and Neuropsychology, School
for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University,
Maastricht, the Netherlands
| | - Rik Ossenkoppele
- Department of Neurology and Alzheimer Center, VU
University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, the Netherlands,Department of Radiology and Nuclear Medicine, VU
University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, the Netherlands,Department of Neurology, Memory and Aging Center,
University of California, San Francisco,Helen Wills Neuroscience Institute, University of
California, Berkeley
| | - Betty M. Tijms
- Department of Neurology and Alzheimer Center, VU
University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, the Netherlands
| | - Anne M. Fagan
- Knight Alzheimer’s Disease Research Center,
Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Oskar Hansson
- Clinical Memory Research Unit, Clinical Sciences
Malmö, Lund University, Lund, Sweden
| | - William E. Klunk
- Department of Psychiatry, University of Pittsburgh
School of Medicine, Pittsburgh, Pennsylvania
| | - Wiesje M. van der Flier
- Department of Neurology and Alzheimer Center, VU
University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, the Netherlands,Department of Epidemiology and Biostatistics, VU
University Medical Center, Amsterdam, the Netherlands
| | - Victor L. Villemagne
- Department of Nuclear Medicine and Centre for PET,
Austin Health, Melbourne, Australia
| | - Giovanni B. Frisoni
- Laboratory of Alzheimer's Neuroimaging and
Epidemiology, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy,Memory Clinic and LANVIE–Laboratory of
Neuroimaging of Aging, University Hospitals, and University of Geneva, Geneva, Switzerland
| | - Adam S. Fleisher
- Banner Alzheimer’s Institute, Phoenix,
Arizona,Eli Lilly and Company, Indianapolis, Indiana,Department of Neurosciences, University of
California, San Diego
| | - Alberto Lleó
- Neurology Department, Hospital de Sant Pau,
Barcelona, Spain
| | | | - Anders Wallin
- Institute of Neuroscience and Physiology,
Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia
(BIODEM), University of Antwerp, Antwerp, Belgium
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center,
Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gäel Chételat
- Institut National de la Santé et de la
Recherche Médicale (INSERM), CHU de Caen, Caen, France
| | - José Luis Molinuevo
- Alzheimer’s Disease and Other Cognitive
Disorders Unit, IDIBAPS, Clinic University Hospital, Barcelona, Spain
| | - Susan M. Landau
- Helen Wills Neuroscience Institute, University of
California, Berkeley
| | - Niklas Mattsson
- Clinical Memory Research Unit, Clinical Sciences
Malmö, Lund University, Lund, Sweden
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy,
Friedrich-Alexander University of Erlangen–Nuremberg, Erlangen, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of
Leipzig, Leipzig, Germany
| | - Christopher C. Rowe
- Knight Alzheimer’s Disease Research Center,
Department of Neurology, Washington University School of Medicine, St Louis, Missouri,Department of Nuclear Medicine and Centre for PET,
Austin Health, Melbourne, Australia
| | - Lucilla Parnetti
- Section of Neurology, Center for Memory
Disturbances, University of Perugia, Perugia, Italy
| | - Julius Popp
- Department of Psychiatry, Service of Old Age
Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Tormod Fladby
- Department of Neurology, Akershus University
Hospital, Lørenskog, Norway
| | - William J. Jagust
- Helen Wills Neuroscience Institute, University of
California, Berkeley
| | - Pauline Aalten
- Department of Psychiatry and Neuropsychology, School
for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University,
Maastricht, the Netherlands
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National
University, College of Medicine, Seoul, South Korea
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology and Alzheimer
Research Centre KU Leuven, Catholic University Leuven, Leuven, Belgium
| | - Catarina Resende de Oliveira
- Center for Neuroscience and Cell Biology, Faculty of
Medicine, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Elisabeth Kapaki
- First Department of Neurology, Eginition Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Lutz Froelich
- Department of Geriatric Psychiatry, Central
Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
| | - Adrian Ivanoiu
- Memory Clinic and Neurochemistry Laboratory, Saint
Luc University Hospital, Institute of Neuroscience, Université catholique de Louvain,
Brussels, Belgium
| | - Tomasz Gabryelewicz
- Department of Neurodegenerative Disorders,
Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
| | - Marcel M. Verbeek
- Departments of Neurology and Laboratory Medicine,
Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud
University Medical Center, Nijmegen, the Netherlands
| | - Páscual Sanchez-Juan
- Neurology Service, Universitary Hospital
Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | - Vincent Camus
- CHRU de Tours, CIC INSERM 1415, INSERM U930, and
Université François Rabelais de Tours, Tours, France
| | - Marzena Zboch
- Alzheimer Center, Wroclaw Medical University,
Scinawa, Poland
| | - David J. Brooks
- Division of Neuroscience, Medical Research Council
Clinical Sciences Centre, Imperial College London, London, England
| | - Alexander Drzezga
- Department of Nuclear Medicine, University of
Cologne, Cologne, Germany
| | - Juha O. Rinne
- Turku PET Centre and Division of Clinical
Neurosciences Turku, University of Turku and Turku University Hospital, Turku, Finland
| | - Andrew Newberg
- Myrna Brind Center of Integrative Medicine, Thomas
Jefferson University and Hospital, Philadelphia, Pennsylvania
| | - Alexandre de Mendonça
- Institute of Molecular Medicine and Faculty of
Medicine, University of Lisbon, Lisbon, Portugal
| | - Marie Sarazin
- Neurologie de la Mémoire et du Langage, Centre
Hospitalier Sainte-Anne, Université Paris 5, Paris, France
| | - Gil D. Rabinovici
- Department of Neurology, Memory and Aging Center,
University of California, San Francisco
| | - Karine Madsen
- Neurobiology Research Unit, Copenhagen University
Hospital, Copenhagen, Denmark
| | - Milica G. Kramberger
- Center for Cognitive Impairments, University Medical
Centre Ljubljana, Ljubljana, Slovenia
| | - Agneta Nordberg
- Department NVS, Center for Alzheimer Research,
Translational Alzheimer Neurobiology, Karolinska Institutet, and Geriatric Medicine,
Karolinska University Hospital, Stockholm, Sweden
| | - Vincent Mok
- Lui Che Woo Institute of Innovative Medicine,
Department of Medicine and Therapeutics, Therese Pei Fong Chow Research Centre for
Prevention of Dementia, Hong Kong
| | - Barbara Mroczko
- Department of Neurodegeneration Diagnostics, Leading
National Research Centre in Białystok (KNOW), Medical University of Białystok,
Białystok, Poland
| | - David A. Wolk
- Department of Neurology, University of Pennsylvania,
Philadelphia
| | - Philipp T. Meyer
- Department of Nuclear Medicine, University Hospital
Freiburg, Freiburg, Germany
| | - Magda Tsolaki
- Third Department of Neurology, Aristotle University
of Thessaloniki, Thessaloniki, Greece
| | | | - Philip Scheltens
- Department of Neurology and Alzheimer Center, VU
University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, the Netherlands
| | - Frans R. J. Verhey
- Department of Psychiatry and Neuropsychology, School
for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University,
Maastricht, the Netherlands
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School
for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University,
Maastricht, the Netherlands,Department of Neurology and Alzheimer Center, VU
University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, the Netherlands
| | - Dag Aarsland
- Center for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Daniel Alcolea
- Neurology Department, Hospital de Sant Pau, Barcelona, Spain
| | | | - Ina S Almdahl
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Steven E Arnold
- Department of Neurology, University of Pennsylvania, Philadelphia
| | - Inês Baldeiras
- Center for Neuroscience and Cell Biology, Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, the Netherlands
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Enrica Cavedo
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Département de Neurologie, Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A), Hôpital Pitié-Stijmsalpêtrière, Boulevard de l'hôpital, F-75013, Paris, France.,AXA Research Fund & UPMC Chair, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Inserm, CNRS, Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Kewei Chen
- Banner Alzheimer's Institute, Phoenix, Arizona
| | - Elena Chipi
- Section of Neurology, Center for Memory Disturbances, University of Perugia, Perugia, Italy
| | - Ann D Cohen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stefan Förster
- Department of Nuclear Medicine, Technische Universitaet München, Munich, Germany
| | - Juan Fortea
- Neurology Department, Hospital de Sant Pau, Barcelona, Spain
| | - Kristian S Frederiksen
- Danish Dementia Research Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Yvonne Freund-Levi
- Department of Geriatrics, Karolinska University Hospital Huddinge, Section of Clinical Geriatrics, Institution of NVS, Karolinska Institutet, Stockholm, Sweden
| | - Olymbia Gkatzima
- Third Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar der Technischen Universitaet München, Munich, Germany
| | - Harald Hampel
- Département de Neurologie, Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A), Hôpital Pitié-Stijmsalpêtrière, Boulevard de l'hôpital, F-75013, Paris, France.,AXA Research Fund & UPMC Chair, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Inserm, CNRS, Institut du Cerveau et de la Moelle Épinière, Paris, France.,Department of Psychiatry, Alzheimer Memorial Center and Geriatric Psychiatry Branch, Ludwig-Maximilian University, Munich, Germany
| | - Lucrezia Hausner
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sabine Hellwig
- Center of Geriatrics and Gerontology, University Hospital Freiburg, Freiburg, Germany
| | - Sanna-Kaisa Herukka
- Department of Neurology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Peter Johannsen
- Memory Clinic, Danish Dementia Research Center, Rigshospitalet, Copenhagen, Denmark
| | | | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | | | - Koen van Laere
- Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium
| | - Mony de Leon
- School of Medicine, Center for Brain Health, New York University, New York
| | - Viviana Lisetti
- Section of Neurology, Center for Memory Disturbances, University of Perugia, Perugia, Italy
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Jan Marcusson
- Geriatric Medicine, Department of Clinical and Experimental Medicine, University of Linköping, Linköping, Sweden
| | - Olga Meulenbroek
- Department of Geriatric Medicine, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hanne M Møllergård
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - John C Morris
- Knight Alzheimer's Disease Research Center, Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Arto Nordlund
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Gerald P Novak
- Janssen Research and Development, Titusville, New Jersey
| | - George P Paraskevas
- First Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gayan Perera
- Roche Products, Welwyn Garden City, United Kingdom.,Department of Psychological Medicine, Institute of Psychiatry, Kings College London, London, United Kingdom
| | - Oliver Peters
- Department of Psychiatry and Psychotherapy, Charité Berlin, German Center for Neurodegenrative Diseases (DZNE), Berlin, Germany
| | - Inez H G B Ramakers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Lorena Rami
- Alzheimer's Disease and Other Cognitive Disorders Unit, IDIBAPS, Clinic University Hospital, Barcelona, Spain
| | | | - Catherine M Roe
- Knight Alzheimer's Disease Research Center, Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Uros Rot
- Center for Cognitive Impairments, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August University, Göttingen, Germany
| | - Isabel Santana
- Center for Neuroscience and Cell Biology, Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Johannes Schröder
- Sektion Gerontopsychiatrie, Universität Heidelberg, Heidelberg, Germany
| | - Sang W Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hilkka Soininen
- Department of Neurology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Luiza Spiru
- Department of Geriatrics-Gerontology-Gerontopsychiatry, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Erik Stomrud
- Clinical Memory Research Unit, Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Hanne Struyfs
- Reference Center for Biological Markers of Dementia (BIODEM), University of Antwerp, Antwerp, Belgium
| | - Charlotte E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Stephanie J B Vos
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Linda J C van Waalwijk van Doorn
- Departments of Neurology and Laboratory Medicine, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gunhild Waldemar
- Department of Nuclear Medicine, Technische Universitaet München, Munich, Germany
| | - Åsa K Wallin
- Clinical Memory Research Unit, Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August University, Göttingen, Germany
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,UCL Institute of Neurology, Queen Square, London, United Kingdom
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42
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Devous MD, Joshi AD, Navitsky M, Southekal S, Pontecorvo MJ, Shen H, Lu M, Shankle WR, Seibyl JP, Marek K, Mintun MA. Test-Retest Reproducibility for the Tau PET Imaging Agent Flortaucipir F 18. J Nucl Med 2017; 59:937-943. [PMID: 29284675 DOI: 10.2967/jnumed.117.200691] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 08/14/2017] [Accepted: 11/08/2017] [Indexed: 01/16/2023] Open
Abstract
Alzheimer disease (AD) is characterized by β-amyloid (Aβ) plaques and tau neurofibrillary tangles. There are several PET imaging biomarkers for Aβ including 11C-PiB and 18F-florbetapir. Recently, PET tracers for tau neurofibrillary tangles have become available and have shown utility in detection and monitoring of neurofibrillary pathology over time. Flortaucipir F 18 is one such tracer. Initial clinical studies indicated greater tau binding in AD and mild cognitive impairment patients than in controls in a pattern consistent with tau pathology observed at autopsy. However, little is known about the reproducibility of such findings. To our knowledge, this study reports the first data regarding test-retest reproducibility of flortaucipir F 18 PET. Methods: Twenty-one subjects who completed the study (5 healthy controls, 6 mild cognitive impairment, and 10 AD) received 370 MBq of flortaucipir F 18 and were imaged for 20 min beginning 80 min after injection and again at 110 min after injection. Follow-up (retest) imaging occurred between 48 h and 4 wk after initial imaging. Images were spatially normalized to Montreal Neurological Institute template space. SUVRs were calculated using AAL (Automated Anatomical Labeling atlas) volumes of interest (VOIs) for parietal, temporal, occipital, anterior, and posterior hippocampal, parahippocampal, and fusiform regions, as well as a posterior neocortical VOI composed of average values from parietal, temporal, and occipital areas. Further, a VOI derived by discriminant analysis that maximally separated diagnostic groups (multiblock barycentric discriminant analysis [MUBADA]) was used. All VOIs were referenced to a subsection of cerebellar gray matter (cere-crus) as well as a parametrically derived white matter-based reference region (parametric estimate of reference signal intensity [PERSI]). t test, correlation analyses, and intraclass correlation coefficient were used to explore test-retest performance. Results: Test-retest analyses demonstrated low variability in flortaucipir F 18 SUVR. The SD of mean percentage change between test and retest using the PERSI reference region was 2.22% for a large posterior neocortical VOI, 1.84% for MUBADA, 1.46% for frontal, 1.98% for temporal, 2.28% for parietal, and 3.27% for occipital VOIs. Further, significant correlations (R2 > 0.85; P < 0.001) were observed for all regions, and intraclass correlation coefficient values (test-retest consistency) were greater than 0.92 for all regions. Conclusion: Significant test-retest reproducibility for flortaucipir F 18 was found across neocortical and mesial temporal lobe structures. These preliminary data suggest that flortaucipir F 18 tau imaging could be used to examine changes in tau burden over time.
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Affiliation(s)
- Michael D Devous
- Avid Radiopharmaceuticals, Inc. (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania
| | - Abhinay D Joshi
- Avid Radiopharmaceuticals, Inc. (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania
| | - Michael Navitsky
- Avid Radiopharmaceuticals, Inc. (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania
| | - Sudeepti Southekal
- Avid Radiopharmaceuticals, Inc. (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania
| | - Michael J Pontecorvo
- Avid Radiopharmaceuticals, Inc. (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania
| | - Haiqing Shen
- Avid Radiopharmaceuticals, Inc. (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania
| | - Ming Lu
- Avid Radiopharmaceuticals, Inc. (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania
| | - William R Shankle
- Shankle Clinic Memory and Cognitive Disorders Program, Hoag Neurosciences Institute, Newport Beach, California; and
| | | | - Ken Marek
- Molecular NeuroImaging, New Haven, Connecticut
| | - Mark A Mintun
- Avid Radiopharmaceuticals, Inc. (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania
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43
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Southekal S, Devous MD, Kennedy I, Navitsky M, Lu M, Joshi AD, Pontecorvo MJ, Mintun MA. Flortaucipir F 18 Quantitation Using Parametric Estimation of Reference Signal Intensity. J Nucl Med 2017; 59:944-951. [PMID: 29191858 DOI: 10.2967/jnumed.117.200006] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [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: 08/14/2017] [Accepted: 11/03/2017] [Indexed: 11/16/2022] Open
Abstract
PET imaging of tau pathology in Alzheimer disease may benefit from the use of white matter reference regions. These regions have shown reduced variability compared with conventional cerebellar regions in amyloid imaging. However, they are susceptible to contamination from partial-volume blurring of tracer uptake in the cortex. We present a new technique, PERSI (Parametric Estimation of Reference Signal Intensity), for flortaucipir F 18 count normalization that leverages the advantages of white matter reference regions while mitigating potential partial-volume effects. Methods: Subjects with a clinical diagnosis of Alzheimer disease, mild cognitive impairment, or normal cognition underwent T1-weighted MRI and florbetapir imaging (to determine amyloid [Aβ] status) at screening and flortaucipir F 18 imaging at single or multiple time points. Flortaucipir F 18 images, acquired as 4 × 5 min frames 80 min after a 370-MBq injection, were motion-corrected, averaged, and transformed to Montreal Neurological Institute (MNI) space. The PERSI reference region was calculated for each scan by fitting a bimodal gaussian distribution to the voxel-intensity histogram within an atlas-based white matter region and using the center and width of the lower-intensity peak to identify the voxel intensities to be included. Four conventional reference regions were also evaluated: whole cerebellum, cerebellar gray matter, atlas-based white matter, and subject-specific white matter. SUVr (standardized uptake value ratio) was calculated for a statistically defined neocortical volume of interest. Performance was evaluated with respect to test-retest variability in a phase 2 study of 21 subjects (5-34 d between scans). Baseline variability in controls (SD of SUVr and ΔSUVr) and effect sizes for group differences (Cohen d; Aβ-positive impaired vs. Aβ-negative normal) were evaluated in another phase 2 study with cross-sectional data (n = 215) and longitudinal data (n = 142/215; 18 ± 2 mo between scans). Results: PERSI showed superior test-retest reproducibility (1.84%) and group separation ability (cross-sectional Cohen d = 9.45; longitudinal Cohen d = 2.34) compared with other reference regions. Baseline SUVr variability and ΔSUVr were minimal in Aβ control subjects with no specific flortaucipir F 18 uptake (SUVr, 1.0 ± 0.04; ΔSUVr, 0.0 ± 0.02). Conclusion: PERSI reduced variability while enhancing discrimination between diagnostic cohorts. Such improvements could lead to more accurate disease staging and robust measurements of changes in tau burden over time for the evaluation of putative therapies.
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Affiliation(s)
- Sudeepti Southekal
- Avid Radiopharmaceuticals, Inc. (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia Pennsylvania
| | - Michael D Devous
- Avid Radiopharmaceuticals, Inc. (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia Pennsylvania
| | - Ian Kennedy
- Avid Radiopharmaceuticals, Inc. (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia Pennsylvania
| | - Michael Navitsky
- Avid Radiopharmaceuticals, Inc. (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia Pennsylvania
| | - Ming Lu
- Avid Radiopharmaceuticals, Inc. (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia Pennsylvania
| | - Abhinay D Joshi
- Avid Radiopharmaceuticals, Inc. (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia Pennsylvania
| | - Michael J Pontecorvo
- Avid Radiopharmaceuticals, Inc. (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia Pennsylvania
| | - Mark A Mintun
- Avid Radiopharmaceuticals, Inc. (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia Pennsylvania
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44
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Pontecorvo MJ, Siderowf A, Dubois B, Doraiswamy PM, Frisoni GB, Grundman M, Nobili F, Sadowsky CH, Salloway S, Arora AK, Chevrette A, Deberdt W, Dell'Agnello G, Flitter M, Galante N, Lowrey MJ, Lu M, McGeehan A, Devous Sr. MD, Mintun MA. Effectiveness of Florbetapir PET Imaging in Changing Patient Management. Dement Geriatr Cogn Disord 2017; 44:129-143. [PMID: 28787712 PMCID: PMC5806476 DOI: 10.1159/000478007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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] [Accepted: 06/05/2017] [Indexed: 12/24/2022] Open
Abstract
AIMS To evaluate the impact of amyloid PET imaging on diagnosis and patient management in a multicenter, randomized, controlled study. METHODS Physicians identified patients seeking a diagnosis for mild cognitive impairment or dementia, possibly due to Alzheimer disease (AD), and recorded a working diagnosis and a management plan. The patients underwent florbetapir PET scanning and were randomized to either immediate or delayed (1-year) feedback regarding amyloid status. At the 3-month visit, the physician updated the diagnosis and recorded a summary of the actual patient management since the post-scan visit. The study examined the impact of immediate versus delayed feedback on patient diagnosis/management at 3 and 12 months. RESULTS A total of 618 subjects were randomized (1:1) to immediate or delayed feedback arms, and 602 subjects completed the 3-month primary endpoint visit. A higher proportion of patients in the immediate feedback arm showed a change in diagnosis compared to the controls (32.6 vs. 6.4%; p = 0.0001). Similarly, a higher proportion of patients receiving immediate feedback had a change in management plan (68 vs. 55.5%; p < 0.002), mainly driven by changes in AD medication. Specifically, acetylcholinesterase inhibitors were prescribed to 67% of the amyloid-positive and 27% of the amyloid-negative subjects in the information group compared with 56 and 43%, respectively, in the control group (p < 0.0001). These between-group differences persisted until the 12-month visit. CONCLUSION Knowledge of the amyloid status affects the diagnosis and alters patient management.
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Affiliation(s)
- Michael J. Pontecorvo
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA,*Michael J. Pontecorvo, PhD, Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), 3711 Market Street, Philadelphia, PA 19104 (USA), E-Mail
| | - Andrew Siderowf
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Bruno Dubois
- Dementia Research Center (IM2A), Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Université Pierre et Marie Curie-Paris 6, AP-HP, Hôpital de la Salpêtrière, Paris, France
| | - P. Murali Doraiswamy
- Department of Psychiatry, Duke University Health System and the Duke Institute for Brain Sciences, Durham, North Carolina, USA
| | - Giovanni B. Frisoni
- Department of Psychiatry, University Hospitals and University of Geneva, Geneva, Switzerland,Department of Internal Medicine, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Michael Grundman
- Global R&D Partners, LLC, California, USA,University of California, San Diego, California, USA
| | - Flavio Nobili
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
| | | | | | - Anupa K. Arora
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Antoine Chevrette
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | | | | | - Matthew Flitter
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Nick Galante
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Mark J. Lowrey
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Ming Lu
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Anne McGeehan
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Michael D. Devous Sr.
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Mark A. Mintun
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
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45
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Breault C, Piper J, Joshi AD, Pirozzi SD, Nelson AS, Lu M, Pontecorvo MJ, Mintun MA, Devous MD. Correlation between two methods of florbetapir PET quantitative analysis. Am J Nucl Med Mol Imaging 2017; 7:84-91. [PMID: 28721302 PMCID: PMC5511118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/10/2017] [Indexed: 06/07/2023]
Abstract
This study evaluated performance of a commercially available standardized software program for calculation of florbetapir PET standard uptake value ratios (SUVr) in comparison with an established research method. Florbetapir PET images for 183 subjects clinically diagnosed as cognitively normal (CN), mild cognitive impairment (MCI) or probable Alzheimer's disease (AD) (45 AD, 60 MCI, and 78 CN) were evaluated using two software processing algorithms. The research method uses a single florbetapir PET template generated by averaging both amyloid positive and amyloid negative registered brains together. The commercial software simultaneously optimizes the registration between the florbetapir PET images and three templates: amyloid negative, amyloid positive, and an average. Cortical average SUVr values were calculated across six predefined anatomic regions with respect to the whole cerebellum reference region. SUVr values were well correlated between the two methods (r2 = 0.98). The relationship between the methods computed from the regression analysis is: Commercial method SUVr = (0.9757*Research SUVr) + 0.0299. A previously defined cutoff SUVr of 1.1 for distinguishing amyloid positivity by the research method corresponded to 1.1 (95% CI = 1.098, 1.11) for the commercial method. This study suggests that the commercial method is comparable to the published research method of SUVr analysis for florbetapir PET images, thus facilitating the potential use of standardized quantitative approaches to PET amyloid imaging.
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Affiliation(s)
- Christopher Breault
- Avid Radiopharmaceuticals (A Wholly Owned Subsidiary of Eli Lilly and Company)3711 Market St, Philadelphia 19104, PA, U S A
- Spectrum Dynamics Medical Inc. (A Biosensors International Group Company)2478 Embarcadero Way, Palo Alto 94303, CA, U S A
| | - Jonathan Piper
- MIM Software Inc.25800 Science Park Drive, Suite 180, Cleveland 44122, OH, U S A
| | - Abhinay D Joshi
- Avid Radiopharmaceuticals (A Wholly Owned Subsidiary of Eli Lilly and Company)3711 Market St, Philadelphia 19104, PA, U S A
| | - Sara D Pirozzi
- MIM Software Inc.25800 Science Park Drive, Suite 180, Cleveland 44122, OH, U S A
| | - Aaron S Nelson
- MIM Software Inc.25800 Science Park Drive, Suite 180, Cleveland 44122, OH, U S A
| | - Ming Lu
- Avid Radiopharmaceuticals (A Wholly Owned Subsidiary of Eli Lilly and Company)3711 Market St, Philadelphia 19104, PA, U S A
| | - Michael J Pontecorvo
- Avid Radiopharmaceuticals (A Wholly Owned Subsidiary of Eli Lilly and Company)3711 Market St, Philadelphia 19104, PA, U S A
| | - Mark A Mintun
- Avid Radiopharmaceuticals (A Wholly Owned Subsidiary of Eli Lilly and Company)3711 Market St, Philadelphia 19104, PA, U S A
| | - Michael D Devous
- Avid Radiopharmaceuticals (A Wholly Owned Subsidiary of Eli Lilly and Company)3711 Market St, Philadelphia 19104, PA, U S A
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46
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Wolters EE, Golla SS, Timmers T, Ossenkoppele R, Groot C, Weijden CW, Verfaillie SC, Scheltens P, Flier WM, Schwarte LA, Mintun MA, Devous MD, Schuit RC, Windhorst AD, Lammertsma AA, Boellaard R, Berckel BN, Yaqub MM. [IC‐P‐206]: PARAMETRIC IMAGING OF TAU LOAD IN ALZHEIMER's PATIENTS AND CONTROLS USING FLORTAUCIPIR. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.2582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Emma E. Wolters
- Alzheimer Center, Department of Neurology, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
- Department of Radiology and Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Sandeep S.V. Golla
- Department of Radiology and Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Tessa Timmers
- Alzheimer Center, Department of Neurology, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
- Department of Radiology and Nuclear Medicine, Amsterdam NeuroscienceVU University Medical CenterAmsterdamNetherlands
| | - Rik Ossenkoppele
- Alzheimer Center and Department of Neurology, Amsterdam NeuroscienceVU University Medical CenterAmsterdamNetherlands
- Department of Radiology and Nuclear Medicine, Amsterdam NeuroscienceVU University Medical CenterAmsterdamNetherlands
| | - Colin Groot
- Department of Radiology and Nuclear Medicine, Amsterdam NeuroscienceVU University Medical CenterAmsterdamNetherlands
- Alzheimer Center and Department of NeurologyVU University Medical Center, Amsterdam NeuroscienceAmsterdamNetherlands
| | - Chris W.J. Weijden
- Alzheimer Center, Department of Neurology, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
- Department of Radiology and Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Sander C.J. Verfaillie
- Alzheimer Center, Department of Neurology, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Philip Scheltens
- Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Wiesje M. Flier
- Alzheimer Center, Department of Neurology, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
- Department of Epidemiology and BiostatisticsVU University Medical CenterAmsterdamNetherlands
| | - Lothar A. Schwarte
- Department of AnesthesiologyVU University Medical CenterAmsterdamNetherlands
| | | | | | - Robert C. Schuit
- Department of Radiology and Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Albert D. Windhorst
- Department of Radiology and Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Adriaan A. Lammertsma
- Department of Radiology and Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
- University Medical Center GroningenGroningenNetherlands
| | - Bart N.M. Berckel
- Department of Radiology and Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Maqsood M. Yaqub
- Department of Radiology and Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
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Shcherbinin S, Devous MD, Lin Q, Lu M, Brittain CF, Siderowf AD, Flitter ML, Pontecorvo MJ, Joshi AD, Southekal S, Schwarz AJ, Mintun MA. [P4–530]: MODELING OF TAU TRAJECTORIES ACROSS THE ALZHEIMER's DISEASE SPECTRUM USING [18F]‐FLORTAUCIPIR PET IMAGING. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.07.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - Qun Lin
- Eli Lilly and CompanyWindleshamUnited Kingdom
| | - Ming Lu
- Eli Lilly and CompanyIndianapolisINUSA
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48
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Mintun MA, Devous MD, Lu M, Pontecorvo MJ, Joshi AD, Southekal S, Siderowf A, Lowrey M, Devine M, Benedum TE, Pearson C, Lim NC, Case MG, Sundell KL, Siemers ER. [O5–01–01]: PET BIOMARKERS IN THE EXPEDITION 3 TRIAL OF PATIENTS WITH MILD AD. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.07.506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mark A. Mintun
- Avid RadiopharmaceuticalsPhiladelphiaPAUSA
- Eli Lilly and CompanyIndianapolisINUSA
| | | | - Ming Lu
- Avid RadiopharmaceuticalsPhiladelphiaPAUSA
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49
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Wolters EE, Golla SS, Timmers T, Ossenkoppele R, Groot C, Weijden CW, Verfaillie SC, Scheltens P, Flier WM, Schwarte LA, Mintun MA, Devous MD, Schuit RC, Windhorst AD, Lammertsma AA, Boellaard R, Berckel BN, Yaqub MM. [P4–235]: PARAMETRIC IMAGING OF TAU LOAD IN ALZHEIMER's PATIENTS AND CONTROLS USING FLORTAUCIPIR. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.2103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Emma E. Wolters
- Department of Radiology & Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
- Alzheimer Center, Department of Neurology, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Sandeep S.V. Golla
- Department of Radiology & Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Tessa Timmers
- Alzheimer Center, Department of Neurology, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
- Department of Radiology & Nuclear Medicine, Amsterdam NeuroscienceVU University Medical CenterAmsterdamNetherlands
| | - Rik Ossenkoppele
- Alzheimer Center and Department of Neurology, Amsterdam NeuroscienceVU University Medical CenterAmsterdamNetherlands
- Department of Radiology and Nuclear Medicine, Amsterdam NeuroscienceVU University Medical CenterAmsterdamNetherlands
| | - Colin Groot
- Department of Radiology and Nuclear Medicine, Amsterdam NeuroscienceVU University Medical CenterAmsterdamNetherlands
- Alzheimer Center and Department of NeurologyVU University Medical Center, Amsterdam NeuroscienceAmsterdamNetherlands
| | - Chris W.J. Weijden
- Department of Radiology & Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
- Alzheimer Center, Department of Neurology, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Sander C.J. Verfaillie
- Alzheimer Center, Department of Neurology, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Philip Scheltens
- Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Wiesje M. Flier
- Alzheimer Center, Department of Neurology, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
- Department of Epidemiology and BiostatisticsVU University Medical CenterAmsterdamNetherlands
| | - Lothar A. Schwarte
- Department of AnesthesiologyVU University Medical CenterAmsterdamNetherlands
| | | | | | - Robert C. Schuit
- Department of Radiology & Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Albert D. Windhorst
- Department of Radiology & Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Adriaan A. Lammertsma
- Department of Radiology & Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Ronald Boellaard
- Department of Radiology & Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
- University Medical Center GroningenGroningenNetherlands
| | - Bart N.M. Berckel
- Department of Radiology & Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
| | - Maqsood M. Yaqub
- Department of Radiology & Nuclear Medicine, Neuroscience Campus AmsterdamVU University Medical CenterAmsterdamNetherlands
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Pontecorvo MJ, Devous MD, Navitsky M, Lu M, Salloway S, Schaerf FW, Jennings D, Arora AK, McGeehan A, Lim NC, Xiong H, Joshi AD, Siderowf A, Mintun MA. Relationships between flortaucipir PET tau binding and amyloid burden, clinical diagnosis, age and cognition. Brain 2017; 140:748-763. [PMID: 28077397 PMCID: PMC5382945 DOI: 10.1093/brain/aww334] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 11/03/2016] [Indexed: 01/21/2023] Open
Abstract
The advent of tau-targeted positron emission tomography tracers such as flortaucipir (18F-AV-1451, also known as 18F-T807) have made it possible to investigate the sequence of development of tau and amyloid-β in relationship to age, and to the development of cognitive impairment due to Alzheimer's disease. In this study, flortaucipir tau and florbetapir amyloid positron emission tomography were obtained for 217 subjects including 16 young and 58 older cognitively normal subjects, 95 subjects with mild cognitive impairment (Mini-Mental State Examination 24-30) and 48 subjects with clinically-defined possible or probable Alzheimer's disease (Mini-Mental State Examination >10). Images were evaluated visually and quantitatively by regional and voxel-based cortical to cerebellar standard uptake value ratios. For amyloid positron emission tomography positive (Aβ+) subjects, flortaucipir neocortical standard uptake value ratio was significantly higher with more advanced clinical stage (Alzheimer's disease > mild cognitive impairment > older cognitively normal) and was significantly elevated for Aβ+ mild cognitive impairment and Alzheimer's disease subjects relative to the respective Aβ- subjects. In contrast, florbetapir Aβ- older cognitively normal subjects showed an increase in flortaucipir standard uptake value ratios in mesial temporal lobe regions (amygdala, hippocampus/choroid plexus region of interest) compared to younger cognitively normal subjects, but no increased standard uptake value ratios in neocortical regions. Analysis of covariance with planned contrasts showed no differences in regional or composite posterior neocortical flortaucipir standard uptake value ratio as a function of diagnostic group among Aβ- older cognitively normal or clinically diagnosed Alzheimer's disease or mild cognitive impairment subjects. The pattern of flortaucipir distribution among Aβ+ subjects was reminiscent of the cross-sectional distribution of tau reported in post-mortem pathology studies, in that the most commonly affected regions were the inferior and lateral temporal lobes, the same regions where the first signs of increased retention appeared in Aβ+ cognitively normal subjects. However, there was large variability in extent/density of flortaucipir tau binding among Aβ+ subjects. Although high neocortical flortaucipir retention was consistently associated with an Aβ+ florbetapir positron emission tomography scan, not all Aβ+ subjects had elevated flortaucipir standard uptake value ratios. Finally, within the Aβ+ group, increasing levels of flortaucipir tau binding were associated with increased cognitive impairment, as assessed by Mini-Mental State Examination and Alzheimer's Disease Assessment Scale. These results suggest development of tau beyond the mesial temporal lobe is associated with, and may be dependent on, amyloid accumulation. Further, the results are consistent with the hypothesis that cortical tau is associated with cognitive impairment.
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Affiliation(s)
| | | | | | - Ming Lu
- Avid Radiopharmaceuticals, Philadelphia, PA 19104, USA
| | | | - Frederick W Schaerf
- Neuropsychiatric Research Center of Southwest Florida, Fort Myers, FL 33912, USA
| | | | - Anupa K Arora
- Avid Radiopharmaceuticals, Philadelphia, PA 19104, USA
| | - Anne McGeehan
- Avid Radiopharmaceuticals, Philadelphia, PA 19104, USA
| | | | - Hui Xiong
- Avid Radiopharmaceuticals, Philadelphia, PA 19104, USA
| | | | | | - Mark A Mintun
- Avid Radiopharmaceuticals, Philadelphia, PA 19104, USA
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