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Burnham SC, Iaccarino L, Pontecorvo MJ, Fleisher AS, Lu M, Collins EC, Devous MD. A review of the flortaucipir literature for positron emission tomography imaging of tau neurofibrillary tangles. Brain Commun 2023; 6:fcad305. [PMID: 38187878 PMCID: PMC10768888 DOI: 10.1093/braincomms/fcad305] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/13/2023] [Accepted: 11/14/2023] [Indexed: 01/09/2024] Open
Abstract
Alzheimer's disease is defined by the presence of β-amyloid plaques and neurofibrillary tau tangles potentially preceding clinical symptoms by many years. Previously only detectable post-mortem, these pathological hallmarks are now identifiable using biomarkers, permitting an in vivo definitive diagnosis of Alzheimer's disease. 18F-flortaucipir (previously known as 18F-T807; 18F-AV-1451) was the first tau positron emission tomography tracer to be introduced and is the only Food and Drug Administration-approved tau positron emission tomography tracer (Tauvid™). It has been widely adopted and validated in a number of independent research and clinical settings. In this review, we present an overview of the published literature on flortaucipir for positron emission tomography imaging of neurofibrillary tau tangles. We considered all accessible peer-reviewed literature pertaining to flortaucipir through 30 April 2022. We found 474 relevant peer-reviewed publications, which were organized into the following categories based on their primary focus: typical Alzheimer's disease, mild cognitive impairment and pre-symptomatic populations; atypical Alzheimer's disease; non-Alzheimer's disease neurodegenerative conditions; head-to-head comparisons with other Tau positron emission tomography tracers; and technical considerations. The available flortaucipir literature provides substantial evidence for the use of this positron emission tomography tracer in assessing neurofibrillary tau tangles in Alzheimer's disease and limited support for its use in other neurodegenerative disorders. Visual interpretation and quantitation approaches, although heterogeneous, mostly converge and demonstrate the high diagnostic and prognostic value of flortaucipir in Alzheimer's disease.
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Affiliation(s)
| | | | | | | | - Ming Lu
- Avid, Eli Lilly and Company, Philadelphia, PA 19104, USA
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Costoya-Sánchez A, Moscoso A, Silva-Rodríguez J, Pontecorvo MJ, Devous MD, Aguiar P, Schöll M, Grothe MJ. Increased Medial Temporal Tau Positron Emission Tomography Uptake in the Absence of Amyloid-β Positivity. JAMA Neurol 2023; 80:1051-1061. [PMID: 37578787 PMCID: PMC10425864 DOI: 10.1001/jamaneurol.2023.2560] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/08/2023] [Accepted: 05/16/2023] [Indexed: 08/15/2023]
Abstract
Importance An increased tau positron emission tomography (PET) signal in the medial temporal lobe (MTL) has been observed in older individuals in the absence of amyloid-β (Aβ) pathology. Little is known about the longitudinal course of this condition, and its association with Alzheimer disease (AD) remains unclear. Objective To study the pathologic and clinical course of older individuals with PET-evidenced MTL tau deposition (TMTL+) in the absence of Aβ pathology (A-), and the association of this condition with the AD continuum. Design, Setting, and Participants A multicentric, observational, longitudinal cohort study was conducted using pooled data from the Alzheimer's Disease Neuroimaging Initiative (ADNI), Harvard Aging Brain Study (HABS), and the AVID-A05 study, collected between July 2, 2015, and August 23, 2021. Participants in the ADNI, HABS, and AVID-A05 studies (N = 1093) with varying degrees of cognitive performance were deemed eligible if they had available tau PET, Aβ PET, and magnetic resonance imaging scans at baseline. Of these, 128 participants did not meet inclusion criteria based on Aβ PET and tau PET biomarker profiles (A+ TMTL-). Exposures Tau and Aβ PET, magnetic resonance imaging, cerebrospinal fluid biomarkers, and cognitive assessments. Main Outcomes and Measures Cross-sectional and longitudinal measures for tau and Aβ PET, cortical atrophy, cognitive scores, and core AD cerebrospinal fluid biomarkers (Aβ42/40 and tau phosphorylated at threonine 181 p-tau181 available in a subset). Results Among the 965 individuals included in the study, 503 were women (52.1%) and the mean (SD) age was 73.9 (8.1) years. A total of 51% of A- individuals and 78% of A+ participants had increased tau PET signal in the entorhinal cortex (TMTL+) compared with healthy younger (aged <39 years) controls. Compared with A- TMTL-, A- TMTL+ participants showed statistically significant, albeit moderate, longitudinal (mean [SD], 1.83 [0.84] years) tau PET increases that were largely limited to the temporal lobe, whereas those with A+ TMTL+ showed faster and more cortically widespread tau PET increases. In contrast to participants with A+ TMTL+, those with A- TMTL+ did not show any noticeable Aβ accumulation over follow-up (mean [SD], 2.36 [0.76] years). Complementary cerebrospinal fluid analysis confirmed longitudinal p-tau181 increases in A- TMTL+ in the absence of increased Aβ accumulation. Participants with A- TMTL+ had accelerated MTL atrophy, whereas those with A+ TMTL+ showed accelerated atrophy in widespread temporoparietal brain regions. Increased MTL tau PET uptake in A- individuals was associated with cognitive decline, but at a significantly slower rate compared with A+ TMTL+. Conclusions and Relevance In this study, individuals with A- TMTL+ exhibited progressive tau accumulation and neurodegeneration, but these processes were comparably slow, remained largely restricted to the MTL, were associated with only subtle changes in global cognitive performance, and were not accompanied by detectable accumulation of Aβ biomarkers. These data suggest that individuals with A- TMTL+ are not on a pathologic trajectory toward AD.
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Affiliation(s)
- Alejandro Costoya-Sánchez
- Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Nuclear Medicine Department and Molecular Imaging Group, Instituto de Investigación Sanitaria de Santiago de Compostel, Travesía da Choupana s/n, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Madrid, Spain
| | - Alexis Moscoso
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Physiology and Neuroscience, University of Gothenburg, Gothenburg, Sweden
| | - Jesús Silva-Rodríguez
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Madrid, Spain
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Michael J. Pontecorvo
- Avid Radiopharmaceuticals, Philadelphia, Pennsylvania
- Eli Lilly and Company, Indianapolis, Indiana
| | - Michael D. Devous
- Avid Radiopharmaceuticals, Philadelphia, Pennsylvania
- Eli Lilly and Company, Indianapolis, Indiana
| | - Pablo Aguiar
- Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Nuclear Medicine Department and Molecular Imaging Group, Instituto de Investigación Sanitaria de Santiago de Compostel, Travesía da Choupana s/n, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Madrid, Spain
| | - Michael Schöll
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Physiology and Neuroscience, University of Gothenburg, Gothenburg, Sweden
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Michel J. Grothe
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Madrid, Spain
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
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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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Heeman F, Moscoso A, Camacho V, van Essen M, Grothe MJ, Lin L, Mainta I, Ribaldi F, Devous MD, Pontecorvo MJ, Frisoni GB, Garibotto V, Schöll M. Relationship between [
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F]flortaucipir PET visual patterns and neurodegeneration. Alzheimers Dement 2022. [DOI: 10.1002/alz.066788] [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: 12/24/2022]
Affiliation(s)
- Fiona Heeman
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Gothenburg Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Alexis Moscoso
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Gothenburg Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Valle Camacho
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau Barcelona Spain
| | - Martijn van Essen
- Department of Clinical Physiology, Sahlgrenska University Hospital Gothenburg Sweden
| | - Michel J. Grothe
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Gothenburg Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Movement Disorders Group, Institute of Biomedicine of Seville‐IBiS Seville Spain
| | - Li Lin
- Department of Radiology, The Third Affiliated Hospital of Sun Yat‐Sen University Guangdong China
| | - Isminni Mainta
- Division of Nuclear Medicine, Geneva University Hospitals Geneva Switzerland
| | - Federica Ribaldi
- Geneva Memory Center, Department of Rehabilitation and Geriatrics, Geneva University Hospitals Geneva Switzerland
| | | | | | - Giovanni B Frisoni
- Geneva Memory Center, Department of Rehabilitation and Geriatrics, Geneva University Hospitals Geneva Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine, Geneva University Hospitals Geneva Switzerland
- Faculty of Medicine, University of Geneva Geneva Switzerland
| | - Michael Schöll
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Gothenburg Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Psychiatry and Neurochemistry, Institute of Physiology and Neuroscience, University of Gothenburg Gothenburg Sweden
- Dementia Research Centre, UCL Queen Square Institute of Neurology London United Kingdom
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Costoya‐Sánchez A, Moscoso A, Silva‐Rodríguez J, Aguiar P, Pontecorvo MJ, Devous MD, Schöll M, Grothe MJ. Longitudinal pathologic course of older individuals with medial temporal tau deposition in the absence of amyloid‐β pathology. Alzheimers Dement 2022. [DOI: 10.1002/alz.065719] [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: 12/24/2022]
Affiliation(s)
| | - Alexis Moscoso
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Gothenburg Sweden
| | | | - Pablo Aguiar
- University of Santiago de Compostela Santiago de Compostela Spain
| | | | | | - Michael Schöll
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Gothenburg Sweden
- Department of Psychiatry and Neurochemistry, Institute of Physiology and Neuroscience, University of Gothenburg Gothenburg Sweden
- Dementia Research Centre, UCL Queen Square Institute of Neurology London United Kingdom
| | - Michel J. Grothe
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Gothenburg Sweden
- Instituto de Biomedicina de Sevilla ‐ IBiS Seville Spain
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Moscoso A, Heeman F, Camacho V, van Essen M, Grothe MJ, Lin L, Mainta I, Ribaldi F, Devous MD, Pontecorvo MJ, Frisoni GB, Garibotto V, Schöll M. Prevalence and longitudinal clinical outcomes of negative, moderate, and advanced [
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F]flortaucipir PET visual patterns across the Alzheimer's disease spectrum. Alzheimers Dement 2022. [DOI: 10.1002/alz.067673] [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: 12/24/2022]
Affiliation(s)
- Alexis Moscoso
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Gothenburg Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Fiona Heeman
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Gothenburg Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Valle Camacho
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau Barcelona Spain
| | - Martijn van Essen
- Department of Clinical Physiology, Sahlgrenska University Hospital Gothenburg Sweden
| | - Michel J. Grothe
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Gothenburg Sweden
- Movement Disorders Group, Institute of Biomedicine of Seville‐IBiS Seville Spain
| | - Li Lin
- Department of Radiology, The Third Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
| | - Isminni Mainta
- Division of Nuclear Medicine, Geneva University Hospitals Geneva Switzerland
| | - Federica Ribaldi
- Geneva Memory Center, Department of Rehabilitation and Geriatrics, Geneva University Hospitals Geneva Switzerland
| | | | | | - Giovanni B Frisoni
- Geneva Memory Center, Department of Rehabilitation and Geriatrics, Geneva University Hospitals Geneva Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine, Geneva University Hospitals Geneva Switzerland
- Faculty of Medicine, University of Geneva Geneva Switzerland
| | - Michael Schöll
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Gothenburg Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Clinical physiology, Sahlgrenska University hospital Gothenburg Sweden
- UCL Queen Square Institute of Neurology London United Kingdom
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Heeman F, Moscoso A, Camacho V, van Essen M, Grothe MJ, Lin L, Mainta I, Ribaldi F, Devous MD, Pontecorvo MJ, Frisoni GB, Garibotto V, Schöll M. Relationship between [
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F]flortaucipir PET visual patterns and neurodegeneration. Alzheimers Dement 2022. [DOI: 10.1002/alz.067143] [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: 12/24/2022]
Affiliation(s)
- Fiona Heeman
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Gothenburg Sweden
| | - Alexis Moscoso
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Gothenburg Sweden
| | - Valle Camacho
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau Barcelona Spain
| | - Martijn van Essen
- Department of Clinical Physiology, Sahlgrenska University Hospital Gothenburg Sweden
| | - Michel J. Grothe
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Gothenburg Sweden
- Movement Disorders Group, Institute of Biomedicine of Seville‐IBiS Seville Spain
| | - Li Lin
- Department of Radiology, The Third Affiliated Hospital of Sun Yat‐Sen University Guangdong China
| | - Isminni Mainta
- Division of Nuclear Medicine, Geneva University Hospitals Geneva Switzerland
| | - Federica Ribaldi
- Geneva Memory Center, Department of Rehabilitation and Geriatrics, Geneva University Hospitals Geneva Switzerland
| | | | | | - Giovanni B Frisoni
- Geneva Memory Center, Department of Rehabilitation and Geriatrics, Geneva University Hospitals Geneva Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine, Geneva University Hospitals Geneva Switzerland
- Faculty of Medicine, University of Geneva Geneva Switzerland
| | - Michael Schöll
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Gothenburg Sweden
- Department of Clinical physiology, Sahlgrenska University hospital Gothenburg Sweden
- Dementia Research Centre, UCL Queen Square Institute of Neurology London United Kingdom
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Ossenkoppele R, Mattsson N, Smith R, Groot C, Cho H, La Joie R, Baker SL, Borroni E, Klein G, Pontecorvo MJ, Devous MD, Jagust WJ, Lyoo CH, Rabinovici GD, Hansson O. Tau PET as a prognostic marker in preclinical and prodromal Alzheimer’s disease. Alzheimers Dement 2021. [DOI: 10.1002/alz.055932] [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: 11/11/2022]
Affiliation(s)
- Rik Ossenkoppele
- Alzheimer Center Amsterdam Department of Neurology Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam Netherlands
- Clinical Memory Research Unit Lund University Malmö Sweden
| | - Niklas Mattsson
- Clinical Memory Research Unit Department of Clinical Sciences Malmö Lund University Malmö Sweden
| | - Ruben Smith
- Clinical Memory Research Unit Lund University Malmö Sweden
| | - Colin Groot
- Alzheimer Center and Department of Neurology Amsterdam Neuroscience VU University Medical Center Amsterdam Netherlands
| | - Hanna Cho
- Gangnam Severance Hospital Yonsei University College of Medicine Seoul South Korea
| | - Renaud La Joie
- Memory and Aging Center UCSF Weill Institute for Neurosciences University of California San Francisco CA USA
| | | | | | | | | | | | | | - Chul Hyoung Lyoo
- Gangnam Severance Hospital Yonsei University College of Medicine Seoul South Korea
| | - Gil D. Rabinovici
- Memory and Aging Center UCSF Weill Institute for Neurosciences University of California San Francisco CA USA
| | - Oskar Hansson
- Clinical Memory Research Unit Department of Clinical Sciences Mälmo Lund University Malmö Sweden
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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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Ossenkoppele R, Smith R, Mattsson-Carlgren N, Groot C, Leuzy A, Strandberg O, Palmqvist S, Olsson T, Jögi J, Stormrud E, Cho H, Ryu YH, Choi JY, Boxer AL, Gorno-Tempini ML, Miller BL, Soleimani-Meigooni D, Iaccarino L, La Joie R, Baker S, Borroni E, Klein G, Pontecorvo MJ, Devous MD, Jagust WJ, Lyoo CH, Rabinovici GD, Hansson O. Accuracy of Tau Positron Emission Tomography as a Prognostic Marker in Preclinical and Prodromal Alzheimer Disease: A Head-to-Head Comparison Against Amyloid Positron Emission Tomography and Magnetic Resonance Imaging. JAMA Neurol 2021; 78:961-971. [PMID: 34180956 PMCID: PMC8240013 DOI: 10.1001/jamaneurol.2021.1858] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Question What is the prognostic value of tau positron emission tomography (PET) for predicting cognitive decline across the clinical spectrum of Alzheimer disease? Findings In this longitudinal, multicenter prognostic study including 1431 participants, baseline tau PET predicted change in Mini-Mental State Examination scores during a mean (SD) follow-up of 1.9 (0.8) years. Moreover, tau PET outperformed established volumetric magnetic resonance imaging and amyloid PET markers in head-to-head comparisons, especially in participants with mild cognitive impairment and cognitively normal individuals who were positive for amyloid-β. Meaning These findings suggest that tau PET is a promising prognostic tool for predicting cognitive decline in preclinical and prodromal stages of Alzheimer disease. Importance Tau positron emission tomography (PET) tracers have proven useful for the differential diagnosis of dementia, but their utility for predicting cognitive change is unclear. Objective To examine the prognostic accuracy of baseline fluorine 18 (18F)–flortaucipir and [18F]RO948 (tau) PET in individuals across the Alzheimer disease (AD) clinical spectrum and to perform a head-to-head comparison against established magnetic resonance imaging (MRI) and amyloid PET markers. Design, Setting, and Participants This prognostic study collected data from 8 cohorts in South Korea, Sweden, and the US from June 1, 2014, to February 28, 2021, with a mean (SD) follow-up of 1.9 (0.8) years. A total of 1431 participants were recruited from memory clinics, clinical trials, or cohort studies; 673 were cognitively unimpaired (CU group; 253 [37.6%] positive for amyloid-β [Aβ]), 443 had mild cognitive impairment (MCI group; 271 [61.2%] positive for Aβ), and 315 had a clinical diagnosis of AD dementia (315 [100%] positive for Aβ). Exposures [18F]Flortaucipir PET in the discovery cohort (n = 1135) or [18F]RO948 PET in the replication cohort (n = 296), T1-weighted MRI (n = 1431), and amyloid PET (n = 1329) at baseline and repeated Mini-Mental State Examination (MMSE) evaluation. Main Outcomes and Measures Baseline [18F]flortaucipir/[18F]RO948 PET retention within a temporal region of interest, MRI-based AD-signature cortical thickness, and amyloid PET Centiloids were used to predict changes in MMSE using linear mixed-effects models adjusted for age, sex, education, and cohort. Mediation/interaction analyses tested whether associations between baseline tau PET and cognitive change were mediated by baseline MRI measures and whether age, sex, and APOE genotype modified these associations. Results Among 1431 participants, the mean (SD) age was 71.2 (8.8) years; 751 (52.5%) were male. Findings for [18F]flortaucipir PET predicted longitudinal changes in MMSE, and effect sizes were stronger than for AD-signature cortical thickness and amyloid PET across all participants (R2, 0.35 [tau PET] vs 0.24 [MRI] vs 0.17 [amyloid PET]; P < .001, bootstrapped for difference) in the Aβ-positive MCI group (R2, 0.25 [tau PET] vs 0.15 [MRI] vs 0.07 [amyloid PET]; P < .001, bootstrapped for difference) and in the Aβ-positive CU group (R2, 0.16 [tau PET] vs 0.08 [MRI] vs 0.08 [amyloid PET]; P < .001, bootstrapped for difference). These findings were replicated in the [18F]RO948 PET cohort. MRI mediated the association between [18F]flortaucipir PET and MMSE in the groups with AD dementia (33.4% [95% CI, 15.5%-60.0%] of the total effect) and Aβ-positive MCI (13.6% [95% CI, 0.0%-28.0%] of the total effect), but not the Aβ-positive CU group (3.7% [95% CI, −17.5% to 39.0%]; P = .71). Age (t = −2.28; P = .02), but not sex (t = 0.92; P = .36) or APOE genotype (t = 1.06; P = .29) modified the association between baseline [18F]flortaucipir PET and cognitive change, such that older individuals showed faster cognitive decline at similar tau PET levels. Conclusions and Relevance The findings of this prognostic study suggest that tau PET is a promising tool for predicting cognitive change that is superior to amyloid PET and MRI and may support the prognostic process in preclinical and prodromal stages of AD.
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Affiliation(s)
- Rik Ossenkoppele
- Clinical Memory Research Unit, Lund University, Malmö, Sweden.,Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ruben Smith
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Lund University, Malmö, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden.,Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Colin Groot
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Antoine Leuzy
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Olof Strandberg
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | | | - Tomas Olsson
- Department of Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Jonas Jögi
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
| | - Erik Stormrud
- Clinical Memory Research Unit, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Hanna Cho
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Hoon Ryu
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Yong Choi
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Division of Applied Radiological Imaging, Korea Institute Radiological and Medical Sciences, Seoul, South Korea
| | - Adam L Boxer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco
| | - Maria L Gorno-Tempini
- Department of Neurology, Memory and Aging Center, University of California, San Francisco
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco
| | | | - Leonardo Iaccarino
- Department of Neurology, Memory and Aging Center, University of California, San Francisco
| | - Renaud La Joie
- Department of Neurology, Memory and Aging Center, University of California, San Francisco
| | - Suzanne Baker
- Lawrence Berkeley National Laboratory, Berkeley, California
| | | | | | | | | | - William J Jagust
- Lawrence Berkeley National Laboratory, Berkeley, California.,Helen Wills Neuroscience Institute, University of California, Berkeley
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Gil D Rabinovici
- Department of Neurology, Memory and Aging Center, University of California, San Francisco.,Department of Radiology and Biomedical Imaging, University of California, San Francisco.,Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, California.,Associate Editor, JAMA Neurology
| | - Oskar Hansson
- Clinical Memory Research Unit, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
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11
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Ossenkoppele R, Leuzy A, Cho H, Sudre CH, Strandberg O, Smith R, Palmqvist S, Mattsson-Carlgren N, Olsson T, Jögi J, Stormrud E, Ryu YH, Choi JY, Boxer AL, Gorno-Tempini ML, Miller BL, Soleimani-Meigooni D, Iaccarino L, La Joie R, Borroni E, Klein G, Pontecorvo MJ, Devous MD, Villeneuve S, Lyoo CH, Rabinovici GD, Hansson O. The impact of demographic, clinical, genetic, and imaging variables on tau PET status. Eur J Nucl Med Mol Imaging 2021; 48:2245-2258. [PMID: 33215319 PMCID: PMC8131404 DOI: 10.1007/s00259-020-05099-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE A substantial proportion of amyloid-β (Aβ)+ patients with clinically diagnosed Alzheimer's disease (AD) dementia and mild cognitive impairment (MCI) are tau PET-negative, while some clinically diagnosed non-AD neurodegenerative disorder (non-AD) patients or cognitively unimpaired (CU) subjects are tau PET-positive. We investigated which demographic, clinical, genetic, and imaging variables contributed to tau PET status. METHODS We included 2338 participants (430 Aβ+ AD dementia, 381 Aβ+ MCI, 370 non-AD, and 1157 CU) who underwent [18F]flortaucipir (n = 1944) or [18F]RO948 (n = 719) PET. Tau PET positivity was determined in the entorhinal cortex, temporal meta-ROI, and Braak V-VI regions using previously established cutoffs. We performed bivariate binary logistic regression models with tau PET status (positive/negative) as dependent variable and age, sex, APOEε4, Aβ status (only in CU and non-AD analyses), MMSE, global white matter hyperintensities (WMH), and AD-signature cortical thickness as predictors. Additionally, we performed multivariable binary logistic regression models to account for all other predictors in the same model. RESULTS Tau PET positivity in the temporal meta-ROI was 88.6% for AD dementia, 46.5% for MCI, 9.5% for non-AD, and 6.1% for CU. Among Aβ+ participants with AD dementia and MCI, lower age, MMSE score, and AD-signature cortical thickness showed the strongest associations with tau PET positivity. In non-AD and CU participants, presence of Aβ was the strongest predictor of a positive tau PET scan. CONCLUSION We identified several demographic, clinical, and neurobiological factors that are important to explain the variance in tau PET retention observed across the AD pathological continuum, non-AD neurodegenerative disorders, and cognitively unimpaired persons.
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Affiliation(s)
- Rik Ossenkoppele
- Clinical Memory Research Unit, Lund University, Lund, Sweden.
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Antoine Leuzy
- Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Hanna Cho
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- Centre for Medical Image Computing, Department of Medical Physics, University College London, London, UK
| | - Olof Strandberg
- Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Ruben Smith
- Clinical Memory Research Unit, Lund University, Lund, Sweden
| | | | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Tomas Olsson
- Department of Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Jonas Jögi
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
| | - Erik Stormrud
- Clinical Memory Research Unit, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Young Hoon Ryu
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Yong Choi
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Division of applied RI, Korea Institute Radiological and Medical Sciences, Seoul, South Korea
| | - Adam L Boxer
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, USA
| | - Maria L Gorno-Tempini
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, USA
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, USA
| | - David Soleimani-Meigooni
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, USA
| | - Leonardo Iaccarino
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, USA
| | - Renaud La Joie
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, USA
| | | | | | | | | | - Sylvia Villeneuve
- Departments of Psychiatry and Neurology & Neurosurgery, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Gil D Rabinovici
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, USA
- Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Oskar Hansson
- Clinical Memory Research Unit, Lund University, Lund, Sweden.
- Memory Clinic, Skåne University Hospital, Malmö, Sweden.
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12
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Vogel JW, Young AL, Oxtoby NP, Smith R, Ossenkoppele R, Strandberg OT, La Joie R, Aksman LM, Grothe MJ, Iturria-Medina Y, Pontecorvo MJ, Devous MD, Rabinovici GD, Alexander DC, Lyoo CH, Evans AC, Hansson O. Four distinct trajectories of tau deposition identified in Alzheimer's disease. Nat Med 2021; 27:871-881. [PMID: 33927414 PMCID: PMC8686688 DOI: 10.1038/s41591-021-01309-6] [Citation(s) in RCA: 290] [Impact Index Per Article: 96.7] [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: 08/20/2020] [Accepted: 03/04/2021] [Indexed: 01/15/2023]
Abstract
Alzheimer's disease (AD) is characterized by the spread of tau pathology throughout the cerebral cortex. This spreading pattern was thought to be fairly consistent across individuals, although recent work has demonstrated substantial variability in the population with AD. Using tau-positron emission tomography scans from 1,612 individuals, we identified 4 distinct spatiotemporal trajectories of tau pathology, ranging in prevalence from 18 to 33%. We replicated previously described limbic-predominant and medial temporal lobe-sparing patterns, while also discovering posterior and lateral temporal patterns resembling atypical clinical variants of AD. These 'subtypes' were stable during longitudinal follow-up and were replicated in a separate sample using a different radiotracer. The subtypes presented with distinct demographic and cognitive profiles and differing longitudinal outcomes. Additionally, network diffusion models implied that pathology originates and spreads through distinct corticolimbic networks in the different subtypes. Together, our results suggest that variation in tau pathology is common and systematic, perhaps warranting a re-examination of the notion of 'typical AD' and a revisiting of tau pathological staging.
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Affiliation(s)
- Jacob W Vogel
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada.
| | - Alexandra L Young
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Neil P Oxtoby
- Centre for Medical Image Computing, University College London, London, UK
- Department of Computer Science, University College London, London, UK
| | - Ruben Smith
- Clinical Memory Research Unit, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Rik Ossenkoppele
- Clinical Memory Research Unit, Lund University, Lund, Sweden
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Leon M Aksman
- Centre for Medical Image Computing, University College London, London, UK
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Michel J Grothe
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Seville, Spain
| | | | | | | | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Daniel C Alexander
- Centre for Medical Image Computing, University College London, London, UK
- Department of Computer Science, University College London, London, UK
| | - Chul Hyoung Lyoo
- Departments of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Alan C Evans
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada
| | - Oskar Hansson
- Clinical Memory Research Unit, Lund University, Lund, Sweden.
- Memory Clinic, Skåne University Hospital, Malmö, Sweden.
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13
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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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14
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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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15
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Smith R, Strandberg O, Mattsson-Carlgren N, Leuzy A, Palmqvist S, Pontecorvo MJ, Devous MD, Ossenkoppele R, Hansson O. The accumulation rate of tau aggregates is higher in females and younger amyloid-positive subjects. Brain 2021; 143:3805-3815. [PMID: 33439987 PMCID: PMC7805812 DOI: 10.1093/brain/awaa327] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/21/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023] Open
Abstract
The development of tau-PET allows paired helical filament tau pathology to be visualized in vivo. Increased knowledge about conditions affecting the rate of tau accumulation could guide the development of therapies halting the progression of Alzheimer’s disease. However, the factors modifying the rate of tau accumulation over time in Alzheimer’s disease are still largely unknown. Large-scale longitudinal cohort studies, adjusting for baseline tau load, are needed to establish such risk factors. In the present longitudinal study, 419 participants from four cohorts in the USA (Avid 05e, n = 157; Expedition-3, n = 82; ADNI, n = 123) and Sweden (BioFINDER, n = 57) were scanned repeatedly with tau-PET. The study participants were cognitively unimpaired (n = 153), or patients with mild cognitive impairment (n = 139) or Alzheimer’s disease dementia (n = 127). Participants underwent two to four tau-PET (18F-flortaucipir) scans with a mean (± standard deviation) of 537 (±163) days between the first and last scan. The change in tau-PET signal was estimated in temporal meta- and neocortical regions of interest. Subject specific tau-PET slopes were predicted simultaneously by age, sex, amyloid status (determined by amyloid-β PET), APOE ε4 genotype, study cohort, diagnosis and baseline tau load. We found that accelerated increase in tau-PET signal was observed in amyloid-β-positive mild cognitive impairment (3.0 ± 5.3%) and Alzheimer’s disease dementia (2.9 ± 5.7%), respectively, when compared to either amyloid-β-negative cognitively unimpaired (0.4 ± 2.7%), amyloid-β-negative mild cognitive impairment (−0.4 ± 2.3%) or amyloid-β-positive cognitively unimpaired (1.2 ± 2.8%). Tau-PET uptake was accelerated in females (temporal region of interest: t = 2.86, P = 0.005; neocortical region of interest: t = 2.90, P = 0.004), younger individuals (temporal region of interest: t = −2.49, P = 0.013), and individuals with higher baseline tau-PET signal (temporal region of interest: t = 3.83, P < 0.001; neocortical region of interest: t = 5.01, P < 0.001). Tau-PET slopes decreased with age in amyloid-β-positive subjects, but were stable by age in amyloid-β-negative subjects (age × amyloid-β status interaction: t = −2.39, P = 0.018). There were no effects of study cohort or APOE ε4 positivity. In a similar analysis on longitudinal amyloid-β-PET (in ADNI subjects only, n = 639), we found significant associations between the rate of amyloid-β accumulation and APOE ε4 positivity, older age and baseline amyloid-β positivity, but no effect of sex. In conclusion, in this longitudinal PET study comprising four cohorts, we found that the tau accumulation rate is greater in females and younger amyloid-β-positive individuals, while amyloid-β accumulation is greater in APOE ε4 carriers and older individuals. These findings are important considerations for the design of clinical trials, and might improve our understanding of factors associated with faster tau aggregation and spread.
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Affiliation(s)
- Ruben Smith
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Olof Strandberg
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden.,Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Antoine Leuzy
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Lund, Sweden
| | | | | | - Rik Ossenkoppele
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Amsterdam University Medical Center, Alzheimercenter, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Lund, Sweden
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Zimmer JA, Shcherbinin S, Devous MD, Bragg SM, Selzler KJ, Wessels AM, Shering C, Mullen J, Landry J, Andersen SW, Downing AM, Fleisher AS, Svaldi DO, Sims JR. Lanabecestat: Neuroimaging results in early symptomatic Alzheimer's disease. Alzheimers Dement (N Y) 2021; 7:e12123. [PMID: 33614894 PMCID: PMC7882543 DOI: 10.1002/trc2.12123] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Lanabecestat, a beta-site amyloid precursor protein-cleaving enzyme 1 (BACE1) inhibitor, was investigated as a potential Alzheimer's disease (AD)-modifying treatment. As previously reported, amyloid beta (Aβ) neuritic plaque burden reduction did not result in clinical benefit. Lanabecestat's effects on neuroimaging biomarkers and correlations between neuroimaging biomarkers and efficacy measures are reported. METHODS AMARANTH and DAYBREAK-ALZ were 104- and 78-week, multicenter, randomized, double-blind, placebo-controlled studies of lanabecestat in early symptomatic AD (AMARANTH) and mild AD dementia (DAYBREAK-ALZ). Patients randomly (1:1:1) received placebo, lanabecestat 20 mg, or lanabecestat 50 mg daily (AMARANTH, n = 2218; DAYBREAK-ALZ, n = 1722). Florbetapir positron emission tomography (PET), fluorodeoxyglucose (FDG) PET, flortaucipir PET, and volumetric magnetic resonance imaging (MRI) were used to measure Aβ neuritic plaque burden, cerebral metabolism, aggregated tau neurofibrillary tangles, and brain volume, respectively. Additionally, florbetapir perfusion scans were performed in DAYBREAK-ALZ. Efficacy measures included 13-item Alzheimer's Disease Assessment Scale-Cognitive Subscale, Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory, Clinical Dementia Rating-Sum of Boxes, Functional Activities Questionnaire, and Mini-Mental State Examination. These studies stopped early due to futility. RESULTS Despite previously observed annualized reduction in Aβ neuritic plaque burden, there were no treatment differences in annualized change of aggregated tau neurofibrillary tangle burden (AMARANTH, n = 284; DAYBREAK-ALZ, n = 70), cerebral metabolism (AMARANTH, n = 260; DAYBREAK-ALZ, n = 38) and perfusion (DAYBREAK-ALZ, n = 213). Greater brain volume reduction (AMARANTH, n = 1697 [whole brain]; DAYBREAK-ALZ, n = 650 [whole brain]) occurred on lanabecestat compared to placebo. Higher baseline aggregated tau neurofibrillary tangle burden, lower cerebral metabolism, and lower brain volumes correlated with poorer baseline efficacy scores and greater clinical worsening. Lower baseline cerebral perfusion correlated with poorer baseline efficacy scores. Reduction in cerebral metabolism or whole brain volume correlated with clinical worsening, regardless of treatment assignment. DISCUSSION Tau pathology and cerebral metabolism assessments showed no evidence of lanabecestat slowing pathophysiologic progression of AD. Lanabecestat exposure was associated with brain volume reductions. Correlations between imaging measures and cognitive assessments may aid future study design.
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Affiliation(s)
| | | | | | | | | | | | - Craig Shering
- AstraZeneca, NeuroscienceBiopharmaceuticals R&DBostonMassachusettsUSA
| | - Jamie Mullen
- AstraZeneca, NeuroscienceBiopharmaceuticals R&DBostonMassachusettsUSA
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17
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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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18
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Smith R, Strandberg O, Mattsson N, Leuzy A, Palmqvist S, Pontecorvo MJ, Devous MD, Ossenkoppele R, Hansson O. The accumulation rate of tau aggregates is higher in females and younger individuals. Alzheimers Dement 2020. [DOI: 10.1002/alz.043876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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)
- Ruben Smith
- Clinical Memory Research Unit Lund University Malmö Sweden
- Neurology Clinic Skåne University Hospital Lund Sweden
| | - Olof Strandberg
- Clinical Memory Research Unit Department of Clinical Sciences Mälmo Lund University Lund Sweden
| | | | - Antoine Leuzy
- Clinical Memory Research Unit Lund University Malmö Sweden
| | | | | | | | - Rik Ossenkoppele
- Alzheimer Center Amsterdam Department of Neurology Amsterdam Neuroscience Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam Netherlands
| | - Oskar Hansson
- Clinical Memory Research Unit Department of Clinical Sciences Mälmo Lund University Malmö Sweden
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19
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Charil A, Shcherbinin S, Southekal S, Devous MD, Mintun M, Murray ME, Miller BB, Schwarz AJ. Tau Subtypes of Alzheimer's Disease Determined in vivo Using Flortaucipir PET Imaging. J Alzheimers Dis 2020; 71:1037-1048. [PMID: 31476153 DOI: 10.3233/jad-190264] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 12/23/2022]
Abstract
At autopsy, individuals with Alzheimer's disease (AD) exhibit heterogeneity in the distribution of neurofibrillary tangles in neocortical and hippocampal regions. Subtypes of AD, defined using an algorithm based on the relative number of tangle counts in these regions, have been proposed-hippocampal sparing (relative sparing of the hippocampus but high cortical load), limbic predominant (high hippocampal load but lower load in association cortices), and typical (balanced neurofibrillary tangles counts in the hippocampus and association cortices) AD-and shown to be associated with distinct antemortem clinical phenotypes. The ability to distinguish these AD subtypes from the more typical tau signature in vivo could have important implications for clinical research. Flortaucipir positron emission tomography (PET) images acquired from 45 amyloid-positive participants, defined clinically as mild cognitive impairment or AD, aged 50-92 years, 56% female, and estimated to be Braak V-VI based on their PET pattern of tau pathology, were studied. By translating the neuropathologic algorithm to flortaucipir PET scans, patterns of tau pathology consistent with autopsy findings, and with a similar prevalence, were identified in vivo. 6/45 (13%) participants were identified as hippocampal sparing and 6/45 (13%) as limbic predominant AD subtypes. Hippocampal sparing participants were significantly younger than those assigned to the other two subtypes. Worse performance on delayed recall was associated with increased hippocampal tau signal, and worse performance on the trail making test B-A was associated with lower values of the hippocampus to cortex ratio. Prospective studies can further validate the flortaucipir SUVR cut-points and the phenotype of the corresponding AD subtypes.
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Affiliation(s)
| | | | | | | | - Mark Mintun
- Eli Lilly and Company, Indianapolis, IN, USA.,Avid Radiopharmaceuticals, Philadelphia, PA, USA
| | | | | | - Adam J Schwarz
- Eli Lilly and Company, Indianapolis, IN, USA.,Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.,Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN, USA
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20
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Womack KB, Dubiel R, Callender L, Dunklin C, Dahdah M, Harris TS, Devous MD, Juengst SB, Bell K, Diaz-Arrastia R, Ding K. 123I-Iofluopane Single-Photon Emission Computed Tomography as an Imaging Biomarker of Pre-Synaptic Dopaminergic System after Moderate-to-Severe Traumatic Brain Injury. J Neurotrauma 2020; 37:2113-2119. [PMID: 32216525 DOI: 10.1089/neu.2019.6892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/05/2023] Open
Abstract
Dopaminergic (DA) system function is frequently disrupted after traumatic brain injury (TBI). However, published interventions that target the DA system with the hope of enhancing functional outcomes are inconclusive, partially because of the lack of DA signaling biomarkers that can be used to select patients likely to benefit from DA-directed therapies or to monitor treatment efficacy. The aim of this study was to evaluate the feasibility of using 123I-iofluopane single-photon emission computerized tomography (SPECT) to assess pre-synaptic DA system dysfunction after severe TBI. Eighteen patients with severe TBI were enrolled in this study. 123I-iofluopane SPECT imaging was performed at baseline and again 2.5 h after a single dose of methylphenidate (MP) administered enterally. DA transporter (DAT) specific binding ratio (SBR) before and after MP was measured. Functional outcomes included the Disability Rating Scale, JFK Coma Recovery Scale-Revised, Functional Independence Measure, and Functional Assessment Measure. Thirteen of 18 patients completed the study. Average time from injury to SPECT scan was 48 days (standard deviation [SD], 24 days; median, 31). Baseline ioflupane striatal SBR was 1.51 ± 0.46 (median, 1.67). A 43.1% (SD, 16; median, 46.5) displacement of ioflupane from pre-synaptic DAT was observed after MP administration. Baseline SBR positively correlated with functional status at baseline and 4 weeks after completion of the study. Serum MP levels correlated with relative change in SBR (rs = 0.60; p = 0.04). Our findings suggest that 123I-iofluopane SPECT is a promising tool to determine the severity of pre-synaptic DA terminal disruption and for monitoring pharmacokinetics and pharmacodynamics of therapeutic interventions targeting the DA system.
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Affiliation(s)
- Kyle B Womack
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rosemary Dubiel
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, USA.,Baylor Scott & White Health, Dallas, Texas, USA
| | - Librada Callender
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, USA.,Baylor Scott & White Health, Dallas, Texas, USA
| | - Cynthia Dunklin
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, USA.,Baylor Scott & White Health, Dallas, Texas, USA
| | | | - Thomas S Harris
- Avid Radiopharmaceuticals Inc, Philadelphia, Pennsylvania, USA
| | | | - Shannon B Juengst
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kan Ding
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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21
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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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22
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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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23
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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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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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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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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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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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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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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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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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Sheng M, Lu H, Liu P, Li Y, Ravi H, Peng SL, Diaz-Arrastia R, Devous MD, Womack KB. Sildenafil Improves Vascular and Metabolic Function in Patients with Alzheimer's Disease. J Alzheimers Dis 2018; 60:1351-1364. [PMID: 29036811 DOI: 10.3233/jad-161006] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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: 12/27/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is the leading cause of degenerative dementia in the aging population. Patients with AD have alterations in cerebral hemodynamic function including reduced cerebral blood flow (CBF) and cerebral metabolic rate. Therefore, improved cerebrovascular function may be an attractive goal for pharmaceutical intervention in AD. OBJECTIVE We wished to observe the acute effects of sildenafil on cerebrovascular function and brain metabolism in patients with AD. METHODS We used several novel non-invasive MRI techniques to investigate the alterations of CBF, cerebral metabolic rate of oxygen (CMRO2), and cerebrovascular reactivity (CVR) after a single dose of sildenafil administration in order to assess its physiological effects in patients with AD. CBF, CMRO2, and CVR measurements using MRI were performed before and one hour after the oral administration of 50 mg sildenafil. Baseline Montreal Cognitive Assessment score was also obtained. RESULTS Complete CBF and CMRO2 data were obtained in twelve patients. Complete CVR data were obtained in eight patients. Global CBF and CMRO2 significantly increased (p = 0.03, p = 0.05, respectively) following sildenafil administration. Voxel-wise analyses of CBF maps showed that increased CBF was most pronounced in the bilateral medial temporal lobes. CVR significantly decreased after administration of sildenafil. CONCLUSION Our data suggest that a single dose of sildenafil improves cerebral hemodynamic function and increases cerebral oxygen metabolism in patients with AD.
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Affiliation(s)
- Min Sheng
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Radiology, Beijing Eden Hospital, Beijing, China
| | - Hanzhang Lu
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peiying Liu
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yang Li
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harshan Ravi
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shin-Lei Peng
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Penn Presbyterian Medical Center, Philadelphia, PA, USA
| | - Michael D Devous
- Department of Neurology and Neurotherapeutics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kyle B Womack
- Department of Neurology and Neurotherapeutics, The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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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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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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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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Schwarz AJ, Shcherbinin S, Slieker LJ, Risacher SL, Charil A, Irizarry MC, Fleisher AS, Southekal S, Joshi AD, Devous MD, Miller BB, Saykin AJ. Topographic staging of tau positron emission tomography images. Alzheimers Dement (Amst) 2018; 10:221-231. [PMID: 29780867 PMCID: PMC5956800 DOI: 10.1016/j.dadm.2018.01.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction It has been proposed that the signal distribution on tau positron emission tomography (PET) images could be used to define pathologic stages similar to those seen in neuropathology. Methods Three topographic staging schemes for tau PET, two sampling the temporal and occipital subregions only and one sampling cortical gray matter across the major brain lobes, were evaluated on flortaucipir F 18 PET images in a test-retest scenario and from Alzheimer's Disease Neuroimaging Initiative 2. Results All three schemes estimated stages that were significantly associated with amyloid status and when dichotomized to tau positive or negative were 90% to 94% concordant in the populations identified. However, the schemes with fewer regions and simpler decision rules yielded more robust performance in terms of fewer unclassified scans and increased test-retest reproducibility of assigned stage. Discussion Tau PET staging schemes could be useful tools to concisely index the regional involvement of tau pathology in living subjects. Simpler schemes may be more robust.
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Affiliation(s)
- Adam J Schwarz
- Eli Lilly and Company, Indianapolis, IN, USA.,Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | | | | | - Shannon L Risacher
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | - Sudeepti Southekal
- Avid Radiopharmaceuticals (a Wholly Owned Subsidiary of Eli Lilly and Company), Philadelphia, PA, USA
| | - Abhinay D Joshi
- Avid Radiopharmaceuticals (a Wholly Owned Subsidiary of Eli Lilly and Company), Philadelphia, PA, USA
| | - Michael D Devous
- Avid Radiopharmaceuticals (a Wholly Owned Subsidiary of Eli Lilly and Company), Philadelphia, PA, USA
| | | | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
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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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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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Schonhaut DR, McMillan CT, Spina S, Dickerson BC, Siderowf A, Devous MD, Tsai R, Winer J, Russell DS, Litvan I, Roberson ED, Seeley WW, Grinberg LT, Kramer JH, Miller BL, Pressman P, Nasrallah I, Baker SL, Gomperts SN, Johnson KA, Grossman M, Jagust WJ, Boxer AL, Rabinovici GD. 18 F-flortaucipir tau positron emission tomography distinguishes established progressive supranuclear palsy from controls and Parkinson disease: A multicenter study. Ann Neurol 2017; 82:622-634. [PMID: 28980714 DOI: 10.1002/ana.25060] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/10/2017] [Accepted: 09/24/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE 18 F-flortaucipir (formerly 18 F-AV1451 or 18 F-T807) binds to neurofibrillary tangles in Alzheimer disease, but tissue studies assessing binding to tau aggregates in progressive supranuclear palsy (PSP) have yielded mixed results. We compared in vivo 18 F-flortaucipir uptake in patients meeting clinical research criteria for PSP (n = 33) to normal controls (n = 46) and patients meeting criteria for Parkinson disease (PD; n = 26). METHODS Participants underwent magnetic resonance imaging and positron emission tomography for amyloid-β (11 C-PiB or 18 F-florbetapir) and tau (18 F-flortaucipir). 18 F-flortaucipir standardized uptake value ratios were calculated (t = 80-100 minutes, cerebellum gray matter reference). Voxelwise and region-of-interest group comparisons were performed in template space, with receiver operating characteristic curve analyses to assess single-subject discrimination. Qualitative comparisons with postmortem tau are reported in 1 patient who died 9 months after 18 F-flortaucipir. RESULTS Clinical PSP patients showed bilaterally elevated 18 F-flortaucipir uptake in globus pallidus, putamen, subthalamic nucleus, midbrain, and dentate nucleus relative to controls and PD patients (voxelwise p < 0.05 family wise error corrected). Globus pallidus binding best distinguished PSP patients from controls and PD (area under the curve [AUC] = 0.872 vs controls, AUC = 0.893 vs PD). PSP clinical severity did not correlate with 18 F-flortaucipir in any region. A patient with clinical PSP and pathological diagnosis of corticobasal degeneration had severe tau pathology in PSP-related brain structures with good correspondence between in vivo 18 F-flortaucipir and postmortem tau neuropathology. INTERPRETATION 18 F-flortaucipir uptake was elevated in PSP versus controls and PD patients in a pattern consistent with the expected distribution of tau pathology. Ann Neurol 2017;82:622-634.
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Affiliation(s)
- Daniel R Schonhaut
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA.,Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Corey T McMillan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Salvatore Spina
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA
| | - Bradford C Dickerson
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | | | | | - Richard Tsai
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA
| | - Joseph Winer
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA
| | | | - Irene Litvan
- Department of Neurology, University of California, San Diego, San Diego, CA
| | - Erik D Roberson
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
| | - William W Seeley
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA.,Department of Pathology, University of California, San Francisco, San Francisco, CA
| | - Lea T Grinberg
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA.,Department of Pathology, University of California, San Francisco, San Francisco, CA
| | - Joel H Kramer
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA
| | - Bruce L Miller
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA
| | - Peter Pressman
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA
| | - Ilya Nasrallah
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Suzanne L Baker
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA
| | - Stephen N Gomperts
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | - Keith A Johnson
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | - Murray Grossman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - William J Jagust
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA
| | - Adam L Boxer
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA
| | - Gil D Rabinovici
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA.,Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA
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Farrell ME, Kennedy KM, Rodrigue KM, Wig G, Bischof GN, Rieck JR, Chen X, Festini SB, Devous MD, Park DC. Association of Longitudinal Cognitive Decline With Amyloid Burden in Middle-aged and Older Adults: Evidence for a Dose-Response Relationship. JAMA Neurol 2017; 74:830-838. [PMID: 28558099 PMCID: PMC5710531 DOI: 10.1001/jamaneurol.2017.0892] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Presently, the clinical standard for reporting the results of an amyloid positron emission tomography scan is to assign a dichotomous rating of positive or negative for the presence of amyloid. In a 4-year longitudinal study, we investigated whether using a continuous measure of the magnitude of baseline amyloid burden would provide valuable information about the rate of future cognitive decline over the subsequent 4 years compared with a dichotomous measure in middle-aged and older adults. Objective To examine whether a continuous, dose-response relationship between amyloid burden and cognitive decline was present among middle-aged and older adults. Design, Setting, and Participants This cohort study included 174 participants from the Dallas Lifespan Brain Study who were 40 to 89 years old at the beginning of the study, were cognitively normal at baseline (a Mini-Mental State Examination score of 26 or higher) with no history of neurological or psychiatric disorders, and had completed amyloid imaging ([18F]-florbetapir) at baseline and cognitive assessments at baseline and a 4-year follow-up. Continuous amyloid burden was measured as the mean cortical standardized uptake value ratio (SUVR) at baseline. Main Outcomes and Measures Linear mixed models assessed the effect of increasing baseline amyloid over time (SUVR × time interaction) on episodic memory, reasoning, processing speed, vocabulary, and Mini-Mental State Examination performance. Age, sex, education, apolipoprotein ε4, and the random effect of intercepts were included as covariates. Results The mean (SD) age for all participants (n = 174) was 66.44 (11.74) years, and 65 participants (37%) were men. The primary analyses yielded significant SUVR × time interactions in episodic memory, processing speed, vocabulary, and Mini-Mental State Examination performance, but not in reasoning performance. Higher baseline SUVR projected greater cognitive decline over 4 years. When controlling for variance related to a dichotomized positive/negative classification, most effects on cognition remained. Dichotomized amyloid status alone yielded fewer significant effects of amyloid on cognitive decline than continuous SUVR. Among amyloid-positive participants, increasing baseline SUVR predicted an increasing decline in episodic memory, but other effects on cognition were more limited. Finally, higher baseline amyloid burden among middle-aged adults was related to changes in vocabulary, with the effect driven by 3 apolipoprotein ε4 homozygotes. Conclusions and Relevance These results suggest that the magnitude of amyloid burden at baseline is associated with the rate of cognitive decline over 4 years and potentially provides important information about the rate of future cognitive decline that is not available from a dichotomous positive/negative categorization.
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Affiliation(s)
- Michelle E Farrell
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas
| | - Kristen M Kennedy
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas
| | - Karen M Rodrigue
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas
| | - Gagan Wig
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas
| | - Gérard N Bischof
- Multimodal Neuroimaging Group, Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany3Institute of Neuroscience and Medicine (INM-3), Cognitive Neuroscience Research Center, Jülich, Germany
| | - Jennifer R Rieck
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Xi Chen
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas
| | - Sara B Festini
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas
| | - Michael D Devous
- Avid Radiopharmaceuticals, a Wholly Owned Subsidiary of Eli Lilly, Philadelphia, Pennsylvania
| | - Denise C Park
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas6Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
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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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Charil A, Shcherbinin S, Southekal S, Joshi AD, Devous MD, Miller BB, Schwarz AJ. [P4–227]: THE ASSOCIATION OF TAU BURDEN IN CEREBRAL LOBES AND FUNCTIONAL BRAIN NETWORKS WITH PERFORMANCE IN DIFFERENT COGNITIVE DOMAINS. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.2095] [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]
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Charil A, Shcherbinin S, Southekal S, Joshi AD, Devous MD, Miller BB, Schwarz AJ. [IC‐P‐081]: THE ASSOCIATION OF TAU BURDEN IN CEREBRAL LOBES AND FUNCTIONAL BRAIN NETWORKS WITH PERFORMANCE IN DIFFERENT COGNITIVE DOMAINS. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.2354] [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: 11/25/2022]
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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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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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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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Fleisher AS, Joshi AD, Sundell KL, Chen YF, Kollack-Walker S, Lu M, Chen S, Devous MD, Seibyl J, Marek K, Siemers ER, Mintun MA. Use of white matter reference regions for detection of change in florbetapir positron emission tomography from completed phase 3 solanezumab trials. Alzheimers Dement 2017; 13:1117-1124. [PMID: 28365320 DOI: 10.1016/j.jalz.2017.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 08/25/2016] [Revised: 01/30/2017] [Accepted: 02/18/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION We compared subject-specific white matter (SSWM) and whole cerebellum (CBL) reference regions for power to detect longitudinal change in amyloid positron emission tomography signal. METHODS Positive florbetapir positron emission tomography scans were analyzed from participants (66 placebo treated and 63 solanezumab treated) with mild dementia caused by Alzheimer's disease from the EXPEDITION and EXPEDITION2 studies. For comparison to CBL, a second normalization was performed on longitudinal data using an SSWM correction factor (SSWM normalization ratio [SSWMnr]). Analysis of covariance assessed baseline to 18-month change between treatment with solanezumab and placebo. Sample and effect size estimations provided magnitude of observed treatment changes. RESULTS Longitudinal percent change between placebo and solanezumab using CBL was not significant (P = .536) but was significant for SSWMnr (P = .042). Compared with CBL, SSWMnr technique increased the power to detect a treatment difference, more than tripling the effect size and reducing the sample size requirements by 85% to 90%. DISCUSSION Adjusting longitudinal standardized uptake value ratios with an SSWM reference region in these antiamyloid treatment trials increased mean change detection and decreased variance resulting in the substantial improvement in statistical power to detect change.
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Affiliation(s)
| | | | | | | | | | - Ming Lu
- Avid Radiopharmaceuticals, Philadelphia, PA, USA
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Bischof GN, Rodrigue KM, Kennedy KM, Devous MD, Park DC. Amyloid deposition in younger adults is linked to episodic memory performance. Neurology 2016; 87:2562-2566. [PMID: 27837001 DOI: 10.1212/wnl.0000000000003425] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 09/12/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To examine the relationship of β-amyloid (Aβ) deposition to episodic memory in younger (30-49 years), middle-older (50-69 years), and older adults (70-89 years). We hypothesized that subclinical levels of amyloid would be linked to memory in adults across the lifespan in a dose-dependent fashion. Of great interest was whether, within the younger group, a relationship between amyloid level and memory performance could be established. METHODS A total of 147 participants from the Dallas Lifespan Brain Study, aged 30-89, underwent PET imaging with 18F-florbetapir and cognitive assessment. We assessed the relationship between age group and amyloid and tested whether Aβ differentially affected memory performance across the 3 age groups. RESULTS We report a significant association of age to amyloid burden for younger and middle-older adults (r = 0.57 and 0.28, respectively), but not for the oldest group, although absolute level of amyloid increased across the age groups. Importantly, the youngest group showed a significant decrease in recall (r = -0.47, p = 0.004) and recognition memory (r = -0.48, p = 0.003) as a function of increases in Aβ burden, whereas this relationship was absent in the middle-older and oldest group (all p > 0.23). CONCLUSIONS These results indicate that variance in subclinical levels of Aβ in younger adults is meaningful, and suggest that higher SUVRs relative to one's peers at a younger age is not entirely benign.
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Affiliation(s)
- Gérard N Bischof
- From the Center for Vital Longevity (G.N.B., K.M.R., K.M.K., D.C.P.), School of Behavioral and Brain Sciences, University of Texas at Dallas; Multimodal Neuroimaging Group (G.N.B.), Department of Nuclear Medicine, University Hospital Cologne; Cognitive Neuroscience (G.N.B.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Germany; and Department of Radiology (M.D.D.), University of Texas Southwestern Medical Center, Dallas.
| | - Karen M Rodrigue
- From the Center for Vital Longevity (G.N.B., K.M.R., K.M.K., D.C.P.), School of Behavioral and Brain Sciences, University of Texas at Dallas; Multimodal Neuroimaging Group (G.N.B.), Department of Nuclear Medicine, University Hospital Cologne; Cognitive Neuroscience (G.N.B.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Germany; and Department of Radiology (M.D.D.), University of Texas Southwestern Medical Center, Dallas
| | - Kristen M Kennedy
- From the Center for Vital Longevity (G.N.B., K.M.R., K.M.K., D.C.P.), School of Behavioral and Brain Sciences, University of Texas at Dallas; Multimodal Neuroimaging Group (G.N.B.), Department of Nuclear Medicine, University Hospital Cologne; Cognitive Neuroscience (G.N.B.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Germany; and Department of Radiology (M.D.D.), University of Texas Southwestern Medical Center, Dallas
| | - Michael D Devous
- From the Center for Vital Longevity (G.N.B., K.M.R., K.M.K., D.C.P.), School of Behavioral and Brain Sciences, University of Texas at Dallas; Multimodal Neuroimaging Group (G.N.B.), Department of Nuclear Medicine, University Hospital Cologne; Cognitive Neuroscience (G.N.B.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Germany; and Department of Radiology (M.D.D.), University of Texas Southwestern Medical Center, Dallas
| | - Denise C Park
- From the Center for Vital Longevity (G.N.B., K.M.R., K.M.K., D.C.P.), School of Behavioral and Brain Sciences, University of Texas at Dallas; Multimodal Neuroimaging Group (G.N.B.), Department of Nuclear Medicine, University Hospital Cologne; Cognitive Neuroscience (G.N.B.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Germany; and Department of Radiology (M.D.D.), University of Texas Southwestern Medical Center, Dallas
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Mete M, Sakoglu U, Spence JS, Devous MD, Harris TS, Adinoff B. Successful classification of cocaine dependence using brain imaging: a generalizable machine learning approach. BMC Bioinformatics 2016; 17:357. [PMID: 27766943 PMCID: PMC5073995 DOI: 10.1186/s12859-016-1218-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 01/14/2023] Open
Abstract
Background Neuroimaging studies have yielded significant advances in the understanding of neural processes relevant to the development and persistence of addiction. However, these advances have not explored extensively for diagnostic accuracy in human subjects. The aim of this study was to develop a statistical approach, using a machine learning framework, to correctly classify brain images of cocaine-dependent participants and healthy controls. In this study, a framework suitable for educing potential brain regions that differed between the two groups was developed and implemented. Single Photon Emission Computerized Tomography (SPECT) images obtained during rest or a saline infusion in three cohorts of 2–4 week abstinent cocaine-dependent participants (n = 93) and healthy controls (n = 69) were used to develop a classification model. An information theoretic-based feature selection algorithm was first conducted to reduce the number of voxels. A density-based clustering algorithm was then used to form spatially connected voxel clouds in three-dimensional space. A statistical classifier, Support Vectors Machine (SVM), was then used for participant classification. Statistically insignificant voxels of spatially connected brain regions were removed iteratively and classification accuracy was reported through the iterations. Results The voxel-based analysis identified 1,500 spatially connected voxels in 30 distinct clusters after a grid search in SVM parameters. Participants were successfully classified with 0.88 and 0.89 F-measure accuracies in 10-fold cross validation (10xCV) and leave-one-out (LOO) approaches, respectively. Sensitivity and specificity were 0.90 and 0.89 for LOO; 0.83 and 0.83 for 10xCV. Many of the 30 selected clusters are highly relevant to the addictive process, including regions relevant to cognitive control, default mode network related self-referential thought, behavioral inhibition, and contextual memories. Relative hyperactivity and hypoactivity of regional cerebral blood flow in brain regions in cocaine-dependent participants are presented with corresponding level of significance. Conclusions The SVM-based approach successfully classified cocaine-dependent and healthy control participants using voxels selected with information theoretic-based and statistical methods from participants’ SPECT data. The regions found in this study align with brain regions reported in the literature. These findings support the future use of brain imaging and SVM-based classifier in the diagnosis of substance use disorders and furthering an understanding of their underlying pathology. Electronic supplementary material The online version of this article (doi:10.1186/s12859-016-1218-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mutlu Mete
- Department of Computer Science and Information Systems, Texas A&M University-Commerce, Commerce, TX, USA.
| | - Unal Sakoglu
- Computer Engineering, University of Houston - Clear Lake, Houston, TX, USA
| | - Jeffrey S Spence
- Center for Brain Health, University of Texas at Dallas, Richardson, TX, USA
| | - Michael D Devous
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA.,Avid Radiopharmaceuticals, Philadelphia, PA, USA
| | | | - Bryon Adinoff
- Veterans Affairs North Texas Health Care System, Dallas, TX, USA.,Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
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