PET measures of benzodiazepine receptors in progressive supranuclear palsy

OBJECTIVE: To evaluate the integrity of neurons containing benzodiazepine receptors in metabolically affected regions of the brain in patients with clinically diagnosed progressive supranuclear palsy (PSP). METHODS: The cerebral distribution of [11C]flumazenil (FMZ), a ligand that binds to the gamma-aminobutyric acid A (GABAA) receptor, and [18F]fluorodeoxyglucose (FDG), a measure of local cerebral glucose metabolism, was determined with PET in 12 patients with PSP and 10 normal control subjects. Tracer kinetic analysis was applied to quantify data and analysis was performed using three-dimensional stereotactic surface projections and stereotactically determined volumes of interest. RESULTS: There was a global reduction in FMZ binding of 13%, with a reduction in the anterior cingulate gyrus of 20% (p = 0.004), where glucose metabolic rates also showed the greatest reduction. CONCLUSIONS: PSP causes loss of benzodiazepine receptors in the cerebral cortex. Consistent with postmortem studies, the authors did not find significant changes in FMZ binding in subcortical nuclei that exhibit the most pathologic change. This study suggests that both loss of intrinsic neurons containing benzodiazepine receptors and deafferentation of the cerebral cortex from distant brain regions contribute to cerebral cortical hypometabolism in PSP.     

Distribution and binding parameters of GABA and benzodiazepine receptors in the cat motor thalamus and adjacent nuclear groups

Quantitative receptor binding autoradiography technique was utilized to study GABA and benzodiazepine receptors in the cat motor thalamus (ventral anterior, ventral medial and ventral lateral nuclei) and adjacent thalamic subdivisions. Binding parameters (Bmax and Kd) and distribution pattern of the binding sites for 3 tritiated ligands [3H]muscimol ([3H]MUS), [3H]flunitrazepam ([3H]FLU) and [3H]baclofen ([3H]BAC) were analyzed and compared using measurements from discrete and anatomically well-defined thalamic regions. There was little correlation in the regional distribution of the 3 binding sites. The concentration of [3H]BAC binding sites in thalamic nuclei of interest was very low, practically at the limit of resolution of the quantitative autoradiographic technique; whereas appreciable quantities of [3H]MUS and [3H]FLU binding sites were present in the motor and adjacent limbic nuclei of the thalamus. There was more difference between the nuclei in regard to the number of high affinity GABA receptors than benzodiazepine receptors. Moreover, the ratio of Bmax[3H]MUS/Bmax[3H]FLU varied from 2.2 to 4.4 in different thalamic regions suggesting the presence of a diverse population of GABAA and benzodiazepine receptors. The distribution pattern of the 3 binding sites was compared to the topography of GABAergic afferents of the basal ganglia origin and the frequency of GABAergic synapses formed by thalamic local circuit neurons (LCN) in the motor thalamus that were established earlier. It was concluded that in the cat motor thalamus: (1) none of the ligands studied appear to reveal the receptors associated with nigro- or pallidothalamic synapses; (2) [3H]MUS binding sites may be associated with the dendrodendritic contacts formed by LCN; and (3) the [3H]FLU binding sites are physically unrelated to [3H]MUS binding sites. The concentration of [3H]FLU and [3H]MUS binding sites in the midline nuclei and of [3H]MUS binding sites in the limbic nuclei was remarkably high. It was concluded that in addition to previously suggested limbic structures, the midline nuclei with their very high content of benzodiazepine receptors may be considered as a neuroanatomical substrate of certain forms of anxiety.     

PET imaging of human gliomas with ligands for the peripheral benzodiazepine binding site

Human gliomas were imaged in vivo using ligands for the peripheral-type benzodiazepine binding site (or omega 3 binding site) and positron emission tomography (PET). Although gliomas have a high density of the peripheral-type benzodiazepine binding site, PET scans with a selective ligand for this site, [11C] Ro5-4864, failed to demonstrate higher radioactivity levels in human gliomas than in brain. In vitro studies of surgically removed specimens of human glioma demonstrated little binding of Ro5-4864 but high levels of binding of another selective ligand, PK 11195. Scans with [11C]PK 11195 demonstrated increased radioactivity in glioma compared to brain in 8 of 10 patients. Radioactivity in tumor and the ratios of radioactivity in tumor to that in remote gray and in white matter correlated significantly with the specific activity of [11C]PK 11195, suggesting that accumulation represents saturable high-affinity binding. We conclude that the PK 11195 manifests greater binding than Ro5-4864 to the peripheral-type benzodiazepine binding site on human gliomas and that human gliomas can be successfully imaged using [11C]PK 11195 and PET.     

Cerebral benzodiazepine receptors in depressed patients measured with [123I]iomazenil SPECT.

BACKGROUND: A recent magnetic resonance spectroscopy (MRS) study revealed low gamma-aminobutyric acid (GABA) levels in the occipital cortex of depressed patients. No in vivo study has been reported to measure postsynaptic GABA receptors in the patients. METHODS: Cortical benzodiazepine (BZ) binding to GABA(A) receptors was measured with [(123)I]iomazenil and single photon emission computed tomography in unmedicated patients with unipolar major depression (n = 13) and healthy subjects (n = 19). Group differences were evaluated by means of statistical parametric mapping (SPM) with partial volume correction for gray matter. Occipital GABA levels were determined by proton MRS in a subgroup (n = 6) of the patients. RESULTS: No evidence of altered BZ binding was found in patients with depression compared with healthy control subjects in the SPM analysis. Although reduction in gray matter volume was observed in the frontal cortex and amygdala of the patients, partial volume correction of the atrophy did not change the result of unaltered BZ binding. GABA levels were found lower in the occipital cortex; however, BZ binding did not show significant relationship to GABA levels. CONCLUSIONS: GABA(A) receptor binding measured in vivo with BZ radioligand binding are not altered in patients with depression.     

Inverse agonist binding of peripheral benzodiazepine receptors in anxiety disorder

The binding characteristics of the pBR (peripheral benzodiazepine receptor) inverse agonist, [³H]-Ro 5-4864, were examined in patients diagnosed as generalized anxiety disorder. As compared to normal healthy controls, the anxious subjects demonstrated a statistically significant (p < 0.001) increase in the density of pBR in platelets. The enhanced pBR binding correlated significantly with the severity of global anxiety symptom of the Hamilton Anxiety Rating Scale (HAR-S, p < 0.001). The Psychic component, but not the Somatic component, of the HAR-S, correlated significantly (p < 0.001) with the enhanced pBR binding in platelets. The results provide evidence for the hypothesis of dysregulation of peripheral benzodiazepine receptors in generalized anxiety disorder. Received: 15 November 2000 / Accepted: 16 May 2001     

SPECT and PET imaging of brain tumors.

The unique capacity of measuring or visualizing intracellular biochemical processes allows nuclear medicine techniques to determine functional and metabolic activities of various disorders. This article describes the critical role of single-photon emission computed tomography (SPECT) and positron emission tomography (PET) imaging of brain tumors beyond what can be achieved by anatomic methods.     

Regulation of peripheral-type benzodiazepine receptors following repeated benzodiazepine administration.

The effects of chronic benzodiazepine (BZD) treatment on rat peripheral-type benzodiazepine receptors (PBR) were studied. Five days treatment with the PBR ligands RO 5-4864 or diazepam (DZ) up-regulates kidney PBR. In contrast clonazepam, a specific central-type BZD receptor ligand, did not alter 3H-RO 5-4864 binding. Fourteen days administration of DZ produced an up-regulation of kidney and heart PBR and a down-regulation of testicular PBR. The results suggest that chronic BZD exposure differentially regulates PBR in peripheral organs.     

PET and SPECT imaging in psychiatric disorders.

OBJECTIVES: To review recent findings from positron emission tomography (PET) and single photon emission computed tomography (SPECT) studies that investigate the pathophysiology and treatment of schizophrenia, depression, and dementia. METHODS: We carried out a review of the literature. RESULTS: PET and SPECT studies have provided evidence of dopamine system dysregulation in patients with schizophrenia and variable loss of monoamines in patients with depression. Antipsychotic response has been demonstrated to be associated with blockade of dopamine D2 receptors, and antidepressant response has now been linked to blockade of serotonin transporter receptors. PET and SPECT have been extensively evaluated as diagnostic procedures for dementia. Substantial progress has been made in developing radioligands that bind to amyloid deposits in the brain, which should provide new opportunities for early diagnosis and treatment monitoring in Alzheimer's disease. CONCLUSION: Advances in PET and SPECT imaging have provided new insights into the biology of major psychiatric disorders and their treatment. In the future, we can expect that these imaging techniques will become more central to the management of psychiatric disorders.     

Kinetic evaluation in nonhuman primates of two new PET ligands for peripheral benzodiazepine receptors in brain

Peripheral benzodiazepine receptors (PBRs) are upregulated on activated microglia and are, thereby, biomarkers of cellular inflammation in brain. We recently developed two PET ligands with an aryloxyanilide structure to image PBRs and now evaluate the kinetics of these radiotracers in monkey to determine whether they are suitable to explore in human. Baseline and receptor-blocking scans were performed with [(11)C]PBR01 and [(18)F]PBR06 in conjunction with serial measurements of the arterial plasma concentration of parent radiotracer separated from radiometabolite. We used brain and plasma data with compartmental modeling to calculate regional brain distribution volume, which is equal to the ratio at equilibrium of the concentration of radioligand in brain to that of plasma. The distribution volume of [(11)C]PBR01 was inaccurately estimated in the baseline scans, possibly because of the short half-life of (11)C or the presence of radiometabolite in brain. In contrast, the distribution volume of [(18)F]PBR06 was stably determined within 200 min of scanning, and nondisplaceable uptake was only approximately 10% of total brain uptake. [(18)F]PBR06 is promising for use in human because brain activity could be quantified with standard compartmental models and showed higher ratios ( approximately 10:1) of specific to nonspecific uptake. A critical factor for human use will be whether the tracer has adequately fast wash out from brain relative to the half-life of the radionuclide to obtain stable values of distribution volume.     

SPECT and PET in neurology

Both single photon emission computed tomography (SPECT) and positron emission tomography (PET) are helpful in the practice of neurology. Ictal SPECT is useful to determine the origin of focal seizures in the pre-surgical evaluation. In some centers, it is used to predict the likelihood of massive cerebral swelling after stroke and of cerebral infarction after a subarachnoid hemorrhage. It has also been used to study dopaminergic function in parkinsonian syndromes and in the evaluation of dementia. Given its higher resolution and some other factors, PET is more useful in the evaluation of brain tumors, dementia and the parkinsonian syndromes. It is also useful in the presurgical evaluation of epilepsy.     

Food deprivation modulates gamma-aminobutyric acid receptors and peripheral benzodiazepine binding sites in rats

The effect of 5 days of food deprivation followed by 5 days of refeeding on gamma-aminobutyric acid (GABA) receptors, central benzodiazepine receptors (CBR), and peripheral benzodiazepine binding sites (PBzS) was studied in female Sprague-Dawley rats. Starvation induced a decrease in the density of PBzS in peripheral organs: adrenal (35%; P less than 0.001), kidney (33%; P less than 0.01), and heart (34%; P less than 0.001). Restoration of [3H]PK 11195 binding to normal values was observed in all three organs after 5 days of refeeding. The density of PBzS in the ovary, pituitary, and hypothalamus was not affected by starvation. Food deprivation resulted in a 35% decrease in cerebellar GABA receptors (P less than 0.01), while CBR in the hypothalamus and cerebral cortex remained unaltered. The changes in PBzS observed in the heart and kidney may be related to the long-term metabolic stress associated with starvation and to the functional changes occurring in these organs. The down-regulation of the adrenal PBzS is attributable to the suppressive effect of hypercortisolemia on pituitary ACTH release. The reduction in cerebellar GABA receptors may be an adaptive response to food deprivation stress and may be relevant to the proaggressive effect of hunger.     

Quantitation of benzodiazepine receptor binding with PET [11C]iomazenil and SPECT [123I]iomazenil: preliminary results of a direct comparison in healthy human subjects.

Although positron emission tomography (PET) and single photon emission computed tomography (SPECT) are increasingly used for quantitation of neuroreceptor binding, almost no studies to date have involved a direct comparison of the two. One study found a high level of agreement between the two techniques, although there was a systematic 30% increase in measures of benzodiazepine receptor binding in SPECT compared with PET. The purpose of the current study was to directly compare quantitation of benzodiazepine receptor binding in the same human subjects using PET and SPECT with high specific activity [11C]iomazenil and [123I]iomazenil, respectively. All subjects were administered a single bolus of high specific activity iomazenil labeled with 11C or 123I followed by dynamic PET or SPECT imaging of the brain. Arterial blood samples were obtained for measurement of metabolite-corrected radioligand in plasma. Compartmental modeling was used to fit values for kinetic rate constants of transfer of radioligand between plasma and brain compartments. These values were used for calculation of binding potential (BP = Bmax/Kd) and product of BP and the fraction of free non-protein-bound parent compound (V3'). Mean values for V3' in PET and SPECT were as follows: temporal cortex 23+/-5 and 22+/-3 ml/g, frontal cortex23+/-6 and 22+/-3 ml/g, occipital cortex 28+/-3 and 31+/-5 ml/g, and striatum 4+/-4 and 7+/-4 ml/g. These preliminary findings indicate that PET and SPECT provide comparable results in quantitation of neuroreceptor binding in the human brain.     

Peripheral-type benzodiazepine receptors in anxiety disorders.

Peripheral benzodiazepine receptors (pBDZr) were analyzed in lymphocyte membranes from patients with anxiety disorders (generalized anxiety disorder (GAD), n = 15; panic disorder (PD), n = 10; obsessive-compulsive disorder (OCD), n = 18), other mental disorders (n = 40) and 50 healthy controls, by the specific binding of 3H-PK11195. The number of binding sites (Bmax) was significantly decreased in groups with both GAD and OCD as compared with age-matched controls, by 45% and 25% respectively, whereas the binding affinity (Kd) was the same in all disorder and control groups. Conversely, no changes in binding capacity was observed in the other disorder groups and particularly in the one with PD. The abnormality in pBDZr observed in patients with GAD was restored to a normal value after long-term treatment with 2'-chloro-N-desmethyldiazepam, which also coincided with their recovery from anxiety. Our data suggest that the clinical heterogeneity in anxiety disorders might be related to different biological mechanisms and that lymphocyte pBDZr might be useful in demonstrating these differences.     

Pharmacology of benzodiazepine receptors: an update.

Benzodiazepine receptors are allosteric modulatory sites on GABAA receptors. GABAA receptors are probably composed of five protein subunits, at least some of which belong to different subunit classes. So far six alpha-, four beta-, three gamma-, and delta- and two rho = p subunits of GABAA receptors have been identified. A large number of different subunit combinations, each of which will result in a GABAA receptor with distinct electrophysiological and pharmacological properties, are therefore possible. Many compounds from different chemical classes which are able to bind to benzodiazepine receptors have been identified. Depending on their individual efficacy, binding of these compounds either enhances, reduces or does not influence GABAergic transmission. However, the individual efficacy of the benzodiazepine receptor ligands changes with the subunit composition of the GABAA receptor. The investigation of the regional distribution, subunit composition and pharmacology of GABAA receptors will result in the development of new and more selective compounds for psychiatry.     

SPECT and PET in nonlesional epilepsy

Clinical Epileptology - Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are applied in epilepsy mostly during presurgical assessment. Nonlesional focal...     

Altropane,a SPECT or PET imaging probe for dopamine neurons: I. dopamine transporter binding in primate brain

Increasing evidence suggests that the dopamine transporter is an important marker for physiological and pathological changes in dopamine neurons. Potent dopamine transport inhibitors of the phenyltropane series (e.g., WIN 35,428 or CFT) are particularly suitable for PET (positron emission tomography) or SPECT (single photon emission computed tomography) imaging of the dopamine transporter in living brain. We investigated whether altropane, an N-iodoallyl analog of WIN 35,428 (IACFT:E-N-iodoallyl-2β-carbomethoxy-3β-(4-fluorophenyl)tropane), displayed in vitro properties suitable for evaluation as a SPECT imaging agent. In brain striatum of cynomolgus monkey (Macaca fascicularis), the unlabeled E-isomer (IC₅₀: 6.62 ± 0.78 nM) was more potent than the Z-isomer (IC₅₀: 52.6 ± 0.3 nM) and displayed a relatively high dopamine:serotonin transporter selectivity (28-fold). In radiolabeled form, [¹²⁵I]altropane bound to sites in the striatum with a single high affinity (K_D: 5.33 ± 0.55 nM) and with a site density (B_MAX: 301 pmol/g original wet tissue weight) that was within the density range reported previously for the dopamine transporter in striatum. Drugs inhibited [¹²⁵I]altropane binding with a rank order of potency that corresponded closely to their potencies for inhibiting [³H]WIN 35,428 binding (r²: 0.99; P < 0.0001) to the blocking dopamine transport. The favorable binding properties of altropane, together with its rapid entry into primate brain and highly localized distribution in dopamine-rich brain regions, suggest it is a suitable iodinated probe for monitoring the dopamine transporter in vitro and in vivo by SPECT or PET imaging. Synapse 29:93–104, 1998. © 1998 Wiley-Liss, Inc.