raclopride and Huntington-Disease

Two patients with moderate Huntington's disease (HD) received bilateral fetal striatal allografts. One patient demonstrated, for the first time, increased striatal D2 receptor binding, evident with 11C-raclopride positron emission tomography, and prolonged clinical improvement over 5 years, suggesting long term survival and efficacy of the graft. The other patient did not improve clinically or radiologically. Our results indicate that striatal transplantation in HD may be beneficial but further studies are needed to confirm this.

Topics: Adrenergic Uptake Inhibitors; Adult; Brain Edema; Brain Tissue Transplantation; Carbon Radioisotopes; Case-Control Studies; Caudate Nucleus; Combined Modality Therapy; Corpus Striatum; Cyclosporine; Dopamine Antagonists; Female; Fetal Tissue Transplantation; Follow-Up Studies; Humans; Huntington Disease; Immunosuppressive Agents; Lymphocytosis; Male; Middle Aged; Morpholines; Neurologic Examination; Neuropsychological Tests; Positron-Emission Tomography; Postoperative Complications; Putamen; Raclopride; Reboxetine; Stereotaxic Techniques; Tissue Survival

Huntington disease (HD) is characterized by the progressive death of medium spiny dopamine receptor bearing striatal GABAergic neurons. In addition, microglial activation in the areas of neuronal loss has recently been described in postmortem studies. Activated microglia are known to release neurotoxic cytokines, and these may contribute to the pathologic process.. To evaluate in vivo the involvement of microglia activation in HD, the authors studied patients at different stages of the disease using [(11)C](R)-PK11195 PET, a marker of microglia activation, and [(11)C]raclopride PET, a marker of dopamine D2 receptor binding and hence striatal GABAergic cell function.. In HD patients, a significant increase in striatal [(11)C](R)-PK11195 binding was observed, which significantly correlated with disease severity as reflected by the striatal reduction in [(11)C]raclopride binding, the Unified Huntington's Disease Rating Scale score, and the patients' CAG index. Also detected were significant increases in microglia activation in cortical regions including prefrontal cortex and anterior cingulate.. These [(11)C](R)-PK11195 PET findings show that the level of microglial activation correlates with Huntington disease (HD) severity. They lend support to the view that microglia contribute to the ongoing neuronal degeneration in HD and indicate that [(11)C](R)-PK11195 PET provides a valuable marker when monitoring the efficacy of putative neuroprotecting agents in this relentlessly progressive genetic disorder.

Topics: Adult; Aged; Amides; Corpus Striatum; Female; Humans; Huntington Disease; Isoquinolines; Male; Microglia; Middle Aged; Positron-Emission Tomography; Raclopride; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Statistics as Topic

To calculate binding potentials (BP) in [11C]raclopride brain PET studies a reference tissue model is widely used. The aim of the present study was to improve the determination of time activity curves (TAC) of reference tissue regions using cluster analysis. In four patients with Huntington disease TACs of a cerebellar reference region were calculated either from manually placed circular ROIs within the cerebellum or by cluster analysis. BP estimates derived from cluster analysis are independent from inter- and intraobserver variations and show an improved reproducibility combined with a low variability compared to manually placed cerebellar ROIs. This is of high value in longitudinal studies.

Topics: Adult; Algorithms; Cerebellum; Cluster Analysis; Feasibility Studies; Female; Humans; Huntington Disease; Image Interpretation, Computer-Assisted; Male; Metabolic Clearance Rate; Middle Aged; Protein Binding; Raclopride; Radiopharmaceuticals; Receptors, Dopamine D2; Reproducibility of Results; Sensitivity and Specificity; Tissue Distribution; Tomography, Emission-Computed

We used [11C]raclopride and positron emission tomography (PET) to assess the relationship between striatal dopamine D2 receptor binding, trinucleotide repeat number (CAG), and subject age in 10 asymptomatic and 8 symptomatic carriers of the Huntington's disease (HD) mutation. In both preclinical and symptomatic gene carriers, we found significant correlations between CAG repeat length and the ratio of percent loss in striatal D2 receptor binding divided by age. In accord with neuropathological studies, we obtained an intercept at 35.5 CAG repeats in the symptomatic HD patients. Nonetheless, we noted that the slopes of the correlation lines differed significantly for the presymptomatic and symptomatic cohorts. These PET results support the notion that the HD disease process is a function of trinucleotide length and age, and that the development of clinical signs and symptoms is associated with CAG repeat lengths greater than 35.5. However, our analysis also suggests that striatal degeneration may proceed in a nonlinear fashion. These findings have implications for the design of neuroprotective strategies for the treatment of HD.

Topics: Adult; Caudate Nucleus; Cross-Sectional Studies; Disease Progression; Dopamine Antagonists; Heterozygote; Humans; Huntington Disease; Middle Aged; Putamen; Raclopride; Receptors, Dopamine; Regression Analysis; Salicylamides; Tomography, Emission-Computed; Trinucleotide Repeats

Incidental learning of appropriate stimulus-response associations is crucial for optimal functioning within our complex environment. Positive and negative prediction errors (PEs) serve as neural teaching signals within distinct ('direct'/'indirect') dopaminergic pathways to update associations and optimize subsequent behavior. Using a computational reinforcement learning model, we assessed learning from positive and negative PEs on a probabilistic task (Weather Prediction Task - WPT) in three populations that allow different inferences on the role of dopamine (DA) signals: (1) Healthy volunteers that repeatedly underwent [

Topics: Aged; Dopamine; Female; Humans; Huntington Disease; Learning; Levodopa; Middle Aged; Parkinson Disease; Positron-Emission Tomography; Raclopride; Reinforcement, Psychology; Ventral Striatum

[(18)F]desmethoxyfallypride ([(18)F]DMFP) is a promising tracer for longitudinal assessment of striatal dopamine D2/D3-receptor (D2R) availability by positron emission tomography (PET) in small animal models. We explored the feasibility of [(18)F]DMFP-PET to image D2R availability in rat models of Huntington's (HD) and Parkinson's disease (PD).. Animals received either unilateral intrastriatal quinolinic acid lesions or medial forebrain bundle injections of 6-OHDA to produce the loss of striatal projection neurones or deplete the striatal dopamine, corresponding to established animal models for HD and PD, respectively. Three weeks after lesioning, PET scans were acquired on a microPET Focus 120 system following the tail vein injection of [(18)F]DMFP.. [(18)F]DMFP-PET clearly visualized lesion induced decreases and increases of D2R availability. In vivo estimates of D2R binding and changes thereof gained by pharmacokinetic analyses correlated significantly with D2R density and its change provided by in vitro [(3)H]raclopride-autoradiography.. In conclusion, [(18)F]DMFP-PET is a suitable method for in vivo D2R-assessment in preclinical research, e.g for monitoring cell-based therapies.

Topics: Animals; Disease Models, Animal; Huntington Disease; Parkinson Disease; Positron-Emission Tomography; Raclopride; Radioactive Tracers; Rats; Receptors, Dopamine D2; Receptors, Dopamine D3; Salicylamides

We used (11)C-raclopride PET, a marker of D(2) dopamine receptor binding, and statistical parametric mapping (SPM) to localise cortical D(2) receptor dysfunction in individual Huntington's disease (HD) gene carriers (16 symptomatic and 11 premanifest subjects) and assess its clinical significance. 62.5% of symptomatic HD patients and 54.5% of premanifest carriers showed cortical reductions in D(2) binding. The most frequent decreases in cortical binding in individual HD subjects were seen in temporal and frontal areas. Symptomatic HD subjects with decreased cortical D(2) binding had worse scores on neuropsychological tests assessing attention and executive functions than subjects without cortical dopamine dysfunction, notwithstanding comparable reduction in striatal D(2) binding and motor disability. Our results indicate that cortical dopaminergic dysfunction is common in both symptomatic and premanifest HD gene carriers. It is an early event in HD pathophysiology and could contribute to the impairment in neuropsychological performance in these patients.

Topics: Adult; Binding, Competitive; Carbon Radioisotopes; Cerebral Cortex; Dopamine; Dopamine Antagonists; Female; Frontal Lobe; Genetic Markers; Heterozygote; Humans; Huntington Disease; Male; Middle Aged; Positron-Emission Tomography; Predictive Value of Tests; Prognosis; Raclopride; Receptors, Dopamine D2; Temporal Lobe

Carriers of the Huntington disease (HD) mutation develop a progressive neurodegenerative disorder after a pre-clinical phase. We examined the value of (11)C-raclopride PET (RAC) as a biomarker for pre-clinical HD pathophysiology.. In a prospective cohort study with clinical and neuropsychological assessment we collected complete RAC data in 18 pre-clinical mutation carriers (HD-PMC) and 11 controls. Follow-up was 2 years. We calculated striatal RAC binding potential (BP) to measure dopamine D2 receptor availability.. No HD-PMC had overt neuropsychological dysfunction. RAC-BP in putamen was abnormal in up to 44% of HD-PMC. The rate of RAC-BP decline (2.6% per year) was not significantly higher than in controls. Follow-up putaminal BP correlated weakly with predicted distance to onset of clinical HD (P = 0.034), but the rate of decline did not. Three HD-PMC developed motor abnormalities suspect for HD but did not show an increased rate of decline of putaminal BP.. Many HD-PMC have striatal abnormalities but we found no clearly increased rate of D2 receptor changes around the onset of clinical HD. A longer follow-up of the present study cohort is needed to establish the value of RAC-BP in assessing the risk of clinical conversion from striatal D2 binding data.

Topics: Adult; Cohort Studies; Corpus Striatum; Disease Progression; Female; Heterozygote; Humans; Huntingtin Protein; Huntington Disease; Image Interpretation, Computer-Assisted; Male; Middle Aged; Mutation; Nerve Tissue Proteins; Neuropsychological Tests; Nuclear Proteins; Positron-Emission Tomography; Raclopride; Radiopharmaceuticals; Receptors, Dopamine D2

Recent studies have shown alterations in metabolism, sleep and circadian rhythms as well as in several neuropeptides derived from the hypothalamic-pituitary axis in Huntington's disease patients; however, the pathology underlying these abnormalities is not known. Our aim was to assess in vivo D(2) receptor's loss/dysfunction and increases in microglial activation in the hypothalamus of symptomatic Huntington's disease patients and premanifest Huntington's disease gene carriers using PET with (11)C-raclopride (RAC), a specific D(2) receptor ligand and (11)C-(R)-PK11195 (PK), a marker of microglial activation. We have studied 9 symptomatic Huntington's disease patients (age = 46.8 +/- 4.7 years; mean +/- SD) and 10 premanifest Huntington's disease gene carriers (age = 41.9 +/- 8.2 years; mean +/- SD). RAC and PK findings for these subjects were compared with those of a group of normal controls (RAC, n = 9; PK, n = 10). In the symptomatic Huntington's disease group, we found a significant decrease (P = 0.0012) in mean hypothalamic RAC binding potential (BP) and a significant increase in mean hypothalamic PK BP (P = 0.0008). Similarly, a significant decrease (P = 0.0143) in mean hypothalamic RAC BP and a significant increase in mean hypothalamic PK BP (P = 0.0057) were observed in the premanifest Huntington's disease group. Hypothalamic RAC and PK BP values correlated with each other in combined Huntington's disease groups (r = -0.6180, P = 0.0048) but not with striatal RAC and PK BP values. Our data demonstrate, for the first time, significant D(2) receptor loss and microglia activation in the hypothalamus of Huntington's disease. These pathological changes occur very early in the course of the disease and may partly explain the development of commonly reported symptoms in Huntington's disease including progressive weight loss, alterations in sexual behaviour and disturbances in the wake-sleep cycle.

Topics: Adult; Brain Mapping; Carbon Radioisotopes; Female; Heterozygote; Humans; Huntington Disease; Hypothalamus; Isoquinolines; Male; Microglia; Middle Aged; Positron-Emission Tomography; Raclopride; Receptors, Dopamine D2

Microglial activation may play a role in the pathogenesis of Huntington's disease (HD). Using 11C-(R)-PK11195 (PK) positron emission tomography (PET), we investigated microglial activation in HD presymptomatic gene carriers (PGCs), its relationship with striatal neuronal dysfunction measured with 11C-raclopride (RAC) PET, and the role of PK PET as a possible marker of subclinical disease progression in PGCs. Eleven HD PGCs underwent PK and RAC PET. Their results were compared with those of healthy controls. PK and RAC binding was measured using region-of-interest analysis. Regional increases in PK binding were also localized with voxel-based statistical parametric mapping. HD PGCs had lower striatal RAC binding than the controls but significantly higher striatal and cortical PK binding. Individual levels of higher striatal PK binding in PGCs correlated with lower striatal RAC binding and, after excluding one outlier, with a higher probability of developing HD in 5 years. The inverse association between striatal PK and RAC binding in PGCs continues into early to moderate stages of HD. This study demonstrated for the first time in vivo widespread microglial activation in preclinical HD which correlated with striatal neuronal dysfunction. These findings indicate that microglial activation is an early event in the pathogenic processes of HD and is associated with subclinical progression of disease. PK PET may be a useful marker of active subclinical disease and a means of investigating the efficacy of neuroprotection strategies in PGCs.

Topics: Adult; Brain Mapping; Carbon Radioisotopes; Cerebral Cortex; Corpus Striatum; Disease Progression; Female; Heterozygote; Humans; Huntington Disease; Image Processing, Computer-Assisted; Isoquinolines; Male; Microglia; Middle Aged; Neurons; Positron-Emission Tomography; Raclopride; Radiopharmaceuticals

The neural basis for the transition from preclinical to symptomatic Huntington's disease (HD) is unknown. We used serial positron emission tomography (PET) imaging in preclinical HD gene carriers (p-HD) to assess the metabolic changes that occur during this period. Twelve p-HD subjects were followed longitudinally with [11C]-raclopride and [18F]-fluorodeoxyglucose PET imaging, with scans at baseline, 18 and 44 months. Progressive declines in striatal D2-receptor binding were correlated with concurrent changes in regional metabolism and in the activity of an HD-related metabolic network. We found that striatal D2 binding declined over time (P < 0.005). The activity of a reproducible HD-related metabolic covariance pattern increased between baseline and 18 months (P < 0.003) but declined at 44 months (P < 0.04). These network changes coincided with progressive declines in striatal and thalamic metabolic activity (P < 0.01). Striatal metabolism was abnormally low at all time points (P < 0.005). By contrast, thalamic metabolism was elevated at baseline (P < 0.01), but fell to subnormal levels in the p-HD subjects who developed symptoms. These findings were confirmed with an MRI-based atrophy correction for each individual PET scan. Increases in network expression and thalamic glucose metabolism may be compensatory for early neuronal losses in p-HD. Declines in these measures may herald the onset of symptoms in gene carriers.

Topics: Adult; Analysis of Variance; Case-Control Studies; Corpus Striatum; Disease Progression; Fluorodeoxyglucose F18; Gyrus Cinguli; Heterozygote; Humans; Huntington Disease; Longitudinal Studies; Male; Middle Aged; Motor Cortex; Neuropsychological Tests; Occipital Lobe; Positron-Emission Tomography; Protein Binding; Raclopride; Radiopharmaceuticals; Receptors, Dopamine D2; Thalamus

To investigate efficacy of cystamine induced neuroprotection, we conducted PET imaging studies of cerebral glucose metabolism with [(18)F]FDG (2-deoxy-2-[(18)F]fluoro-d-glucose) and striatal dopamine D2 receptor function with [(11)C]raclopride in R6/2 transgenic Huntington mice. In the control mice, exponentially decreasing glucose utilization was observed in the striatum N(str) [SUV]=(41.75+/-11.80)(58,str)*exp(-(0.041+/-0.007)*t [days]); cortex N(cort) [SUV]=24.14+/-3.66)(58,cort)*exp(-(0.043+/-0.007)*t [days]); and cerebellum N(cer) [SUV]=(34.97+/-10.58)(58,cer)*exp(-(0.037+/-0.008)*t [days]) as a function of age starting at 58 days. Given that the underlying degeneration rate in the cystamine treated mice is similar to that observed in control animals, the protection coefficient (beta) calculated from the equation N(t)=N(58)*exp(-(1-beta)*k*t) was 0.133+/-0.035 for the striatum; 0.122+/-0.028 for the cortex and 0.224+/-00.042 for the cerebellum with a dose of 100 mg/kg. The 50 mg/kg cystamine dose provided significant protection only for the striatum and only minor protection was obtained using lower doses. Striatal binding potential of [(11)C]raclopride was 1.059+/-0.030 in the control mice, and enhanced in the cystamine treated animals in a dose dependent manner up to 1.245+/-0.063 using the 100 mg/kg dose. Histological analysis confirmed cystamine induced neuroprotection of striatal and cortical neurons and Nissl staining revealed that formation of cellular inclusions was reversed in a dose dependent manner. Cerebral imaging and histological evidence support the use of cystamine as a neuroprotective agent for Huntington's disease (HD) pathology.

Topics: Age Factors; Animals; Binding, Competitive; Body Weight; Brain; Brain Chemistry; Brain Mapping; Cerebral Cortex; Cystamine; Disease Models, Animal; Dopamine Antagonists; Dose-Response Relationship, Drug; Drug Interactions; Fluorodeoxyglucose F18; Glucose; Huntington Disease; Image Processing, Computer-Assisted; Inclusion Bodies; Male; Mice; Mice, Transgenic; Motor Activity; Neuroprotective Agents; Peptides; Positron-Emission Tomography; Raclopride; Transglutaminases; Tritium

Among 27 preclinical carriers of the Huntington disease mutation (PMC), the authors found normal striatal values for MRI volumetry in 88% and for fluorodesoxyglucose PET metabolic index in 67%. Raclopride PET binding potential (RAC-BP) was decreased in 50% and correlated with increases in the product of age and CAG repeat length (p < 0.0005). Dopamine D2 receptor availability measured by RAC-BP seems the most sensitive indicator of early neuronal impairment in PMC.

Topics: Adult; Binding, Competitive; Biomarkers; Corpus Striatum; Disease Progression; DNA Mutational Analysis; Dopamine; Dopamine Antagonists; Female; Fluorodeoxyglucose F18; Glucose; Humans; Huntingtin Protein; Huntington Disease; Magnetic Resonance Imaging; Male; Middle Aged; Mutation; Nerve Degeneration; Nerve Tissue Proteins; Nuclear Proteins; Positron-Emission Tomography; Predictive Value of Tests; Raclopride; Receptors, Dopamine D2; Trinucleotide Repeat Expansion

We have studied the progression of striatal and extrastriatal post-synaptic dopaminergic changes in a group of 12 patients with Huntington's disease using serial (11)C-raclopride PET, a specific marker of D2 dopamine receptor binding. All patients had two (11)C-raclopride PET scans 29.2 +/- 12.8 months apart, and six of them had a third scan 13.2 +/- 3.9 months later. We found a mean annual 4.8% loss of striatal (11)C-raclopride binding potential (BP) between the first and second scans, and a 5.2% loss between the second and third scans. Statistical Parametric Mapping (SPM) localized significant baseline reductions in (11)C-raclopride BP in both striatal and extrastriatal areas, including amygdala, temporal and frontal cortex in Huntington's disease compared with normal subjects matched for age and sex. When the (11)C-raclopride scans performed 29 months after the baseline scans were considered, SPM revealed further significant striatal, frontal and temporal reductions in (11)C-raclopride BP in Huntington's disease. Cross-sectional Unified Huntington's Disease Rating Scale (UHDRS) scores correlated with (11)C-raclopride binding, but there was no correlation between individual changes in UHDRS motor scores and changes in striatal binding. Performance on all neuropsychological measures deteriorated with time but only the accuracy score of the one-touch Tower of London test correlated significantly with striatal and putamen D2 binding. In summary, serial (11)C-raclopride PET demonstrates a linear progression of striatal loss of D2 receptors in early clinically affected Huntington's disease patients over 3 years. SPM also revealed a progressive loss of temporal and frontal D2 binding. Changes over time in clinical scores and in neuropsychological assessments, except for measures of planning, did not correlate with striatal D2 binding. This probably reflects both contributions from other affected brain structures and high variance in these measures.

Topics: Adult; Analysis of Variance; Brain; Brain Mapping; Carbon Radioisotopes; Disease Progression; Female; Humans; Huntington Disease; Image Processing, Computer-Assisted; Linear Models; Magnetic Resonance Imaging; Male; Mathematical Computing; Middle Aged; Neuropsychological Tests; Raclopride; Radiopharmaceuticals; Receptors, Dopamine D2; Tomography, Emission-Computed

We proposed [11C]KF18446 as a selective radioligand for mapping the adenosine A2A receptors being highly enriched in the striatum by positron emission tomography (PET). In the present study, we investigated whether [11C]KF18446 PET can detect the change in the striatal adenosine A2A receptors in the rat after unilateral injection of an excitotoxin quinolinic acid into the striatum, a Huntington's disease model, to demonstrate the usefulness of [11C]KF18446. The extent of the striatal lesion was identified based on MRI, to which the PET was co-registered. The binding potential of [11C]KF18446 significantly decreased in the quinolinic acid-lesioned striatum. The decrease was comparable to the decrease in the potential of [11C]raclopride binding to dopamine D2 receptors in the lesioned striatum, but seemed to be larger than the decrease in the potential of [11C]SCH 23390 binding to dopamine D1 receptors. Ex vivo and in vitro autoradiography validated the PET signals. We concluded that [11C]KF18446 PET can detect change in the adenosine A2A receptors in the rat model, and will provide a new diagnostic tool for characterizing post-synaptic striatopallidal neurons in the stratum.

Topics: Animals; Autoradiography; Benzazepines; Brain; Carbon Radioisotopes; Cerebellum; Corpus Striatum; Huntington Disease; Male; Quinolinic Acid; Raclopride; Radiopharmaceuticals; Rats; Rats, Wistar; Receptor, Adenosine A2A; Receptors, Dopamine; Receptors, Dopamine D1; Receptors, Dopamine D2; Receptors, Purinergic P1; Reference Values; Tomography, Emission-Computed; Xanthines

It has been demonstrated that withdrawal from chronic treatment with haloperidol is associated with a long-lasting increase in the number of striatal dopamine D(2) receptors and variable changes in D(1) receptors. We have investigated the effect of withdrawal from sub-chronic administration of haloperidol on the density of dopamine receptors, dopamine receptor gene expression, and spontaneous locomotor activity. Following a 3-week treatment period with haloperidol (1.5 mg/kg, i.p.), spontaneous locomotor activity measurements, autoradiography of D(1) and D(2) receptors and in situ hybridisation histochemistry of D(1) and D(2) mRNA were performed. Using [3H]raclopride as the ligand, sub-chronic haloperidol administration produced a robust upregulation in D(2) binding in the striatum of rats which correlated with parallel increases in spontaneous locomotor activity from 24 h to 4 weeks. Using, [3H]SCH23390 as the ligand, D(1) binding was largely unaffected by the drug treatment. Non-significant changes were measured in the striatal expression of D(1) receptor mRNA or the nigral or striatal expression of D(2) receptor mRNA. Our findings have implications for the use of dopaminergic ligands in positron emission tomography (PET) imaging of patients under regimens of chronic neuroleptics in particular in the context of forthcoming trials of neural grafts in Huntington's disease (HD) striatum.

Topics: Animals; Antipsychotic Agents; Autoradiography; Benzazepines; Corpus Striatum; Dopamine Antagonists; Gene Expression; Haloperidol; Huntington Disease; In Situ Hybridization; Linear Models; Male; Motor Activity; Nucleus Accumbens; Raclopride; Radionuclide Imaging; Rats; Rats, Inbred Strains; Receptors, Dopamine D1; Receptors, Dopamine D2; RNA, Messenger; Substantia Nigra; Tissue Distribution

Huntington's disease (HD) is generally considered a hyperkinetic disorder, although hypokinetic features are part of the motor syndrome. Moreover, the striatum is considered to play a key role in initiating and executing motor programs and achieving optimal scheduling in response generation. Controversial results regarding the association between clinical features and markers of progression of the disease might be the result of inadequate restriction of clinical signs to the choreatic syndrome.. To determine the relationship of neurologic motor and cognitive indices in patients with HD with intrinsic neuronal loss in the striatum, as measured using raclopride C11 and PET.. A cross-sectional study was performed on 11 patients with mild HD (stages 0-2). Motor (Unified Huntington's Disease Rating Scale [UHDRS], saccadic and tapping speed) and cognitive (verbal fluency, Trail Making Test, Stroop Test, Symbol Digit Modalities Test, Conditioned Associative Learning Test, and silhouette identification and object decision of the Visual Object and Space Perception battery) scores were correlated with raclopride C11 binding.. Bradykinesia (a summation of five items of the UHDRS motor scale) was the best predictor for stage, that is, functional capacity, and showed a highly significant relationship with putaminous D2 binding (r = -0.94) and with CAG expansion length x years of age (r = 0.96). The exclusion of two patients with a rigid-akinetic HD variant did not alter these coefficients. Chorea was less well correlated than bradykinesia with D2 binding in all striatal regions. Performance on different cognitive tests, especially in timed tasks, was highly correlated with raclopride C11 binding in caudate nucleus and ventral striatum.. Loss of D2 binding in the striatum is highly correlated with the deficit in fast motor and cognitive processing in patients with early Huntington's Disease. Thus, impairment of rapid execution of adequate responses to environmental changes seems to be a common manifestation of striatal disorders.

Topics: Adult; Caudate Nucleus; Cognition; Corpus Striatum; Cross-Sectional Studies; Dopamine Antagonists; Humans; Huntington Disease; Hypokinesia; Middle Aged; Movement; Neurologic Examination; Neuropsychological Tests; Raclopride; Tomography, Emission-Computed

We used positron emission tomography and [11C]flumazenil to analyze the benzodiazepine receptor binding in symptomatic and asymptomatic carriers of the Huntington's disease gene. We found an inverse relationship between [11C]flumazenil and [11C]raclopride binding in the putamen of symptomatic patients, and interpret this result as GABA receptor upregulation.

Topics: Adult; Carbon Radioisotopes; Caudate Nucleus; Dopamine Antagonists; Female; Flumazenil; GABA Modulators; Humans; Huntington Disease; Male; Middle Aged; Putamen; Raclopride; Receptors, GABA-A; Tomography, Emission-Computed

Using serial [(11)C]SCH 23390- and [11C]raclopride-PET, we have measured the rate of loss of striatal dopamine D1 and D2 receptor binding over a mean of 40 months in nine asymptomatic adult Huntington's disease mutation carriers, four patients with symptomatic disease, seven mutation-negative controls and three subjects at risk for the disease. Eight of the nine asymptomatic Huntington's disease mutation carriers had serial [11C]raclopride-PET and showed a mean annual loss of striatal D2 binding of 4.0%. Only five of these eight, however, showed active progression, and they had a mean annual loss of D2 binding of 6.5%. All nine asymptomatic mutation carriers had serial [11C]SCH 23390-PET and showed a mean annual loss of striatal D1 binding of 2. 0%. Four of these subjects demonstrated active progression and they had a mean annual loss of 4.5%. Our four symptomatic Huntington's disease patients showed a mean annual loss of D2 binding of 3.0% and of D1 binding of 5.0%. Loss of striatal D1 and D2 binding was significantly greater in the known mutation carriers than in the combined at-risk and gene-negative groups (P < 0.05). At follow-up PET all subjects were clinically assessed using the Unified Huntington's Disease Rating Scale. Scores for motor function and total functional capacity correlated with PET measures of striatal dopamine receptor binding both in the asymptomatic mutation carriers (D1, P < 0.01) and across the combined asymptomatic and clinically affected Huntington's disease mutation carrier group (D1 and D2, P < 0.001). We conclude that PET measures of striatal D1 and D2 dopamine binding can be used to identify asymptomatic Huntington's disease mutation carriers who are actively progressing and who would thus be suitable for putative neuroprotective therapies. Measures of disease progression rates in Huntington's disease patients and asymptomatic mutation carriers will be of critical importance in future trials of experimental restorative treatments.

Topics: Adult; Aged; Benzazepines; Corpus Striatum; Disease Progression; Dopamine Antagonists; Female; Humans; Huntington Disease; Male; Middle Aged; Prospective Studies; Raclopride; Receptors, Dopamine D1; Receptors, Dopamine D2; Retrospective Studies; Tomography, Emission-Computed

PET and: markers for the pre- and postsynaptic neurons were used to study the dopamine system in vivo in Huntington's disease. The radioligands used were [11C]SCH 23390 for D1-receptors, [11C]raclopride for D2-receptors and [11C]beta-CIT for dopamine transporters. Five patients with Huntington's disease and five matched controls were recruited. Brain anatomy was examined by MRI. The findings in patients were as follows. Postsynaptic D1- and D2-receptor densities were similarly reduced in the striatum. A reduction in D1-receptor density was shown in the temporal cortex; it draws attention to the cortical degeneration in relation to the cognitive deficits observed in Huntington's disease. The reduction of D1- and D2-receptor binding potentials in the striatum correlated significantly with increasing duration of illness. The correlation between the duration of illness and decline of D1- and D2-receptors make these receptors valuable as quantitative markers for the Huntington's disease degenerative process. Besides postsynaptic changes, a significant 50% decrease of [11C]beta-CIT binding to the dopamine transporter was found in the striatum. A reduced striatal blood flow in Huntington's disease cannot be excluded and could account for a small part of the decrease in [11C]beta-CIT binding. We suggest that the finding reflects a loss of presynaptic terminals or a reduced expression of dopamine transporter in the nigrostriatal dopaminergic system in Huntington's disease.

Topics: Adult; Benzazepines; Brain; Carbon Radioisotopes; Cocaine; Dopamine Antagonists; Female; Humans; Huntington Disease; Iodine Radioisotopes; Ligands; Magnetic Resonance Imaging; Male; Middle Aged; Neurons; Raclopride; Receptors, Dopamine D1; Receptors, Dopamine D2; Receptors, Presynaptic; Salicylamides; Tomography, Emission-Computed

The main aim of this study was to investigate the relationship between dopaminergic markers and brain volumes for striatal and cortical structures, and cognitive performance in patients with Huntington's disease and control subjects. We used PET and MRI data as predictors of performance in tasks assessing executive function, visuospatial ability, episodic memory, verbal fluency, perceptual speed and reasoning. The dopamine neurotransmission parameters (D1 and D2 receptor density and dopamine transporter density) and the volumetric measurements for caudate and putamen accounted for substantial portions of the variance across the majority of cognitive tasks. In addition, frontal volume showed a strong relationship with all cognitive tasks. D1 binding and volume measurements for the temporal cortex and thalamic volume showed associations with a select number of cognitive tasks. The overall data pattern is consistent with the view that Huntington's disease may be characterized as a frontostriatal dementia, in which cognitive deficits may result from pathological changes at multiple sites in the frontostriatal circuitry.

Topics: Benzazepines; Biomarkers; Brain; Carbon Radioisotopes; Carrier Proteins; Cocaine; Cognition Disorders; Dopamine; Dopamine Plasma Membrane Transport Proteins; Female; Humans; Huntington Disease; Magnetic Resonance Imaging; Male; Membrane Glycoproteins; Membrane Transport Proteins; Memory; Middle Aged; Nerve Tissue Proteins; Organ Specificity; Perception; Predictive Value of Tests; Raclopride; Radiography; Receptors, Dopamine D1; Receptors, Dopamine D2; Reference Values; Salicylamides; Speech; Thinking; Tomography, Emission-Computed

We used PET scans with the tracers [18F]fluorodeoxyglucose (FDG) and [11C]raclopride (RACLO) to study glucose metabolism and dopamine D2 receptor binding in the caudate nucleus and putamen of 18 carriers of the Huntington's disease gene mutation (10 asymptomatic subjects and eight untreated symptomatic Huntington's disease patients in an early disease stage). We also performed MRI scans and measured the bicaudate ratio (BCR) in the same subjects. Data were compared with those from nine mutation-negative members of Huntington's disease families and separate groups of age matched controls. The PET scans were repeated 1.5-3 years later in six of the asymptomatic gene carriers. Symptomatic Huntington's disease patients showed a marked reduction of FDG and RACLO uptake in the caudate nucleus and putamen and a significant increase of BCR. Asymptomatic mutation carriers revealed significant hypometabolism in the caudate nucleus and putamen. The RACLO binding was significantly decreased in the putamen. Decrements of caudate nucleus tracer uptake, particularly RACLO, correlated significantly with BCR increases in both symptomatic and asymptomatic gene carriers. In asymptomatic carriers, metabolic and receptor binding decreases were also significantly associated with the CAG repeat number but not with the individual's age. Discriminant function analysis correctly classified clinical and genetic status in 24 of 27 subjects on the basis of their striatal PET values (83% sensitivity and 100% specificity). Three asymptomatic mutation carriers were classified/grouped together with mutation-negative subjects, indicating that these individuals had normal striatal RACLO and FDG uptake. Follow-up PET data from gene-positive subjects showed a significant reduction in the mean striatal RACLO binding of 6.3% per year. Striatal glucose metabolism revealed an overall non significant 2.3% decrease per year. These data indicate that asymptomatic Huntington's disease mutation carriers may show normal neuronal function for a long period of life. These findings also suggest that it may be possible to predict when an asymptomatic gene carrier will develop clinical symptoms from serial PET measurements of striatal function.

Topics: Adult; Carbon Radioisotopes; Caudate Nucleus; Deoxyglucose; Female; Fluorodeoxyglucose F18; Glucose; Heterozygote; Humans; Huntington Disease; Male; Middle Aged; Mutation; Putamen; Raclopride; Receptors, Dopamine D2; Salicylamides; Tomography, Emission-Computed

We have used PET to study striatal D1 and D2 receptor binding in 10 patients with either the choreic or akinetic-rigid variants of Huntington's disease and in three patients with other causes of chorea. Background rigidity and bradykinesia in choreic patients were scored with a four-point scale. PET studies showed a severe and parallel reduction of both striatal D1 and D2 receptor binding in Huntington's disease patients irrespective of their predominant phenotype (mean reduction 60%). Huntington's disease patients with rigidity showed more pronounced reduction of striatal D1 and D2 binding compared with those without rigidity. A case of chorea associated with systemic lupus erythematosus had normal D2 binding. These results suggest that the presence of chorea per se may not be determined by alterations in striatal dopamine receptor binding, but that rigidity in Huntington's disease is associated with severe striatal D1 and D2 receptor loss.

Topics: Adult; Aged; Basal Ganglia; Benzazepines; Carbon Radioisotopes; Caudate Nucleus; Chorea; Dopamine; Female; Humans; Huntington Disease; Lupus Erythematosus, Systemic; Male; Middle Aged; Motor Activity; Muscle Rigidity; Phenotype; Putamen; Raclopride; Receptors, Dopamine D1; Receptors, Dopamine D2; Salicylamides; Tomography, Emission-Computed

Dopamine receptor types D1 and D2 can oppose or enhance each other's actions for electrical, biochemical, and psychomotor effects. We report a D1-D2 interaction in homogenized tissue as revealed by ligand binding. D2 agonists lowered the binding of [3H]raclopride to D2 receptors in striatal and anterior pituitary tissues. Pretreating the tissue with the D1-selective antagonist SCH 23390 prevented the agonist-induced decrease in [3H]raclopride binding to D2 sites in the striatum but not in the anterior pituitary, which has no D1 receptors. Conversely, a dopamine-induced reduction in the binding of [3H]SCH 23390 to D1 receptors could be prevented by the D2-selective antagonist eticlopride. Receptor photolabeling experiments confirmed both these D1-D2 interactions. The blocking effect by SCH 23390 was similar to that produced by a nonhydrolyzable guanine nucleotide analogue, and SCH 23390 reduced the number of agonist-labeled D2 receptors in the high-affinity state. Thus, the D1-D2 link may be mediated by guanine nucleotide-binding protein components. The link may underlie D1-D2 interactions influencing behavior, since the link was missing in over half the postmortem striata from patients with schizophrenia and Huntington disease (both diseases that show some hyperdopamine signs) but was present in human control, Alzheimer, and Parkinson striata.

Topics: Affinity Labels; Animals; Antipsychotic Agents; Benzazepines; Binding, Competitive; Corpus Striatum; Dogs; Dopamine Antagonists; GTP-Binding Proteins; Humans; Huntington Disease; Kinetics; Models, Biological; Pituitary Gland, Anterior; Raclopride; Receptors, Dopamine; Receptors, Dopamine D1; Receptors, Dopamine D2; Reference Values; Salicylamides; Schizophrenia; Swine