Can we use tau positron emission tomography (PET) to detect?chronic traumatic encephalopathy (CTE)?during life??Our new study published in Molecular Neurodegeneration?addressed this question: https://lnkd.in/dha5iV6c.
Two studies were done: (1) 3H-MK-6240 autoradiography and an in-vitro binding studies on?autopsy-confirmed?CTE tissue,?and?(2)?in?vivo?18F-MK-6240 tau PET study in former National Football League (NFL) players.
This is what we found:
(1) Clear signal on 3H-MK-6240 autoradiography and high binding affinity (KD = 2.0) in one of six cases with autopsy-confirmed CTE stage III (high stage). Binding affinity in CTE case was less than an?Alzheimer's disease comparison (KD = 0.46).?Signal corresponded to the tau-immunoreactive lesions in the CTE case, but less prominent than the Alzheimer's disease case. The other CTE cases had sparse p-tau and?no?clear signal.?
(2) The in vivo study of symptomatic?amyloid-PET negative former NFL players showed variable, low-medium intensity 18F-MK-6240 signal across?participants, including?16 with?no cortical signal,?7?with medial temporal lobe uptake,?2?with focal frontal uptake, and 4 with?both medial temporal lobe?+?frontal uptake.?Frontal and medial temporal lobes are affected in high stage CTE (stage III/IV).?Figure 2 (below) from the manuscript shows these different patterns in four former NFL players.
(3) At the group level, former NFL players had greater 18F-MK-6240 uptake in the entorhinal cortex and the entire parahippocampal gyrus compared with?a?control group.?No group differences for cortical regions.
(4) There?was?off-target meningeal binding in all cases.
My interpretation of the data: inconclusive. 18F-MK-6240 might have value in high stage CTE when the tau is most dense particularly in the medial temporal lobes. It seems unlikely that 18F-MK-6240 will be an optimal, diagnostic biomarker for CTE p-tau pathology particularly at the low stages of disease. It will be challenging to detect low stage CTE using tau PET, in general.
What works well for Alzheimer's disease might not be optimal for CTE! Discovery efforts needed!
Sidebar: Team science at its best! This is the product of a National Institute of Neurological Disorders and Stroke (NINDS) (Nsini Umoh) funded study, led by Dr. Gil Rabinovici and Renaud La Joie at the UCSF Memory and Aging Center and our team at the Boston University School of Medicine. The study involved efforts from many people and institutions including teams from the Wisconsin Alzheimer's Disease Research Center, Boston Medical Center (BMC), Concussion Legacy Foundation (Christopher Nowinski, PhD), VA Boston Healthcare System, and the University of Pittsburgh School of Medicine.