Long-term assessment of striatal dopamine transporters in parkinsonian patients with intrastriatal embryonic mesencephalic grafts
Long-term assessment of striatal dopamine transporters in parkinsonian patients with intrastriatal embryonic mesencephalic grafts
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DOI：
10.1007/s00259-005-0032-z
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发表时间：
2006-04-01
影响因子：
9.1
通讯作者：
Tatsch, K
中科院分区：
文献类型：
--
作者：
Pogarell, O;Koch, W;Tatsch, K
目的：纹状体多巴胺转运蛋白（DAT）的单光子发射计算机断层扫描（SPECT）已被用于证明突触前多巴胺能功能障碍和监测帕金森病的进展。在帕金森病患者中，在纹状体植入胚胎中脑组织，正电子发射断层扫描（PET）显示纹状体[F-18]多巴摄取增加作为移植物存活和纹状体神经再支配的指标。本研究的目的是调查两名接受双侧纹状体内移植人胚胎中脑组织的患者，使用SPECT和I-123标记的DAT配体N-（3-碘丙烯-2-基）-2 β-甲氧羰基-3 β-（4-氯苯基）托烷（IPT）。两名患者接受[I-123]IPT SPECT根据一个标准化的协议前瞻性和重复长达8年移植后。从基线到移植后3年，平均纹状体DAT可用性平均增加了61%（患者1和2分别为93%和29%）。然后在患者2中保持相对稳定长达8年，但在患者1中进一步增加了另外77%的基线值。在临床上，这两名患者经历了中度改善运动性能，但开发中度（患者2）至重度（患者1）关闭药物dyskinesias.Conclusion：我们的数据表明，DAT成像使用IPT和SPECT可以用来证明移植物存活多巴胺能组织植入。由于DAT配体SPECT在常规临床环境中广泛使用，因此该方法可能是[F-18]多巴PET的有用替代品，用于移植帕金森病患者的重复扫描。DAT结合的长期增加与停药运动障碍发展的相关性仍有待进一步阐明。
Purpose: Single-photon emission computed tomography (SPECT) of striatal dopamine transporters (DAT) has been used to demonstrate presynaptic dopaminergic dysfunction and to monitor the progression of Parkinson's disease. In parkinsonian patients who were implanted with embryonic mesencephalic tissue in the striatum, positron emission tomography (PET) has shown an increase in striatal [F-18]dopa uptake as an indicator of graft survival and striatal reinnervation. The aim of this study was to investigate two patients who had undergone bilateral intrastriatal transplantation of human embryonic mesencephalic tissue using SPECT and the I-123-labelled DAT ligand N-(3-iodopropen-2-yl)-2 beta-carbomethoxy-3 beta-(4-chlorophenyl) tropane (IPT).Methods: Two patients were subjected to [I-123]IPT SPECT according to a standardised protocol prospectively and repeatedly up to 8 years after transplantation.Results: From baseline to year 3 after transplantation, mean striatal DAT availability increased by a mean of 61% (93% and 29% in patients 1 and 2, respectively). It then remained relatively stable up to 8 years in patient 2, but increased further by another 77% of baseline values in patient 1. Clinically, both patients experienced a moderate improvement in motor performance but developed moderate (patient 2) to severe (patient 1) off-medication dyskinesias.Conclusion: Our data indicate that DAT imaging using IPT and SPECT can be used to demonstrate graft survival following dopaminergic tissue implantation. Because SPECT with DAT ligands is widely available in the routine clinical setting, this methodology may be a useful alternative to [F-18]dopa PET for repeated scanning of grafted parkinsonian patients. The relevance of the long-term increase in DAT binding for the development of off-medication dyskinesias remains to be elucidated further.