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Progressive multifocal leukoencephalopathy (PML) is a serious central nervous system infection caused by the polyomavirus JC , which can occur in patients with multiple sclerosis who are treated with Natalizumab
.
The clinical management of Natalizumab-related PML patients is challenging, mainly because the current imaging tools for early detection, longitudinal monitoring and differential diagnosis of PML lesions are limited
Infection management diagnosis
Christoph Mahler et al.
published a research article in Brain, evaluating whether transporter (TSPO) PET imaging can be used to monitor the inflammatory activity of PML lesions over time and distinguish it from multiple sclerosis
.
published a research article in Brain, evaluating whether transporter (TSPO) PET imaging can be used to monitor the inflammatory activity of PML lesions over time and distinguish it from multiple sclerosis
.
This single-center study followed up 8 patients with Natalizumab-related PML and used TSPO radioligand 18 F-GE-180 in combination with 3T MRI for PET imaging
.
In addition, the TSPO PET signal and the signal pattern of multiple sclerosis lesions in PML lesions in 17 independent multiple sclerosis patients were compared
18
In addition, by measuring the density and cell characteristics of TSPO-expressing cells in brain slices of 4 patients with early-stage natalizumab-related PML, 5 patients with other forms of PML, and 6 patients with inflammatory demyelinating CNS lesions, TSPO in situ The expression was verified by immunohistochemistry
.
Histological analysis showed that TSPO-expressing phagocytes in PML lesions aggregated in a network, and this phagocytic cells were more evenly distributed in the putative multiple sclerosis lesions
.
TSPO PET imaging showed that the uptake of tracer in natalizumab-related PML lesions was enhanced from the early stage to the chronic stage (52 months after PML diagnosis)
The TSPO-expressing phagocytes in PML lesions aggregate in a network, and this phagocytic cells are more evenly distributed in the putative multiple sclerosis lesions.
TSPO PET imaging shows typical decline in TSPO tracer uptake in Natalizumab-related PML
TSPO PET imaging shows typical decline in TSPO tracer uptake in Natalizumab-related PMLThe TSPO-based 3D diagnostic matrix takes into account the uptake level, shape and texture of TSPO signals, and distinguishes 96% of PML and multiple sclerosis lesions
.
Use TSPO PET to distinguish PML from multiple sclerosis
.
.
Rituximab treatment of relapsing multiple sclerosis activity in post-IRIS-PML effect
.
.
post-IRIS-PML
In fact, in 3 patients, treatment with rituximab did not affect the uptake of the tracer in the designated PML lesions after Natalizumab-related PML treatment, but multiple sclerosis in the designated active phase Restore the tracer intake to the baseline level in the symptomatic lesions
.
.
In summary, this study shows that TSPO PET imaging can reveal the central nervous system inflammation of Natalizumab-related PML
.
TSPO PET may be useful for longitudinal monitoring of disease activity and for distinguishing between relapsing multiple sclerosis activity and PML progression
TSPO PET imaging can reveal the central nervous system inflammation of Natalizumab-related PML
TSPO PET imaging of natalizumab-associated progressive multifocal leukoencephalopathy, Brain, Volume 144, Issue 9, September 2021, Pages 2683–2695, https://doi.
TSPO PET imaging of natalizumab-associated progressive multifocal leukoencephalopathy, Brain, Volume 144, Issue 9, September 2021, Pages 2683-2695, https://doi.
org/10.
1093/brain/awab127 in this message
