Patients suffering from central nervous system (CNS) diseases crucially depend on a sufficient supply with CNS active drugs that help them to control and endure their illness. As the site of action of CNS drugs is in the brain, these substances need to pass the blood-brain barrier (BBB), a physiological barrier seperating the blood circulation and the brain. However, CNS drug treatment is often accompanied by pharmacoresistance (drug resistance). Multidrug transporters, such as permeable glycoprotein (Pgp) are responsible for a gradient dependent transport of substances over the BBB. Drug resistance is hypothesised as a result of overactivity of multidrug transporters at the BBB, with the result of insufficient and poor CNS drug levels in the brain. In the case of epilepsy in up to 20 - 40% of patients drug resistance is observed.
The influence of Ppg overexpression on drug resistance in epilepsy was studied using positron emission tomography (PET), a novel non-invasive nuclear imaging method, together with radioligands that interact with Pgp. Radiolabeled Pgp-substrates ((R)-[11C]verapamil), and inhibitors ([11C]elacridar and [11C]tariquidar) were developed and used to study the influence of Pgp and other transporters at the BBB in a translational research approach; in animal models of epilepsy and in humans.
The aim in translational PET research is a direct comparision of gathered animal and human data. Consequently diverse methodological challenges arise, that need to be addressed and observed in order to enable a translation between species. To achieve full quantification of the function and density of drug transporters at the BBB in both, humans and rodents, kinetic modeling (compartmental modeling) was applied to the PET pharmacokinetic data. Estimated modeling parameters were in succession used to estimate biological and physiological processes of Pgp at the BBB. Subsequently, nonlinear mixed effects modeling was deployed to increase the mechanistic understanding of the transport mechanisms of radioligands across the BBB. Moreover, imaging artifacts, such as partial volume effect and spill over effect play a role in quantitative PET, in particular when imaging small anatomical structures.
Phantom studies were conducted to evaluate these effects and correction methods were explored.
Goal of this thesis is to reveal present and unattended methodological aspects of preclinical, as well as translational neuroimaging of CNS diseases with PET.