• Binding of [F-18]FBR at peripheral benzodiazepine receptor. [ Time Frame: 3 years ] [ Designated as safety issue: No ]
  

• MRI [ Time Frame: 3 years ] [ Designated as safety issue: No ]
  

Drug: [F-18]FBR
N/A

Objective

In endemic regions neurocysticercosis is the most common cause of adult acquired epilepsy and thus an important public health problem. The disease is caused by infection with the larval form of the tapeworm, Taenia solium. Although neurocysticercosis is common only in many developing regions, an increased number of patients are diagnosed in developed countries mostly due to immigration of infected individuals.

The peripheral benzodiazepine receptor (PBR) can be a clinically useful marker to detect neuroinflammation because activated microglia in inflammatory areas expresses high levels of PBR. PBR has been imaged with positron emission tomography (PET) using [(11) C]1-(2-chlorophenyl-N-methylpropyl)-3-isoquinoline carboxamide (PK11195), which provides low levels of specific signal. Recently we developed a new ligand, N-fluroacetyl-N-(2,5-dimethoxybenzyl)-2-phenoxyaniline ([(18)F]FBR), which showed much greater specific signals than [(11) C]PK11195 in non-human primates.

The major objective of this protocol is to assess the utility of [(18) F]FBR PET to detect neuroinflammation in patients with neurocysticercosis.

In other protocols using a PET ligand with similar structure, [(11) C]PBR28, approximately 15% of subjects (3/approximately 20) did not show binding. The reason is not clear but may be caused by polymorphisms of PBR. To avoid doing PET scans for subjects who don't have binding, we will perform a screening whole body scan.

Study population

For [(18) F]FBR brain scans, twenty patients will be recruited and clinically followed under protocol 85-I-0127, Treatment of Cysticercosis including Neurocysticercosis with Praziquantel or Albendazole (PI: Theodore E. Nash, MD, NIAID). Thirty healthy subjects will be recruited.

For whole body scan using [(18) F]FBR, additional 10 healthy subjects will be recruited. Therefore, total accrual numbers are 20 patients with neurocysticercosis and 40 healthy subjects (30 for screening [(11) C]PBR28 scans and 10 for whole body [(18) F]FBR scans.

Prior to a brain [(18) F]FBR scan, each subject will have a screening [(11) C]PBR28 whole body scan with a low injection activity of 6 mCi and a short scan of approximately 1 h. We request permission to perform a screening [(11) C]PBR28 whole body scan on 20 patients and 20 healthy subjects.

Design

After confirming binding of PBR28 in a whole body scan, the first 10 patients with neurocysticercosis and the first 15 age-matched healthy subjects will have brain PET scans. In addition, we will also perform a whole body PET scan on 10 healthy subjects to study the radiation-absorbed doses. Patients will have up to three [(18) F]FBR PET scans during the follow-up and the treatment under 85-I-0127, typically a few weeks apart.

Outcome measures

In brain PET scans, [(18) F]FBR binding will be compared with clinical symptoms and MRI findings. In addition, the binding will be compared between patients and age-matched control subjects. In whole body scans, radiation-absorbed doses will be calculated based on the Medical Internal Radiation Dose scheme.