Development of Positron Emission Tomography β-Amyloid Plaque Imaging Agents

For 100 years, beta-amyloid (A beta) plaques and neurofibrillary tangles (NFTs) have been recognized as the neuropathological hallmarks of Alzheimer's disease (AD), and their presence or absence could only be assessed postmortem using stains and dyes that identified these microscopic structures. Approximately 10 years ago, the first successful A beta plaque specific positron emission tomography (PET) imaging study was conducted in a living human subject clinically diagnosed with probable AD using the C-11-labeled radiopharmaceutical Pittsburgh Compound B (PiB). Laboratory studies and preclinical evaluations to design PiB began a decade earlier than the first human PiB PET study and involved chemical modifications of different well-known dyes that bound specifically to the extended beta-pleated sheets that comprise the fibrils of amyloid proteins such as A beta plaques, NFTs, alpha-synuclein deposits, and prions. These preclinical studies were conducted in our laboratories at the University of Pittsburgh, starting with Congo red derivatives, followed by Chrysamine G derivatives, followed by X-series compounds, and finally with neutral derivatives of thioflavin-T. The in vitro and in vivo evaluations of the different derivatives as candidate PET radioligands for imaging A beta plaques and neurofibrillary tangles in human brain are described in this review, along with I:he specific evaluation criteria by which the candidate radioligands were judged. Out of these studies came PiB, a PET radioligand that binds selectively and with high affinity to only fibrillar forms of A beta. PiB has been used in many different human research protocols throughout the world and has demonstrated the usefulness of assessing the A beta plaque status of subjects many years before the clinical diagnosis of probable AD. Recently, longer-lived F-18-radiolabeled A beta-selective radiopharmaceuticals have been developed. It is likely that the full clinical impact of these imaging agents will be realized by identifying presymptomatic subjects who would benefit from early drug treatments with future disease-modifying AD therapeutics. Semin Nucl Med 42:423-432 (c) 2012 Elsevier Inc. All rights reserved.