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An [F]-Positron Emitting Fluorophore Allows Safe Evaluation of Small Molecule Distribution in the CSF, CSF Fistulas, and CNS Device Placement.

TitleAn [F]-Positron Emitting Fluorophore Allows Safe Evaluation of Small Molecule Distribution in the CSF, CSF Fistulas, and CNS Device Placement.
Publication TypeJournal Article
Year of Publication2019
AuthorsGuo H, Kommidi H, Maachani UB, Voronina JC, Zhang W, Magge RS, Ivanidze J, Wu AP, Souweidane MM, Aras O, Ting R
JournalMol Pharm
Date Published2019 08 05
KeywordsAnimals, Cell Line, Tumor, Central Nervous System Diseases, Cerebrospinal Fluid, Cerebrospinal Fluid Leak, Cerebrospinal Fluid Shunts, Disease Models, Animal, Fluorescein, Fluorescent Dyes, Fluorine Radioisotopes, Humans, Injections, Spinal, Male, Positron-Emission Tomography, Radiopharmaceuticals, Rats, Tissue Distribution, Toxicity Tests, Video-Assisted Surgery

The small molecule fluorescein is commonly used to guide the repair of cerebral spinal fluid leaks (CSFLs) in the clinic. We modified fluorescein so that it is also visible by positron emission tomography (PET). This probe was used to quantitatively track the fast distribution of small molecules in the CSF of rats. We tested this probe in models relevant to the clinical diagnosis and treatment of central nervous system (CNS) diseases that affect CSF flow. In this study, fluorescein was radiolabeled with fluorine-18 to produce Fc-AMBF. [F]-Fc-AMBF was introduced at trace quantities (13.2 nmols, 100 μCi) intrathecally (between L5 and L6) in rats to observe the dynamic distribution and clearance of small molecules in the CSF by both [F]-PET and fluorescence (FL) imaging. Murine models were used to demonstrate the following utilities of Fc-AMBF: (1) utility in monitoring the spontaneous CSFL repair of a compression fracture of the cribriform plate and (2) utility in quantifying CSF flow velocity during neurosurgical lumboperitoneal shunt placement. Fc-AMBF clearly delineated CSF-containing volumes based on noninvasive PET imaging and in ex vivo FL histology. In vivo morbidity ( = 16 rats, <2.7 mg/kg, 77 times the PET dose) was not observed. The clearance of the contrast agent from the CNS was rapid and quantitative ( = 33.8 ± 0.6 min by FL and = 26.0 ± 0.5 min by PET). Fc-AMBF was cleared from the CSF through the vasculature and/or lymphatic system that supplies the cribriform plate and the temporal bone. Fc-AMBF can be used to diagnose CSFLs, image CSFL repair, and determine the CSF flow velocity in the CNS or through lumboperitoneal shunts by PET/FL imaging. In conclusion, Fc-AMBF PET imaging has been demonstrated to safely and dynamically quantitate CSF flow, diagnose fistulas associated with the CSF space, and approximate the clearance of small molecules in the CSF.

Alternate JournalMol Pharm
PubMed ID31290330
PubMed Central IDPMC7478905
Grant ListK99 EB013904 / EB / NIBIB NIH HHS / United States
P30 CA008748 / CA / NCI NIH HHS / United States
R00 EB013904 / EB / NIBIB NIH HHS / United States