In this study, we performed brain-wide quantitative evaluation of the early spatiotemporal changes in neuroinflammation induced by status epilepticus using [18F]DPA-714 PET imaging and found that neuroinflammation was predominantly restricted to the epileptogenic regions in the early phase after epileptic seizures. Moreover, activated microglia were predominantly responsible for the specific accumulation of [18F]DPA-714 in these epileptogenic regions during the critical therapeutic time window for epileptic seizures. The results of the study show that: 1) specific accumulation of [18F]DPA-714 was observed in the epileptogenic regions at 3 days after status epilepticus induced by systemic injection of kainic acid; 2) a series of [18F]DPA-714 PET imaging studies revealed that neuroinflammation initially appeared in the ventral hippocampus and surrounding cortices at 3 days after status epilepticus, and was further sustained in the nearby amygdala and piriform cortex until 7 days after status epilepticus; 3) immunohistochemical analyses revealed that the activated microglia but not reactive astrocytes were correlated with the [18F]DPA-714 accumulation in the epileptogenic regions at least for 1 week after status epilepticus.
Over 50 chemical compounds have been designed and synthesized as TSPO PET probes for the quantitative assessment of inflammatory processes in the brain [17–25]. [11C]PK11195, the first radiolabeled non-benzodiazepine-type PET probe for TSPO has been extensively used as the gold standard for TSPO imaging in preclinical and clinical studies [21, 22, 25, 26]. Nevertheless, several disadvantages have restricted its practical application in the quantitative estimation of neuroinflammation, such as poor signal-to-noise ratio, low brain uptake, and high levels of nonspecific binding [34]. The pyrazolopyrimidine compound [18F]DPA-714, which has higher affinity and better blood-brain barrier permeability, was developed by Kassiou’s group and has been used for the quantitative assessment of neuroinflammation in CNS diseases, including stroke [24], trauma [35], Alzheimer’s disease [36], and amyotrophic lateral sclerosis [37]. Using an acute focal neuroinflammation model, Chauveau et al. [38] demonstrated that [18F]DPA-714 has an increased accumulation in the inflamed area and a reduced nonspecific binding in normal areas compared to [11C]PK11195. Similarly, we also revealed that the specific binding of [18F]DPA-714 in the epileptogenic regions was significantly higher than that of [11C]PK11195 in the status epilepticus model rats using the same animals on the same day (unpublished data). With the improved imaging capability of [18F]DPA-714, we demonstrated that the accumulation of [18F]DPA-714 was significantly increased in the epileptogenic regions at 3 days after status epilepticus (Figs. 1 and 4). Furthermore, the accumulation of [18F]DPA-714 in the epileptogenic regions was successfully displaced by unlabeled PK11195 (Fig. 3), suggesting that [18F]DPA-714 was specifically bound to TSPO even in the early phase after epileptic seizures. Considering together, these observations suggest that PET imaging with [18F]DPA-714, the second-generation TSPO radioligand, is a reliable and higher sensitive imaging tool for the quantitative evaluation of changes in neuroinflammatory processes throughout the brain in the early phase of epileptic seizures.
In the present study, we successfully evaluated the early spatiotemporal changes in neuroinflammation following status epilepticus induced by systemic injection of kainic acid, using [18F]DPA-714 PET imaging. Elucidation of the spatiotemporal changes in neuroinflammation during different stages of seizure, especially the early phase after epileptic seizures, could be crucial for understanding the pathophysiological mechanisms of epileptogenesis and improving the treatment methods. Several TSPO PET imaging studies have attempted to reveal spatiotemporal changes in neuroinflammation following epileptic seizures [27–29]. Brackhan et al. [27] reported that accumulation of [11C]PK11195 was observed in most brain areas until 5–7 days after status epilepticus, and was subsequently more concentrated in epileptogenic regions thereafter. In the present study, we demonstrated that significant accumulation of [18F]DPA-714 was restricted to the epileptogenic regions from 3 days after systemic kainic acid-injection induced status epilepticus (Figs. 1 and 4). Moreover, we also clearly demonstrated the spatiotemporal difference in [18F]DPA-714 accumulation between the epileptogenic regions, such as the BP for [18F]DPA-714 in most epileptogenic regions peaked at 3 days after status epilepticus but remained until 7 days after status epilepticus in the amygdala and piriform cortex (Fig. 5). These observations suggest that [18F]DPA-714 PET imaging has greater sensitivity in detecting the early phase of neuroinflammation following epileptic seizures than [11C]PK11195.
In the present study, we also demonstrated that activated microglia were predominantly responsible for the specific accumulation of [18F]DPA-714 in the epileptogenic regions, at least within the first week. Although TSPO was initially recognized as a specific biomarker for activated microglia [15, 16], some results have also demonstrated that TSPO might also be upregulated in reactive astrocytes [23, 39]. Using CNS neurodegenerative disease animal models, Ji et al.[23] clearly demonstrated that the dominant expression of TSPO (originally called PBR, peripheral benzodiazepine receptor) in the activated astrocytes was associated with minimal or reversible neuronal injury, whereas dominant TSPO expression in the activated microglia was associated with irreversible neuronal insults. Whereas, TSPO expression during epileptogenesis and chronic phase of epileptic seizures correlated well with microglial activation rather than with reactive astrocytes [27, 40]. Consistent with these observations, we found that CD11b-positive activated microglia, but not GFAP-positive reactive astrocytes, were concentrated in the epileptogenic regions, which showed a high accumulation of [18F]DPA-714 (Fig. 6). Activation of microglia and astrocytes has been implicated as a crucial process in the pathophysiology of epileptogenesis [2, 8, 13]. Activated microglia might contribute to neuronal hyperexcitability and susceptibility to seizures through the release of inflammatory mediators, such as IL-1β and TNF-α [2, 41]. Pharmacological interventions that inhibit microglial activation or block IL-1 signaling can suppress epileptic seizures [10, 11]. Reactive astrocytes induced by status epilepticus have been reported to lose homeostatic buffering capabilities, which might facilitate spontaneous seizures [42, 43]. Recent studies demonstrated that microglia are activated immediately after status epilepticus [41, 44] and might contribute to astrocyte reactivation [45]. In line with this finding, Sano et al.[46] demonstrated that early inhibition of microglial activation after the early phase of status epilepticus suppresses astrocyte reactivation and epileptic seizures. These observations suggest that microglial activation in the early period of epileptic seizures could be a crucial therapeutic target for pharmacological intervention, and [18F]DPA-714 PET imaging allows quantitative evaluation of spatiotemporal changes in microglial activation in the early phase after epileptic seizures.
In conclusion, we demonstrated that [18F]DPA-714 PET imaging is a reliable and sensitive tool for the quantitative evaluation of early spatiotemporal dynamics of neuroinflammation following status epilepticus in vivo. The brain-wide [18F]DPA-714 PET imaging analysis showed that neuroinflammation focused in the epileptogenic regions and activated microglia were predominantly correlated with [18F]DPA-714 accumulation at least for 1 week after status epilepticus. Given that most of the antiepileptic drug therapies are symptomatic and adversely affect normal brain function by suppressing neuronal activity nonspecifically, our results suggest that anti-inflammatory treatment based on microglial activation could be a curative therapeutic strategy for epileptic seizures and that [18F]DPA-714 PET imaging could be a fascinating important tool for determining therapeutic windows and monitoring the therapeutic efficacy.