Brain Imaging in Multiple Sclerosis: PET, Neural Pathways Visualization by MRI (11)

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Exclusive interview / Dr. Anton Titov MD and Professor Dr. Paul Matthews, leading multiple sclerosis neurologist, neurodegeneration, brain imaging MRI, functional MRI, PET expert and precision medicine specialist.

You are a leader in brain imaging technologies and you founded the world-leading Center for Functional MRI of the Brain at Oxford University, you built a GlaxoSmithKline's internal clinical imaging program at the Hammersmith Hospital campus of Imperial College London, then you led GSK's clinical development program in multiple sclerosis. And now you've come back to academia and you lead the Division of Brain Sciences at Imperial College London. Where do you see brain imaging technology progressing in the next 5 to 10 years? Well, you've been very generous in your introduction, Anton, and just for the record, I led multiple sclerosis program within GSK, but not all of multiple sclerosis, which at the time was much broader. That being said, the question of where brain imaging is going is, I think, is an interesting one, because I think we're in a very exciting time. First, the range of modalities that we can use to explore multiple sclerosis and its consequences continues to expand. Over the last decade we've seen the advent of optical coherence tomography [OCT] as an increasingly important tool in the evaluation of progression of change in people with multiple sclerosis by virtue of its ability to visualize and accurately quantify the nerve fiber layer in the retina and the ganglion cell layer, both of which show changes with progression of multiple sclerosis. A second area, in which we've seen an expansion of the range of modalities that are beginning to be used more commonly in the study of multiple sclerosis is with a refocusing on positron emission tomography, or PET, methods. There were early demonstrations of possible utility of fluorodeoxyglucose PET Over a decade ago the classic glucose scan, which provides some measure of the density and function of synapses. More recently, work has extended out in a number of groups, including our own, to apply a range of tracers that are sensitive to aspects of microglial and astrocyte activation, by looking at expression of a molecule known as the 18 kDa mitochondrial translocator protein This work already is providing important insight into the multiple sclerosis by highlighting the heterogeneity of chronic lesions in multiple sclerosis, showing that some are associated with pronounced microglial activation, [while] others are not, highlighting the degree to which microglia in the the cortex can be activated, and beginning to define the ways, in which cortical lesions, defined by microglial activation and those defined on the basis of MRI, maybe related, and possibly in providing an additional measures to help in understanding the prognosis of people with progressive multiple sclerosis although the jury is still out because this data is early. More recent PET imaging results suggest that there may be practical ways of providing an additional index of myelin integrity in the brain. The classic amyloid markers that are now used for diagnostic stratification of people with memory complaints may be able to be repurposed as at least qualitative indices of myelin density to supplement measures from MR techniques, such as magnetization transfer. There's also a rich future for applying other PET radio- ligands sensitive, for example, to the presence of inhibitory synapses in the brain, and additional measures.

Brain Imaging in Multiple Sclerosis: PET, Neural Pathways Visualization by MRI (11) best treatment for damaged hair
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