• J. Neurol. Neurosurg. Psychiatr. · Oct 2024

    Nigrostriatal blood-brain barrier opening in Parkinson's disease.

    • Carmen Gasca-Salas, José A Pineda-Pardo, Marta Del Álamo, Tamara Jiménez, Clara Trompeta, Gabriella Toltsis, Lina Garcia-Cañamaque, Beatriz Fernández-Rodríguez, Michele Matarazzo, Isabel Plaza de Las Heras, Elena Natera-Villalba, Raúl Martínez-Fernández, Alicia Duque, Santiago Ruiz de Aguiar, Javier Blesa, Itay Rachmilevich, and José A Obeso.
    • HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.
    • J. Neurol. Neurosurg. Psychiatr. 2024 Oct 16; 95 (11): 108910921089-1092.

    BackgroundThe nigrostriatal system is especially vulnerable to neurodegeneration in Parkinson's disease (PD) and the blood-brain barrier (BBB) is a limiting factor for delivery of therapeutic agents to the brain. This pilot study aimed to demonstrate safety, feasibility and tissue penetration (by 18F-Choline-positron emission tomography (PET)) of MR-guided focused ultrasound (MRgFUS) simultaneous BBB opening (BBB-O) in the substantia nigra (SN) and putamen in PD.MethodsThree patients underwent MRgFUS for midbrain and putamen BBB-O. Patients were evaluated clinically and underwent brain MRI with gadolinium (baseline, 24 hours, 14 days and 3 months postprocedure). In two patients, BBB-O was repeated after 2-3 weeks, and 18F-Choline-PET was performed immediately after.ResultsThe right SN and putamen were simultaneously opened unilaterally in 3 patients once and the left SN in 1 patient in a different session. No severe clinical or neuroimaging adverse events developed in any patient. 18F-Choline-PET uptake was enhanced in the targeted SN and putamen regions.ConclusionBBB-O of the nigrostriatal system is a feasible and well-tolerated approach in patients with PD. 18F-Choline-PET uptake indicates penetration into the parenchyma after BBB-O, which suggests that the opening is functionally effective. This minimally invasive technique could facilitate delivery of putative neurorestorative molecules to brain regions vulnerable to neurodegeneration.© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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