Microglia activation in multiple sclerosis black holes predicts outcome in progressive patients: An in vivo [(11)C](R)-PK11195-PET pilot study

- This study uses PK-PET to investigate microglial activity in MS black holes (BHs).
- PK binding (PKBPND) in MS BH demonstrates a wide heterogeneity.
- In relapsing MS patients PKBPND is significantly lower than in the progressive MS patients (p = 0.00003).
- The baseline PKBPND in progressive MS BHs correlates with disability (p < 0.05) and its accumulation 2 years later (p < 0.01).
- PK-PET shows that microglial activation in MS BH indicate different underlying processes in relapsing and progressive MS.

The pathophysiological correlates and the contribution to persisting disability of hypointense T1-weighted MRI lesions, black holes (BH), in multiple sclerosis (MS) are still unclear. In order to study the in vivo functional correlates of this MRI finding, we used 11C-PK11195 PET (PK-PET) to investigate changes in microglial activity. Ten relapsing and 9 progressive MS subjects had a PK-PET scan and a MRI scan alongside a full clinical assessment, including the expanded disability status scale (EDSS) for evaluation of disability. We studied the PK binding potential of the specifically bound radioligand relative to the non-displaceable radioligand in tissue (BPND) in T1 BHs. Out of a total of 1242 BHs identified, 947 were PK enhancing. The PKBPND was correlated with the EDSS (r = 0.818; p < 0.05) only in the progressive group. In the relapsing patients there was an inverse correlation between PKBPND and BH total lesion volume in whole brain (r = − 0.781; p < 0.05). When progressive patients were grouped according to the disability outcome at 2 years from the PK-PET scan, the total PKBPND in BHs was found to be a significant outcome predictor of disability (p < 0.01). Our findings show that relapsing and progressive patients have heterogeneous patterns of PKBPND in T1 BHs and indicate that BHs are not just “holes” representing loss of axons and myelin, but display inflammatory activity in the form of activated microglia. The significant association between PKBPND, neurological impairment and outcome in progressive subjects supports a role for activated microglia in disability progression.