Microglia measured by TSPO PET are associated with Alzheimer's disease pathology and mediate key steps in a disease progression model

Abstract

Introduction: Evidence suggests microglial activation precedes regional tau and neurodegeneration in Alzheimer's disease (AD). We characterized microglia with translocator protein (TSPO) positron emission tomography (PET) within an AD progression model where global amyloid beta (Aβ) precedes local tau and neurodegeneration, resulting in cognitive impairment.

Methods: Florbetaben, PBR28, and MK-6240 PET, T1 magnetic resonance imaging, and cognitive measures were performed in 19 cognitively unimpaired older adults and 22 patients with mild cognitive impairment or mild AD to examine associations among microglia activation, Aβ, tau, and cognition, adjusting for neurodegeneration. Mediation analyses evaluated the possible role of microglial activation along the AD progression model.

Results: Higher PBR28 uptake was associated with higher Aβ, higher tau, and lower MMSE score, independent of neurodegeneration. PBR28 mediated associations between tau in early and middle Braak stages, between tau and neurodegeneration, and between neurodegeneration and cognition.

Discussion: Microglia are associated with AD pathology and cognition and may mediate relationships between subsequent steps in AD progression.

Keywords: AD progression; Alzheimer's disease; TSPO PET; neuroinflammation.

FIGURE 1

TSPO expression by ¹¹C‐PBR28 uptake (SUVR) correlated with AD‐related PET and cognitive measures across controls (blue circles) and patients (red squares). All associations were corrected for age, sex, race, education, TSPO genotype, and neurodegeneration (%GM in AD composite region). PET, positron emission tomography; SUVR, standardized uptake value ratio; TSPO, translocator protein.

FIGURE 2

TSPO expression by ¹¹C‐PBR28 uptake (SUVR) significantly mediated pathways along AD progression model. SUVR, standardized uptake value ratios; TSPO, translocator protein.