Influence of P-Glycoprotein Inhibition or Deficiency at the Blood-Brain Barrier on 18F-2-Fluoro-2-Deoxy-D-glucose (18F-FDG) Brain Kinetics

The fluorinated D-glucose analog F-18-2-fluoro-2-deoxy-D-glucose (F-18-FDG) is the most prevalent radiopharmaceutical for positron emission tomography (PET) imaging. P-Glycoprotein's (P-gp, MDR1, and ABCB1) function in various cancer cell lines and tumors was shown to impact F-18-FDG incorporation, suggesting that P-gp function at the blood-brain barrier may also modulate F-18-FDG brain kinetics. We tested the influence of P-gp inhibition using the cyclosporine analog valspodar (PSC833; 5 mu M) on the uptake of F-18-FDG in standardized human P-gp-overexpressing cells (MDCKII-MDR1). Consequences for F-18-FDG brain kinetics were then assessed using (i) F-18-FDG PET imaging and suitable kinetic modelling in baboons without or with P-gp inhibition by intravenous cyclosporine infusion (15 mg kg(-1) h(-1)) and (ii) in situ brain perfusion in wild-type and P-gp/Bcrp (breast cancer resistance protein) knockout mice and controlled D-glucose exposure to the brain. In vitro, the time course of F-18-FDG uptake in MDR1 cells was influenced by the presence of valspodar in the absence of D-glucose but not in the presence of high D-glucose concentration. PET analysis revealed that P-gp inhibition had no significant impact on estimated brain kinetics parameters K-1, k(2), k(3), V-T, and CMRGlc. The lack of P-gp effect on in vivo F-18-FDG brain distribution was confirmed in P-gp/Bcrp-deficient mice. P-gp inhibition indirectly modulates F-18-FDG uptake into P-gp-overexpressing cells, possibly through differences in the energetic cell level state. F-18-FDG is not a P-gp substrate at the BBB and F-18-FDG brain kinetics as well as estimated brain glucose metabolism are influenced by neither P-gp inhibition nor P-gp/Bcrp deficiencies in baboon and mice, respectively.