[11C](R)-PK11195 Positron Emission Tomography Imaging of Skull Inflammation in Isolated Rapid-Eye-Movement Sleep
Andreas Myhre Baun1, Michael Firbank2, Rainer Hinz3
1Department of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark.
Background:
Skull bone marrow is a specialized immune compartment supplying cells to the meninges. Experimental evidence suggests skull marrow activity may contribute to neuroinflammation in early Parkinson's disease, but in vivo assessment has not yet been performed in any α-synucleinopathy.
Objective:
The objective is to assess skull/meningeal inflammatory activity in patients with isolated rapid-eye-movement sleep behavior disorder (iRBD).
Methods:
20 iRBD patients recieved longitudinal [11C](R)-PK11195 positron emission tomography scans and were compared to 19 healthy controls.
Results:
Global skull inflammation in the iRBD patients was 22.87% higher (95% confidence interval: 12.78-32.97) compared to controls, especially in frontal regions, differing from that previously reported in Alzheimer's disease and multiple sclerosis. This inflammation progressed during a 3-year follow-up period but did not correlate with phenoconversion.
Conclusion:
This is the first in vivo evidence of skull marrow activation in an α-synucleinopathy. Our findings support a role for the skull-meningeal immune axis in iRBD, linking peripheral and central inflammation in prodromal disease. © 2025 International Parkinson and Movement Disorder Society.
Insights
Skull bone marrow inflammation is elevated in patients with isolated rapid-eye-movement sleep behavior disorder (iRBD), an alpha-synucleinopathy. This study provides the first in vivo evidence of this skull-meningeal immune axis activation in prodromal disease.
Area of Science:
- Neuroimmunology
- Neuroinflammation
- Parkinson's Disease Research
Background:
- Skull bone marrow serves as a specialized immune compartment for the meninges.
- Emerging evidence links skull marrow activity to neuroinflammation in early Parkinson's disease.
- In vivo assessment of skull marrow in alpha-synucleinopathies was previously lacking.
Purpose of the Study:
- To evaluate skull and meningeal inflammatory activity in patients diagnosed with isolated rapid-eye-movement sleep behavior disorder (iRBD).
- To investigate the role of the skull-meningeal immune axis in prodromal alpha-synucleinopathies.
Main Methods:
- Utilized longitudinal [11C](R)-PK11195 positron emission tomography scans.
- Compared 20 iRBD patients with 19 healthy controls.
- Assessed skull marrow activation in vivo.
Main Results:
- iRBD patients exhibited 22.87% higher global skull inflammation compared to controls, particularly in frontal regions.
- Observed inflammation progression over a 3-year follow-up period.
- Skull inflammation did not correlate with phenoconversion to Parkinson's disease.
Conclusions:
- Presents the first in vivo evidence of skull marrow activation in an alpha-synucleinopathy.
- Supports the involvement of the skull-meningeal immune axis in iRBD.
- Links peripheral and central inflammation in prodromal Parkinson's disease.
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