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      P-Glycoprotein Function at the Blood–Brain Barrier: Effects of Age and Gender

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          Abstract

          Purpose

          P-glycoprotein (Pgp) is an efflux transporter involved in transport of several compounds across the blood–brain barrier (BBB). Loss of Pgp function with increasing age may be involved in the development of age-related disorders, but this may differ between males and females. Pgp function can be quantified in vivo using ( R)-[ 11C]verapamil and positron emission tomography. The purpose of this study was to assess global and regional effects of both age and gender on BBB Pgp function.

          Procedures

          Thirty-five healthy men and women in three different age groups were included. Sixty minutes dynamic ( R)-[ 11C]verapamil scans with metabolite-corrected arterial plasma input curves were acquired. Grey matter time–activity curves were fitted to a validated constrained two-tissue compartment plasma input model, providing the volume of distribution ( V T) of ( R)-[ 11C]verapamil as outcome measure.

          Results

          Increased V T of ( R)-[ 11C]verapamil with aging was found in several large brain regions in men. Young and elderly women showed comparable V T values. Young women had higher V T compared with young men.

          Conclusions

          Decreased BBB Pgp is found with aging; however, effects of age on BBB Pgp function differ between men and women.

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          Most cited references31

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          Alzheimer's disease.

          Alzheimer's disease is the most common cause of dementia. Research advances have enabled detailed understanding of the molecular pathogenesis of the hallmarks of the disease--ie, plaques, composed of amyloid beta (Abeta), and tangles, composed of hyperphosphorylated tau. However, as our knowledge increases so does our appreciation for the pathogenic complexity of the disorder. Familial Alzheimer's disease is a very rare autosomal dominant disease with early onset, caused by mutations in the amyloid precursor protein and presenilin genes, both linked to Abeta metabolism. By contrast with familial disease, sporadic Alzheimer's disease is very common with more than 15 million people affected worldwide. The cause of the sporadic form of the disease is unknown, probably because the disease is heterogeneous, caused by ageing in concert with a complex interaction of both genetic and environmental risk factors. This seminar reviews the key aspects of the disease, including epidemiology, genetics, pathogenesis, diagnosis, and treatment, as well as recent developments and controversies.
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            Blood-brain barrier active efflux transporters: ATP-binding cassette gene family.

            The blood-brain barrier (BBB) contributes to brain homeostasis by protecting the brain from potentially harmful endogenous and exogenous substances. BBB active drug efflux transporters of the ATP-binding cassette (ABC) gene family are increasingly recognized as important determinants of drug distribution to, and elimination from, the CNS. The ABC efflux transporter P-glycoprotein (Pgp) has been demonstrated as a key element of the BBB that can actively transport a huge variety of lipophilic drugs out of the brain capillary endothelial cells that form the BBB. In addition to Pgp, other ABC efflux transporters such as members of the multidrug resistance protein (MRP) family and breast cancer resistance protein (BCRP) seem to contribute to BBB function. Consequences of ABC efflux transporters in the BBB include minimizing or avoiding neurotoxic adverse effects of drugs that otherwise would penetrate into the brain. However, ABC efflux transporters may also limit the central distribution of drugs that are beneficial to treat CNS diseases. Furthermore, neurological disorders such as epilepsy may be associated with overexpression of ABC efflux transporters at the BBB, resulting in pharmacoresistance to therapeutic medication. Therefore, modulation of ABC efflux transporters at the BBB forms a novel strategy to enhance the penetration of drugs into the brain and may yield new therapeutic options for drug-resistant CNS diseases.
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              Strategies to advance translational research into brain barriers.

              There is a paucity of therapies for most neurological disorders--from rare lysosomal storage diseases to major public health concerns such as stroke and Alzheimer's disease. Advances in the targeting of drugs to the CNS are essential for the future success of neurotherapeutics; however, the delivery of many potentially therapeutic and diagnostic compounds to specific areas of the brain is restricted by the blood-brain barrier, the blood-CSF barrier, or other specialised CNS barriers. These brain barriers are now recognised as a major obstacle to the treatment of most brain disorders. The challenge to deliver therapies to the CNS is formidable, and the solution will require concerted international efforts among academia, government, and industry. At a recent meeting of expert panels, essential and high-priority recommendations to propel brain barrier research forward in six topical areas were developed and these recommendations are presented here.
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                Author and article information

                Contributors
                +31-20-4448525 , +31-20-4448529 , d.vanassema@vumc.nl
                Journal
                Mol Imaging Biol
                Mol Imaging Biol
                Molecular Imaging and Biology
                Springer-Verlag (New York )
                1536-1632
                1860-2002
                3 April 2012
                3 April 2012
                December 2012
                : 14
                : 6
                : 771-776
                Affiliations
                [1 ]Department of Nuclear Medicine & PET Research, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
                [2 ]Department of Neurology & Alzheimer Center, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
                [3 ]PET Centre, Uppsala University Hospital, 751 85 Uppsala, Sweden
                Article
                556
                10.1007/s11307-012-0556-0
                3492696
                22476967
                76eff063-5645-4df0-bd9f-da407bf8452f
                © The Author(s) 2012
                History
                Categories
                Research Article
                Custom metadata
                © World Molecular Imaging Society 2012

                Molecular biology
                aging,gender,positron emission tomography,blood–brain barrier,p-glycoprotein,(r)-[11c]verapamil

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