Rasagiline, a monoamine oxidase B inhibitor, reduces in vivo [(18)F]THK5351 uptake in progressive supranuclear palsy

BACKGROUND: [(18)F]THK5351 is a tau positron emission tomography tracer that has shown promise in quantifying tau distribution in tauopathies such as Alzheimer's disease (AD) and progressive supranuclear palsy (PSP). However, the interpretation of [(18)F]THK5351 uptake has been shown to be confounded by high monoamine oxidase B (MAO-B) availability across the brain in AD. OBJECTIVES: To test the hypothesis that the MAO-B inhibitor, rasagiline reduces [(18)F]THK5351 uptake in PSP. METHODS: Six individuals (4: PSP; 2: cognitively unimpaired, CU) underwent [(18)F]THK5351 and [(18)F]AZD4694 to quantify baseline tau and amyloid deposition, respectively. Following a 10-day course of 1 mg rasagiline, all participants received a post-challenge [(18)F]THK5351 scan. The baseline and post-rasagiline challenge standardized uptake value (SUV) were generated normalized for patient weight and injected radioactivity. RESULTS: The post-rasagiline regional SUV was reduced on average by 69–89% in PSP, and 53–81% in CU. The distributions of post-rasagiline [(18)F]THK5351 SUV among PSP individuals were not consistent with the typical pattern of tau aggregates in PSP. CONCLUSIONS: Similar to AD, the interpretation of [(18)F]THK5351 uptake in PSP is likely confounded by off-target binding to MAO-B binding sites. [(18)F]THK5351 is not sufficient in quantifying tau aggregates in PSP using the proposed rasagiline dosing regimen.