Central Nervous System Uptake of Anti-CD8+ T Cell Minibodies in Multiple Sclerosis and Progressive Multifocal Leukoencephalopathy: A Pilot Study
Background: Multiple sclerosis (MS) and progressive multifocal leukoencephalopathy (PML) are disorders that affect the central nervous system (CNS). The CNS includes the brain, spinal cord, and optic nerves. Both diseases can cause muscle weakness and impair vision, speech, and coordination. Researchers are working to better understand how MS and PML affect the CNS.
Objective: To test whether an experimental radioactive tracer (minibody) can help positron emission tomography (PET) scans detect certain immune cells in the CNS of people with MS and PML.
Eligibility: People aged 18 years and older with MS, other neuroinflammatory diseases with BBB leakage, or PML.
Design: Participants will come to the clinic for at least 3 visits over 4 to 6 weeks. Participants will undergo testing. They will have a physical and neurological exam. They will have blood tests and tests of their heart function. They will have a magnetic resonance imaging (MRI) scan of the brain. They may have a spinal tap: Their lower back will be numbed, and a needle will be inserted between the bones of the spine to withdraw fluid from around the spinal cord. Minibody is given through a tube with a needle placed in a vein in the arm. This takes 5 to 10 minutes. Participants will have heart function tests before and after receiving the minibody. Participants may have a PET scan on the day of the Minibody and will return the next day for another PET scan. They will lie on a table that moves through a doughnut-shaped machine. This scan will take about 1 hour. Participants with PML may opt to repeat the minibody infusion and the PET scan within 6 months.
⁃ In order to be eligible to participate in this study, an individual must meet all of the following criteria:
⁃ Multiple Sclerosis Inclusion Criteria
• Enrolled in the NINDS Natural History Study for MS (protocol 89-N-0045)
• Able to understand, and willing to sign, a written, informed consent document.
• Willing to comply with all study procedures and available for the duration of the study.
• Male or female, aged \>=18.
• Diagnosis of MS according to the 2017 revision of the McDonald diagnostic criteria48 (in the presence or absence of a clinical relapse).
⁃ PML Inclusion Criteria
• Enrolled in the NINDS Natural History Study for PML (protocol 13-N-0017)
• Able to understand and willing to sign a written, informed consent document
• Willing to comply with all study procedures and available for the duration of the study.
• Male or female, aged \>=18.
• Diagnosis of definite PML according to 2013 AAN Consensus Criteria49 or PML-IRIS based on clinical, radiological and laboratory evidence.
⁃ Patients with Known or Suspected Neuroinflammatory Diseases and Evidence of Open BBB Inclusion Criteria
• Clinical evaluation suggesting an inflammatory disorder of the central nervous system other than MS or PML.
• Recent brain MRI (within 1 month) with gadolinium enhancement indicating open BBB.
• Able to understand and willing to sign a written, informed consent document.
• Willing to comply with all study procedures and available for the duration of the study.
• Male or female, aged \>=18.