Dual radiotracer analysis of cholinergic neuronal changes in prediabetic mouse pancreas

Background: Pancreatic neuronal changes associated with beta cell loss in type 1 diabetes mellitus are complex, involving, in part, parasympathetic mechanisms to compensate for preclinical hyperglycemia. The parasympathetic neurotransmitter acetylcholine (ACh) mediates insulin release via M3 muscarinic receptors on islet beta cells. The vesicular ACh transporter (VAChT) receptor has been shown to be a useful marker of cholinergic activity in vivo. The positron emission tomography (PET) radiotracer (+)-4-[¹⁸F] fluorobenzyltrozamicol ([¹⁸F]FBT) binds to the VAChT receptor on presynaptic cholinergic neurons and can be quantified by PET. The compound 4-diphenylacetoxy-N-methylpiperidine (4-DAMP), available in a tritiated form, binds to M3 muscarinic receptors on beta cells and is a potential target for assessing pancreatic beta cell mass. In this study, we investigate the feasibility of dual radiotracer analysis in identifying neurofunctional changes that may signify type 1 diabetes mellitus in its early preclinical state. Methods: Ex vivo determinations of pancreatic uptake were performed in prediabetic nonobese diabetic mice and controls after intravenous injection of [¹⁸F]FBT or 4-[³H]DAMP. Beta cell loss in prediabetic mice was confirmed using immunohistochemical methods. Results: [¹⁸F]FBT uptake was significantly higher in prediabetic pancreata than controls: 3.22 ± 0.81 and 2.51 ± 1.04, respectively (P < 0.03). 4-[ ³H]DAMP uptake was significantly lower in prediabetic pancreata than controls: 0.612 ± 0.161 and 0.968 ± 0.364, respectively (P = 0.01). Conclusions: These data suggest that a combination of radiotracer imaging agents that bind to neuronal elements intimately involved in insulin production may be an effective method of evaluating changes associated with early beta cell loss using PET.