Usefulness of 11C-methionine-positron emission tomography for the diagnosis of progressive multifocal leukoencephalopathy

The Use of Antimalarial Drugs against Viral Infection

“…Seventeen case reports described the use of MQ at different doses [72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88]. Although in 12 cases there was no progression of the disease at follow-up [72][73][74][77][78][79][81][82][83][84]86,87], it is difficult to draw conclusions due to the challenging treatment protocols and compromised health of the patients. In many cases, MQ was combined with mirtazapine, an antidepressant that, acting on the 5-HT2A serotonin receptor, is able to inhibit JCPyV entry into glial cells, preventing the diffusion of the infection in oligodendrocytes.…”

“…In many cases, MQ was combined with mirtazapine, an antidepressant that, acting on the 5-HT2A serotonin receptor, is able to inhibit JCPyV entry into glial cells, preventing the diffusion of the infection in oligodendrocytes. The outcomes of this treatment are controversial, leading to the resolution of the infection, with a claimed effect of MQ and mirtazapine treatment [86,87,[89][90][91][92][93][94][95][96][97][98][99][100][101][102][103][104][105], and to the resolution of the infection probably due to other factors [96,[106][107][108][109] or to the death of the patient, which was not always directly related to the unsuccessful therapy [87,96,[110][111][112][113][114][115][116]. In one case, the suspension of the therapy was necessary due to the side effects [117].…”

“…Herpesviridae HCMV Artesunate [12,13,[46][47][48] Artesunate-amodiaquine [49] Arthemeter-lumefantrine [64] HHV6 Artesunate [52] Polyomaviridae JCPyV Artesunate [54,55] Mefloquine [72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][122][123][124][125][126] Mefloquine and mirtazapine [86,87,127,128] Mefloquine, mirtazapine and a third drug [118,119] Mefloquine and risperidone [75] Mefloquine, risperidone and cytarabine [120] Mefloquine and cidofovir [121] Mefloquine and PML standard of care [129] Filoviridae EBOV Artesunate-amodiaquine [58,60] Nevertheless, some drugs have already been used in several clinical trials, as summarized in Table 1. Most of them regard the use of antimalarial drugs against HIV infection, but some of them failed, and...…”

Progressive multifocal leukoencephalopathy successfully treated with mefloquine and literature review

“…In vitro studies suggest that mefloquine not only has an anti-JCV property by inhibiting viral DNA replication but also sufficiently penetrates the blood brain barrier [2]. Moreover, these in vitro studies are supported by several case reports of PML successfully treated with mefloquine [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]37]. In PubMed, at least 21 case reports published in English were available, and these cases even included treatment without additional immune reconstitution therapy [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]37] (Table 3).…”

PET Imaging of ¹⁸F-FDG, ¹¹C-methionine, ¹¹C-flumazenil, and ¹¹C-4DST in Progressive Multifocal Leukoencephalopathy

“…Although PET studies in PML have rarely been reported, there have been a few studies investigating the uptake of 18 F-FDG and 11 C-methionine in PML lesions (8,10). Consistent with those findings, the present study showed that the 18 F-FDG uptake had relatively decreased whereas the 11 C-methionine uptake had relatively increased in the PML lesions.…”