TSPO in diverse CNS pathologies and psychiatric disease: a critical review and a way forward
Open accessAbstract
The use of Translocator Protein 18 kDa (TSPO) as a clinical neuroimaging biomarker of brain injury and neuroinflammation has increased exponentially in the last decade. There has been a furious pace in the development of new radiotracers for TSPO positron emission tomography (PET) imaging and its use has now been extensively described in many neurological and mental disorders. This fast pace of research and the ever-increasing number of new laboratories entering the field often times lack an appreciation of the historical perspective of the field and introduce dogmatic, but unproven facts, related to the underlying neurobiology of the TSPO response to brain injury and neuroinflammation. Paradoxically, while in neurodegenerative disorders and in all types of CNS pathologies brain TSPO levels increase, a new observation in psychiatric disorders such as schizophrenia is decreased brain levels of TSPO measured by PET. The neurobiological bases for this new finding is currently not known, but rigorous experimental design using multiple experimental approaches and careful interpretation of results is critically important to provide the methodological and/or biological underpinnings to this new observation. This review provides a perspective of the early history of validating TSPO as a biomarker of brain injury and neuroinflammation and a critical analysis of controversial topics in the literature related to the cellular sources of the TSPO response. The latter is important in order to provide the correct interpretation of PET studies in neurodegenerative and psychiatric disorders. Furthermore, this review proposes some yet to be explored explanations to new findings in psychiatric disorders and new approaches to quantitatively assess the glial sources of the TSPO response in order to move the field forward.
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Increased TSPO expression has been commonly attributed to activated microglia/macrophages and there is often an implication that the activation is pro-inflammatory.
“Increased TSPO expression also has been commonly attributed to activated microglia/macrophages and there is often an implication that the activation is pro-inflammatory (Guilarte, 2019).”
From A quantitative neuropathological assessment of translocator protein expression in multiple sclerosis (2019) · cites this paper as Guilarte, 2019
In “TSPO-PET literature indicating TSPO as an exclusive microglia biomarker” (page unavailable), the review says many studies attribute the TSPO signal to microglia or infiltrating macrophages, supporting the first part of the claim. The passages describe TSPO as a proposed biomarker of neuroinflammation, but do not establish the further claim that the activation is often implied to be pro-inflammatory. The review also cautions that astrocytes can contribute to the signal. (LLM, conf=0.82)
Experimental — accuracy not yet measuredTSPO is a marker of inflammation commonly attributed to microglial activation in neuroinflammatory and neurodegenerative diseases.
“TSPO is a marker of inflammation commonly attributed to microglial activation in neuroinflammatory and neurodegenerative diseases (Guilarte, 2019).”
From A quantitative neuropathological assessment of translocator protein expression in multiple sclerosis (2019) · cites this paper as Guilarte, 2019
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- Authors
- Guilarte, T. R.
- Affiliations
- Florida International University (US)
- Corresponding author
- Guilarte, Tomás R.
- ORCID
- Guilarte, Tomás R.
- Venue
- Pharmacology & Therapeutics
- Publisher
- Elsevier BV
- Published
- 2019-02
- Volume
- 194
- Pages
- 44-58
- ISSN
- 0163-7258 (ISSN-L)
- PMC
- PMC6348013
- OpenAlex
- W2890625851
- Cited by
- 173
- References
- 16
- Citations by year
- 2026: 4 · 2025: 18 · 2024: 27 · 2023: 19 · 2022: 21 · 2021: 29 · 2020: 34 · 2019: 18 · 2018: 3
- FWCI
- 1.99
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Environmental Health Sciences (ES007062-19)
- Topics
- Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Pharmacological Receptor Mechanisms and Effects
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
- Keywords
- translocator protein (TSPO), TSPO PET imaging, neuroinflammation, brain injury, neurodegenerative diseases, mental illness, schizophrenia, neuroimaging biomarkers
- MeSH terms
- Animals, Mental Disorders, Brain, Central Nervous System Diseases, Humans, Neuroglia, Receptors, GABA-A, Biomarkers, Receptors, GABA
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