Development of Effective PET and SPECT Imaging Agents for the Serotonin Transporter: Has a Twenty-Year Journey Reached its Destination?

The serotonin transporter (SERT) has been implicated in a variety of neuropsychiatric disorders including depression, schizophrenia, substance abuse, alcoholism, and Alzheimer's disease. Radiotracer-based in vivo imaging techniques such as Positron Emission Tomography (PET) and Single-Photon Emission Computed Tomography (SPECT) are important tools to investigate the functions of SERT in the living brain under normal conditions and its dysfunction in diseases. In this report we review the development and validation of effective PET and SPECT radiotracers in the last twenty years. First, the requirements for an effective imaging tracer, and factors influencing a tracer's in vivo imaging performance are discussed. PET and SPECT radiotracers for SERT are then categorized and reviewed according to their chemical scaffolds: 1) SSRIs and related compounds; 2) tropane-based ligands; 3) isoquinolines; and 4) substituted diarylsulfides. Critical evaluation and comments are provided for promising radiotracers, if any, emerging from each chemical scaffold. Based on experimental data gathered from radiotracer development for SERT, an examination of the relationship between an imaging tracer's in vitro physicochemical and pharmacological properties and its in vivo performance parameters is provided. Finally, tracers available for imaging applications in humans are assessed and compared in terms of tissue binding kinetics, non-specific binding, and specific binding signals in vivo. From these assessments, we conclude that, after twenty years of development efforts, a number of effective PET and SPECT radiotracers have now been validated and are available for imaging SERT in humans. The applications of these efficacious SERT imaging agents will further advance our understanding of this important transporter in psychiatric and neurodegenerative disorders.