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Abstract Background: Histone deacetylases (HDACs) are epigenetic molecules responsible for regulation of gene transcription. Altered expression of HDACs has been linked to neurodegenerative disease. Here, we used the class I HDAC PET radioligand [ 11 C]Martinostat to quantify and map changes in these molecules in the brain in dementia with Lewy bodies (DLB) and Parkinson’s disease (PD). In this cross-sectional study, we acquired brain PET-MR with [ 11 C]Martinostat in 14 DLB (median age 70 years (IQR 14), 21% female), 10 PD (median age 70 (8), 20% female) including four with cognitive impairment and six without, and 17 healthy control (HC) participants (median age 62 (14), 47% female). [ 11 C]Martinostat uptake was compared amongst groups using whole brain voxel-wise analysis and targeted region of interest (ROI)-based approaches, adjusted for age and sex. Regional expression was also quantified in postmortem brain bank samples. Results: Compared to HC, [ 11 C]Martinostat uptake in DLB was increased in precentral gyrus (ROI p = 0.044) and putamen ( p p = 0.042) and entorhinal cortex ( p = 0.023). [ 11 C]Martinostat uptake in DLB was decreased in inferior parietal cortex p 11 C]Martinostat uptake was also increased in precentral gyrus ( p = 0.019 in those with normal cognition, p = 0.047 in those with impaired cognition), correlating with both disease duration and stage. In cognitively impaired PD, [ 11 C]Martinostat uptake was additionally reduced in inferior parietal cortex ( p = 0.011), similar to DLB. In postmortem DLB tissue, class I HDAC expression was elevated in anterior cingulate cortex (isoform 1 p = 0.041, isoform 3 p = 0.024) and reduced in inferior parietal cortex (isoform 1 p Conclusions: These findings reveal evidence of elevated class I HDACs in motor cortex in PD and bidirectional changes in their regional expression in the Lewy body dementias.
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