Although the name may suggest otherwise, Parkinson’s disease is not one but two diseases, starting either in the brain or in the intestines. Which explains why patients with Parkinson’s describe widely differing symptoms, and points towards personalised medicine as the way forward for people with Parkinson’s disease.
This is the conclusion of a study which has just been
published in the leading neurology journal Brain.
The researchers behind the study are Professor Per
Borghammer and Medical Doctor Jacob Horsager from the Department of Clinical
Medicine at Aarhus University and Aarhus University Hospital, Denmark.
“With the help of advanced scanning techniques, we’ve
shown that Parkinson’s disease can be divided into two variants, which start in
different places in the body. For some patients, the disease starts in the
intestines and spreads from there to the brain through neural connections. For
others, the disease starts in the brain and spreads to the intestines and other
organs such as the heart,” explains Per Borghammer.
He also points out that the discovery could be very
significant for the treatment of Parkinson’s disease in the future, as this
ought to be based on the individual patient’s disease pattern.
Parkinson’s disease is characterised by slow deterioration
of the brain due to accumulated alpha-synuclein, a protein that damages nerve
cells. This leads to the slow, stiff movements which many people associate with
the disease.
In the study, the researchers have used advanced PET
and MRI imaging techniques to examine people with Parkinson’s disease. People
who have not yet been diagnosed but have a high risk of developing the disease
are also included in the study. People diagnosed with REM sleep behaviour
syndrome have an increased risk of developing Parkinson’s disease.
The study showed that some patients had damage to the
brain’s dopamine system before damage in the intestines and heart occurred. In
other patients, scans revealed damage to the nervous systems of the intestines
and heart before the damage in the brain’s dopamine system was visible.
This knowledge is important and it challenges the
understanding of Parkinson’s disease that has been prevalent until now, says
Per Borghammer.
“Until now, many people have viewed the disease as
relatively homogeneous and defined it based on the classical movement
disorders. But at the same time, we’ve been puzzled about why there was such a
big difference between patient symptoms. With this new knowledge, the different
symptoms make more sense and this is also the perspective in which future
research should be viewed,” he says.
The researchers refer to the two types of Parkinson’s
disease as body-first and brain-first. In the case of body-first, it may be
particularly interesting to study the composition of bacteria in the intestines
known as the microbiota.
“It has long since been demonstrated that Parkinson’s
patients have a different microbiome in the intestines than healthy people,
without us truly understanding the significance of this. Now that we’re able to
identify the two types of Parkinson’s disease, we can examine the risk factors
and possible genetic factors that may be different for the two types. The next
step is to examine whether, for example, body-first Parkinson’s disease can be
treated by treating the intestines with faeces transplantation or in other ways
that affect the microbiome,” says Per Borghammer.
“The discovery of brain-first Parkinson’s is a bigger
challenge. This variant of the disease is probably relatively symptom-free
until the movement disorder symptoms appear and the patient is diagnosed with
Parkinson’s. By then the patient has already lost more than half of the
dopamine system, and it will therefore be more difficult to find patients early
enough to be able to slow the disease,” says Per Borghammer.
The study from Aarhus University is longitudinal, i.e.
the participants are called in again after three and six years so that all of
the examinations and scans can be repeated. According to Per Borghammer, this
makes the study the most comprehensive ever, and it provides researchers with
valuable knowledge and clarification about Parkinson’s disease — or diseases.
“Previous studies have indicated that there could be
more than one type of Parkinson’s, but this has not been demonstrated clearly
until this study, which was specifically designed to clarify this question. We
now have knowledge that offers hope for better and more targeted treatment of
people who are affected by Parkinson’s disease in the future,” says Per
Borghammer.
According to the Danish Parkinson’s Disease
Association, there are 8,000 people with Parkinson’s disease in Denmark and up
to eight million diagnosed patients worldwide.
This figure is expected to increase to 15 million in
2050 due to the ageing population, as the risk of getting Parkinson’s disease
increases dramatically the older the population becomes.
Source: https://myfusimotors.com/2020/09/27/parkinsons-disease-is-not-one-but-two-diseases/
No comments:
Post a Comment