New re­search sug­gests Parkin­son’s be­gins in gut

The Saline Courier - - OPINION -

“Congress shall make no law ... abridg­ing the free­dom of speech, or of the press ... . ” — From the First Amend­ment to Con­sti­tu­tion

Dear Doctor: What’s all this I’m hear­ing about Parkin­son’s dis­ease hav­ing some­thing to do with the gut? I thought it was about the ner­vous sys­tem and the brain.

Dear Reader: You’ve ze­roed in on an in­trigu­ing area of in­quiry into Parkin­son’s dis­ease in which new in­for­ma­tion emerges seem­ingly every week. With each new link be­tween Parkin­son’s and the gas­troin­testi­nal tract, re­searchers edge closer to un­cov­er­ing the causes of the dis­ease, as well as iden­ti­fy­ing novel av­enues of treat­ment.

It’s es­ti­mated that more than a mil­lion people are liv­ing with Parkin­son’s dis­ease in the United States, and about 60,000 new cases get di­ag­nosed each year. Symptoms typ­i­cally arise in people age 50 and older, and with mil­lions of baby boomers reach­ing that thresh­old, the need for ef­fec­tive treat­ments is ever more press­ing.

Parkin­son’s is a pro­gres­sive dis­ease of the ner­vous sys­tem in which nerve cells and cer­tain other struc­tures deep within the brain be­gin to de­te­ri­o­rate for rea­sons that are not yet fully un­der­stood. This leads to a deficit of dopamine, a neu­ro­trans­mit­ter that sends sig­nals to nerve cells and helps us achieve smooth and de­lib­er­ate move­ment. The symptoms of Parkin­son’s -- in­clud­ing tremors, rigid­ity, prob­lems with gait and a gen­eral slow­ing of move­ment -- arise from these and other changes. As a re­sult, much of the re­search into Parkin­son’s dis­ease has focused on the brain and ner­vous sys­tem.

In re­cent years, how­ever, sci­en­tists have be­gun to turn their at­ten­tion to some­thing known as the gut-brain axis. This is a term for the va­ri­ety of ways in which the gut com­mu­ni­cates with the brain, in­clud­ing via the ner­vous sys­tem and the en­docrine sys­tem, and sig­nal­ing mech­a­nisms built into the im­mune sys­tem. Among the fac­tors that in­flu­ence these com­mu­ni­ca­tions are the trillions of micro­organ­isms that live within our in­testi­nal tract. This has led sci­en­tists to ex­plore how the mi­cro­biome may play a role in neu­rode­gen­er­a­tive dis­eases, in­clud­ing Parkin­son’s, and how it might be har­nessed in treat­ments -- or even a cure.

One study fol­lowed a group of pa­tients who un­der­went a pro­ce­dure that re­moves por­tions of the va­gus nerve, which runs through­out the body and links the brain and the gut. Five years af­ter the surgery, these pa­tients were found to have a 40% lower in­ci­dence of Parkin­son’s dis­ease than those whose va­gus nerve re­mained in­tact.

In an­other study, con­ducted in mice bred to be sus­cep­ti­ble to Parkin­son’s dis­ease, re­searchers saw a surge in Parkin­son’s symptoms when the mice were im­planted with fe­cal sam­ples from Parkin­son’s pa­tients. This didn’t hap­pen in the mice im­planted with fe­cal sam­ples from healthy adults.

Pre­vi­ous re­search has found that the same ab­nor­mal protein clumps that form in the brains of pa­tients with Parkin­son’s dis­ease are also present in the gut. And from the time that Dr. James Parkin­son first iden­ti­fied the dis­ease in 1817, health care pro­fes­sion­als have noted that symptoms like con­sti­pa­tion and gas­troin­testi­nal dis­tress of­ten de­velop in the years prior to neu­ro­log­i­cal symptoms. All of this has led to in­creas­ing spec­u­la­tion that Parkin­son’s dis­ease orig­i­nates in the gut and spreads to the brain, and has set the stage for ex­plor­ing gut-based ther­a­pies and a po­ten­tial cure.

•••

Eve Glazier, M.D., MBA, is an in­ternist and as­so­ciate pro­fes­sor of medicine at UCLA Health. Eliz­a­beth Ko, M.D., is an in­ternist and as­sis­tant pro­fes­sor of medicine

at UCLA Health.

DR. GLAZIER

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