Tagged: alpha synuclein

The autoimmunity of Parkinson’s disease?


In this post we discuss several recently published research reports suggesting that Parkinson’s disease may be an autoimmune condition. “Autoimmunity” occurs when the defence system of the body starts attacks the body itself.

This new research does not explain what causes of Parkinson’s disease, but it could explain why certain brain cells are being lost in some people with Parkinson’s disease. And such information could point us towards novel therapeutic strategies.


The first issue of Nature. Source: SimpleWikipedia

The journal Nature was first published on 4th November 1869, by Alexander MacMillan. It hoped to “provide cultivated readers with an accessible forum for reading about advances in scientific knowledge.” It has subsequently become one of the most prestigious scientific journals in the world, with an online readership of approximately 3 million unique readers per month (almost as much as we have here at the SoPD).

Each Wednesday afternoon, researchers around the world await the weekly outpouring of new research from Nature. And this week a research report was published in Nature that could be big for the world of Parkinson’s disease. Really big!

On the 21st June, this report was published:

Title: T cells from patients with Parkinson’s disease recognize α-synuclein peptides
Authors: Sulzer D, Alcalay RN, Garretti F, Cote L, Kanter E, Agin-Liebes J, Liong C, McMurtrey C, Hildebrand WH, Mao X, Dawson VL, Dawson TM, Oseroff C, Pham J, Sidney J, Dillon MB, Carpenter C, Weiskopf D, Phillips E, Mallal S, Peters B, Frazier A, Lindestam Arlehamn CS, Sette A
Journal: Nature. 2017 Jun 21. doi: 10.1038/nature22815.
PMID: 28636593

In their study, the investigators collected blood samples from 67 people with Parkinson’s disease and from 36 healthy patients (which were used as control samples). They then exposed the blood samples to fragments of proteins found in brain cells, including fragments of alpha synuclein – this is the protein that is so closely associated with Parkinson’s disease (it makes regular appearances on this blog).

What happened next was rather startling: the blood from the Parkinson’s patients had a strong reaction to two specific fragments of alpha synuclein, while the blood from the control subjects hardly reacted at all to these fragments.

In the image below, you will see the fragments listed along the bottom of the graph (protein fragments are labelled with combinations of alphabetical letters). The grey band on the plot indicates the two fragments that elicited a strong reaction from the blood cells – note the number of black dots (indicating PD samples) within the band, compared to the number of white dots (control samples). The numbers on the left side of the graph indicate the number of reacting cells per 100,000 blood cells.


Source: Nature

The investigators concluded from this experiment that these alpha synuclein fragments may be acting as antigenic epitopes, which would drive immune responses in people with Parkinson’s disease and they decided to investigate this further.

What does antigenic epitopes mean?

It is probably best if we start with a bit of basic immunology.

Approximately 1/5 of all the cells in your body are involved in the immune system, which is responsible for defending you against substances that can make you sick. And usually those cells are really good – read: utterly ruthless and relentless – at protecting us against molecules that can cause infection and disease. They are particularly good at determining what is ‘self’ and what is not ‘self’ – that is to say, they can tell which substances are part of you (as an organism) and which are not. Not ‘self’ could simply be considered as anything that does not have an origin inside your body.

If the immune system is working correctly, when a pathogen (an agent that causes disease or damage) is detected in your body,  it will quickly be determined to be not ‘self’. This judgement will be made by the identification of antigens on the surface of the pathogen. An antigen is defined as any substance or molecule that is capable of causing an immune response in an organism.

A good example of a pathogen is the common cold virus. Once inside the body, the presence of the virus will be detected by cells in the immune system and given that the virus will be presenting antigens on its surface that are clearly not self, an immune response will be initiated. The cells that carry out the immune response are white blood cells known as lymphocytes.


That big cell in the middle is a lymphocyte. Source: ASH

There are basically two types of immune response:

  1. An antibody response
  2. A cell-mediated immune response

These processes are carried out by two different types of lymphocytes (B cells and T cells). In the antibody response, B cells are activated and they begin to secrete Y-shaped proteins called antibodies. These are used by the immune system to label and neutralise foreign or dangerous substances.


Antibodies binding to a virus. Source: Biology-questions-and-answers

Antibodies bind to parts of the antigen called epitopes. Also known as antigenic determinants, an epitope is the part of an antigen that is recognised by an antibody. Antibodies by themselves can do a pretty good job of stopping pathogens, by blocking them from attaching to cells or by sticking together and clustering the antigens to prevent them from doing anything bad.


Antibody binding to antigens. Source: Venngage

Cell-mediated immunity, on the other hand, is an immune response that does not involve antibodies. This approach relies on antigen-presenting cells, cytotoxic T-cells, and the release of various cytokines in response to an antigen.


In cell-mediated immune response, when a foreign object (like a bacteria) enters the body it will be detected by what we call ‘antigen-presenting cells’ (such as macrophage cells). Upon detection, these brave, selfless little cells will engulf the bacteria and digest them into hundreds or thousands of antigen fragments. The macrophage cell will bundle these fragments together in what we call a major histocompatibility complex (MHC). The macrophage cell next displays this MHC on its own cell surface for other cells discover.


Source: Boundless

The ‘other’ cells are another type of lymphocyte called a T cell. T cells derive their name from the fact that they mature in the thymus. Once mature, they are released to do very specific tasks. Until they encounter an ‘antigen-presenting cells’, however, T-cells are as useless and witless as teenagers. They need to be stimulated by the ‘antigen-presenting cells’ before they know what they are going to do with their lives.

Once stimulated, there are basically two main types of T cells:

  • helper T cells
  • cytotoxic T cells

Helper T cells are nice and useful because they like to tell other immune cells about particular pathogens. Cytotoxic T cells, on the other hand, simply get on with the dirty job of killing off antigen presenting cells/bacteria/viruses/etc. And these brutal, heartless thugs do not discriminate – all they care about is whether a particular antigen is present or not.

As we suggested above, in order to do its job a mature T cell must encounter an antigen-presenting cell which will offer the T cell a particular MHC complex to inspect. This interaction will activate the T cell, and it also provides the T-cell a specific set of antigens to go looking for.

Once activated by an antigen-presenting cell, a cytotoxic T cells will begin creating many versions of itself (or clones) through a process of cell division (called mitosis). These clones will have one specific set of cell-surface receptors which will bind to the antigens in the MHC complex that was offered by the antigen-presenting cell. These “brutal, heartless thugs” will next go searching the body for anything that has the antigens it can bind to.


Source: Immuneresponse

Once these cloned cytotoxic T cells have identified something (cell, bacteria, virus, etc) that exhibits the antigens they are looking for they will begin the process of killing that thing. They do their killing by releasing signalling molecules (called cytokines) which encourage an antigen presenting bacteria or cell to undergo apoptosis (or programmed cell death). Some of the cytokines will also recruit other members of the immune system to come and help with the killing, and subsequent cleaning up of the mess.

Ok, so if a cell is presenting an antigen on its surface that a cytotoxic T cell is looking for then that cell could be in big trouble?

Exactly. Anything that is acting as an antigenic epitope for the cytotoxic T cell to bind to will increase the risk of driving an immune response.

So do the brain cells that are lost in Parkinson’s disease presenting these MHC complexes on their cell surface?

Excellent question.

There are actually different types of MHC complexes. The most common are MHC class I and MHC class II. MHC class I complexes are found on all cells except red blood cells, while MHC class II complexes are only found on the antigen-presenting cells. In the brain, MHC class I complexes are present during development, but their levels drop off as we age.

A few years ago, however, the researchers who conducted the study we are reviewing today, published data suggesting that the cells most affected in Parkinson’s disease may have higher levels of MHC class I complexes, which may be making them vulnerable:


Title: MHC-I expression renders catecholaminergic neurons susceptible to T-cell-mediated degeneration.
Authors: Cebrián C, Zucca FA, Mauri P, Steinbeck JA, Studer L, Scherzer CR, Kanter E, Budhu S, Mandelbaum J, Vonsattel JP, Zecca L, Loike JD, Sulzer D
Journal: Nat Commun. 2014 Apr 16;5:3633.
PMID: 24736453           (This article is OPEN ACCESS if you would like to read it)

The investigators analysed human postmortem brain samples from people with and without Parkinson’s disease and they found that MHC class I complexes were present on many of the populations of neurons in the brain that are vulnerable to Parkinson’s disease (particularly the dopamine neurons in the substantia nigra and the norepinephrine producing neurons in an area called the locus coeruleus.

The investigators next conducted experiments in cell cultures using dopamine neurons that were made from human embryonic stem cells and they found that these cells were more susceptible to presenting MHC class I complexes when encouraged to than other types of neurons. The encouragement was caused by the activation of the helper cells in the brain called microglia. And the microglia were activated by exposure to alpha synuclein protein.

Thus, the researchers became interested in the idea that alpha synuclein from one dying cell could be activating microglia cells, which in turn makes other dopamine neurons present MHC class I complexes, making them vulnerable to inducing an immune response (Click here to read an OPEN ACCESS review of this topic by the investigators themselves).

And this was just a cute idea until the researchers published their results this week.

Which brings us back to the report again – there is a really interesting twist in it:


Title: T cells from patients with Parkinson’s disease recognize α-synuclein peptides
Authors: Sulzer D, Alcalay RN, Garretti F, Cote L, Kanter E, Agin-Liebes J, Liong C, McMurtrey C, Hildebrand WH, Mao X, Dawson VL, Dawson TM, Oseroff C, Pham J, Sidney J, Dillon MB, Carpenter C, Weiskopf D, Phillips E, Mallal S, Peters B, Frazier A, Lindestam Arlehamn CS, Sette A.
Journal: Nature. 2017 Jun 21. doi: 10.1038/nature22815.
PMID: 28636593

So the researchers observed T cells in the blood from people with Parkinson’s disease having a strong reaction to two specific fragments from alpha synuclein. These two fragments are from a region of the alpha synuclein protein called Y39. Interestingly, this Y39 region is very close to many of the genetic mutations in alpha synuclein that are associated with Parkinson’s disease (specifically A30P, E46K, A53T – in red on the left in the figure below).


Structure of alpha synuclein, showing mutation sites. Source: Frontiers

The researchers next looked at which MHC-associated proteins were responsible for putting the Y39 fragments into the MHC complexes for cell membrane presentation. The organising and presenting of these MHC complexes on the surface of a cell requires a lot of proteins all working together in perfect synchrony. The researchers found that the fragments were specifically displayed by two MHC class II proteins called HLA/DRB5*01:01 and HLA/DRB1*15:01,…

(and here comes the BIG twist)

…which if mutated are both associated with increased risk of developing Parkinson’s disease.

Title: Association of Parkinson disease with structural and regulatory variants in the HLA region.
Authors: Wissemann WT, Hill-Burns EM, Zabetian CP, Factor SA, Patsopoulos N, Hoglund B, Holcomb C, Donahue RJ, Thomson G, Erlich H, Payami H.
Journal: Am J Hum Genet. 2013 Nov 7;93(5):984-93.
PMID: 24183452                (This report is OPEN ACCESS if you would like to read it)

In this study, the investigators analysed the DNA from 2000 people with Parkinson’s disease and 1986 control subjects and they found that the risk of developing Parkinson’s disease was positively associated with variations in both HLA/DRB5*01:01 and HLA/DRB1*15:01 (in addition to other regions). Whereas approximately 15% of healthy control subjects carry variations in one of these genes, 1/3 of people with Parkinson’s disease have one of them.

So collectively these findings suggest that certain genetic variants in MHC-associated genes may cause particular fragments of alpha synuclein to be exposed in MHC complexes, causing T cells to mistakenly identify the alpha synuclein as a pathogen and thus trigger an autoimmune response that destroys any cell presenting alpha synuclein in MHC complexes. Likewise, the mutations in alpha synuclein which are located near the Y39 region and associated with Parkinson’s disease, could be causing this fragment to accidentally be exposed in MHC complexes (this needs to be further investigated though).



Source: Seekingalpha

The investigators are now seeking to discover whether the immune response provoked by alpha synuclein is a primary cause of Parkinson’s disease or whether it merely contributes to the brain cell death associated with the condition after the disease is triggered by something else. It is already apparent from the results of the study, however, that this ‘antigen presenting process’ is not going to explain every case of Parkinson’s disease, and the investigators acknowledge this. Hence the reason why the media headlines are reporting that autoimmunity may partly explain Parkinson’s disease.

In fact, only 40% of the blood from people with Parkinson’s disease in the study exhibited immune responses to the alpha synuclein fragments, and this may reflect differences between the participants in the study, particularly with regards to genetic variations. For example, last year a research report was published in the journal Cell that identified Parkinson’s associated proteins PINK1 and Parkin as suppressors of an immune response eliciting pathway (Click here to read more about that study).

That study found that in the absence of PINK1 or Parkin fragments of mitochondria (the power stations of cells) could be presented in MCH class I complexes, which would result in an immune response. PINK1 and Parkin are both involved in the normal removal of unhealthy mitochondria (Click here and here to read more about this). Without PINK1 or Parkin, old and dysfunctioning mitochondria start piling, making the cell sick. Thus, it may that people with PINK1 or Parkin genetic mutations may have an autoimmune component to their disease (perhaps falling into ‘the 40%’), while other people with Parkinson’s disease who don’t have these sorts of genetic variants will have alternative explanations to explain their condition.

The research groups that conducted the study we are reviewing today are now recruiting and analysing additional participants (with and without Parkinson’s disease), and are working to identify the molecular steps that lead to the autoimmune response in animal and cellular models.

What exactly is an autoimmune response?

An autoimmune response is an immune response within an organism against its own healthy cells and tissues. Any disease that results from such an immune response is called an autoimmune disease.


Different types of autoimmune diseases. Source: DrJockers

So is Parkinson’s disease an autoimmune disease?

For a condition to be considered an autoimmune disease it needs to conform to what is called Witebsky’s postulates (first formulated by Ernest Witebsky and associates in 1957; though they were modified in 1994). An autoimmune disease must show:

  • Direct evidence from transfer of disease-causing antibody or disease-causing T lymphocyte white blood cells
  • Indirect evidence based on reproduction of the autoimmune disease in experimental animals
  • Circumstantial evidence from clinical clues
  • Genetic evidence suggesting “clustering” with other autoimmune diseases

The research report we have reviewed in this post provides us with evidence of the first requirement. We also have evidence of the second requirement – Click here to read more about this. For the final two requirements, there has been an ever increasing number of reports regarding associations between Parkinson’s disease and other autoimmune diseases.

In fact, just this month alone we have had two separate studies published: one suggesting that naturally occurring “autoantibodies” (which play an important role in clearing and blocking circulating ‘self’ proteins) are lower in people with Parkinson’s disease than healthy control subjects. The second study presents strong evidence that Parkinson’s disease shares a number of genetic associations with autoimmune diseases.

Here is the first study:

Title: Autoimmune antibody decline in Parkinson’s disease and Multiple System Atrophy; a step towards immunotherapeutic strategies.
Authors: Brudek T, Winge K, Folke J, Christensen S, Fog K, Pakkenberg B, Pedersen LØ.
Journal: Mol Neurodegener. 2017 Jun 7;12(1):44.
PMID: 28592329           (This article is OPEN ACCESS if you would like to read it)

In this study, the researchers collected blood samples from samples from 46 people with Parkinson’s disease, 18 people with Multiple System Atrophy (a condition very similar to Parkinson’s disease), and 41 healthy control subjects. When they analysed the blood for autoantibodies targeting the alpha synuclein protein, they found reduced levels in people with Parkinson’s disease when compared to healthy controls, and even more reduced in people with Multiple System Atrophy. The researchers concluded that reduced levels of these antibodies for alpha synuclein results in more alpha synuclein floating around and causing an inflammatory environment. They also propose that the results provide a good rationale for testing immune-based therapeutic strategies directed against pathological alpha synuclein (such as the Affiris and Prothena clinical trials we have previously discussed – click here to read more about this).

The second report is a much larger study:

Title: Genome-wide Pleiotropy Between Parkinson Disease and Autoimmune Diseases
Authors: Witoelar A, Jansen IE, Wang Y, Desikan RS, Gibbs JR, Blauwendraat C, Thompson WK, Hernandez DG, Djurovic S, Schork AJ, Bettella F, Ellinghaus D, Franke A, Lie BA, McEvoy LK, Karlsen TH, Lesage S, Morris HR, Brice A, Wood NW, Heutink P, Hardy J, Singleton AB, Dale AM, Gasser T, Andreassen OA, Sharma M; International Parkinson’s Disease Genomics Consortium (IPDGC), North American Brain Expression Consortium (NABEC), and United Kingdom Brain Expression Consortium (UKBEC) Investigators.
Journal: JAMA Neurol. 2017 Jun 5. doi: 10.1001/jamaneurol.2017.0469.
PMID: 28586827

In this study, the researchers analysed DNA collected from 138 511 individuals of European ancestry and they identified 17 novel genetic loci shared between Parkinson disease and a series of autoimmune conditions (including type 1 diabetes, Crohn disease, ulcerative colitis, rheumatoid arthritis, celiac disease, psoriasis, and multiple sclerosis). According to this study, apparently healthy individuals with a lot of these shared genetic variants which predisposes them to inflammation conditions, could also be at increased risk for developing Parkinson’s disease.

Man, this all sounds really bad. What can we do about it?

Well firstly, we can start by not considering these results as bad news.

In fact, these studies could represent a major step forward in the right direction for a lot of people with Parkinson’s disease. These research findings are extremely useful for us.

As one of the investigators in the blood study, Dr. Alessandro Sette, (from the Centre for Infectious Disease in La Jolla, Calif.) has suggested the findings “raise the possibility that an immunotherapy approach could be used to increase the immune system’s tolerance for alpha synuclein, which could help to ameliorate or prevent worsening symptoms in Parkinson’s disease patients,”.

Dr. Sette also adds that “These findings could provide a much-needed diagnostic test for Parkinson’s disease, and could help us to identify individuals at risk or in the early stages of the disease.”

And the authors of the study also point towards drugs that could be applied to individuals that fit a potential autoimmune criteria for Parkinson’s disease. For example, they mentioned in the research article that candesartan cilexetil – a drug used for hypertension – was recently shown to reduce the activation microglia (the helper cells in the brain) which is caused by a build up of the Parkinson’s associated protein alpha synuclein:


Title: Activation of MyD88-dependent TLR1/2 signaling by misfolded α-synuclein, a protein linked to neurodegenerative disorders.
Authors: Daniele SG, Béraud D, Davenport C, Cheng K, Yin H, Maguire-Zeiss KA.
Journal: Sci Signal. 2015 May 12;8(376):ra45.
PMID: 25969543              (This article is OPEN ACCESS if you would like to read it)

This study found that candesartan cilexetil reversed the activation of microglia exposed to alpha synuclein, supporting the possibility of repurposing this drug for conditions like Parkinson’s disease. And other research groups have also reported neuroprotective effects of candesartan cilexetil in models of Parkinson’s disease (Click here to read more on this). Candesartan (also known by trade names such as Blopress, Atacand, Amias, and Ratacand) is an angiotensin II receptor antagonist used mainly for the treatment of hypertension.


Candesartan. Source: Wikipedia

In addition to pointing us towards novel therapy options, the new results suggesting an autoimmune component to some people with Parkinson’s disease would also represent a tremendous boost of support for therapies that are currently being clinically tested. Specifically those trials that are focused on suppressing the immune system, such as the immunomodulation study being conducted in Nebraska – a clinical trial of the drug Sargramostim in Parkinson’s disease.


Nebraska. Source: The Toast

Sargramostim stimulates regulatory T (Treg) cells. Treg cells are an important part of the immune system that we haven’t discussed in this particular post. They basically maintain law and order in the immune system. They do this by enforcing a dominant negative regulation on other immune cells, particularly other T-cells. Think of T-cells as the inquisitive neighbours curious about and snooping around a local crime scene, and then imagine that Treg cells are the police telling them “nothing to see here, move along”.


Tregs maintaining order. Source: Keywordsuggestions

Treg cells are particularly important for calming down Helper T cells and Cytotoxic T cells (often referred to in combination as T-effectors). The normal situation in your body is to have a balance between Helper T cells/Cytotoxic T cells and Treg cells. If there are too many excited Helper T cells and Cytotoxic T cells, there is increased chances of things going wrong and autoimmunity occurring.

Microsoft Word - Tregs Review Final

A delicate balance between healthy and autoimmune disease. Source: Researchgate

Thus, treatments that suppress the T-effectors may be very useful in slowing down a condition like Parkinson’s disease (particularly if autoimmunity is a component of this condition). One caveat here, however, is that too many Treg cells is not a good situation either, as they can leave the immune system too suppressed and individuals vulnerable to other diseases. A delicate balancing act will be required for such a treatment approach. To read more about the Sargramostim clinical trial in Nebraska, please click here to see our post about it.

So what does it all mean?

Phew! Long post.

It is basically the combination of three posts, each dealing with separate autoimmunity research reports associated with Parkinson’s disease,… plus a lesson in elements of basic immunology (which dragged on a bit). But I felt the research results are really important and the topic deserved to be done as one big post. Understand this: collectively, the research may represent a major turning point for the Parkinson’s disease community.

The research suggests that Parkinson’s disease may – at least partly – be an autoimmune condition. If further investigations (including replication of these original results by independent research groups) supports the idea that some people with Parkinson’s disease have an autoimmune component to their condition, this knowledge will provide us with a starting point to begin dividing the affected individuals into groups which could be better treated by the use of therapies oriented towards autoimmunity.

Ultimately any cure of this condition will probably utilise multiple treatments (eg. something to slow the progress of the disease, something protect cells from dying, something to distract the immune system, and something to begin replacing the cells that have been lost). Key to that future is a better understanding of the various components underlying the disease. The potential discovery of an autoimmune component to Parkinson’s disease in some people may help in the personalisation of therapy.

We are really excited by this.

EDITORIAL NOTE: The information provided by the SoPD website is for information and educational purposes only. Under no circumstances should it ever be considered medical or actionable advice. It is provided by research scientists, not medical practitioners. While many of the drugs/treatments discussed on the website are clinically available, they can have significant side effects and may affect the efficacy of other treatments. Any actions taken – based on what has been read on the website – are the sole responsibility of the reader. Any actions being contemplated by readers should firstly be discussed with a qualified healthcare professional who is aware of your medical history. While some of the information discussed in this post may cause concern, please speak with your medical physician before attempting any change in an existing treatment regime.

The banner for today’s post was sourced from Niaid

On the hunt: Parkure


This is Lysimachos.

Pronounced: “Leasing ma horse (without the R)” – his words not mine.

He is one of the founders of an Edinburgh-based biotech company called “Parkure“.

In today’s post, we’ll have a look at what the company is doing and what it could mean for Parkinson’s disease.


Source: Parkure

The first thing I asked Dr Lysimachos Zografos when we met was: “Are you crazy?”

Understand that I did not mean the question in a negative or offensive manner. I asked it in the same way people ask if Elon Musk is crazy for starting a company with the goal of ‘colonising Mars’.

In 2014, Lysimachos left a nice job in academic research to start a small biotech firm that would use flies to screen for drugs that could be used to treat Parkinson’s disease. An interesting idea, right? But a rather incredible undertaking when you consider the enormous resources of the competition: big pharmaceutical companies. No matter which way you look at this, it has the makings of a real David versus Goliath story.

But also understand this: when I asked him that question, there was a strong element of jealousy in my voice.


Incorporated in October 2014, this University of Edinburgh spin-out company has already had an interesting story. Here at the SoPD, we have been following their activities with interest for some time, and decided to write this post to make readers aware of them.

After struggling to raise much initial start-up capital, the company took the innovative approach of ‘crowd funding’ their first steps, and they managed to attract over £75,000 in investment through the Edinburgh-based technology-focussed crowd funding enterprise ShareIn. Here is the original video of that fund raising effort:

The company was also awarded a SMART Scotland grant from the Scottish Government in December 2014 which matched the investment raised by the crowd funding effort. This was a huge moment for the young company and Lysimachos described it as the most pivotal piece of support he has ever received in his research career.

Dr Zografos was also awarded a one-year RSE Enterprise Fellowship, which started in April of 2015. This award provided not only financial support, but also invaluable sources of advice and help for the young CEO learn the ropes of the business world.

And with this small pot of funding, they were off on their quest to find a cure for Parkinson’s disease.

What did they plan to do?

Before starting Parkure, Lysimachos was working for another University of Edinburgh spin-out company called Brainwave discovery Ltd where he had been working on genetically engineered flies. Specifically, the company uses flies to screen drugs to identify potential treatments and therapies for human conditions.


Drosophila (flies). Source: The Converstation

Why do they use flies to do this?

Several reasons:

  1. Our understanding of the genetics of Drosophila is very good
  2. We can manipulate Drosophila DNA very easily – human genes can be inserted, etc
  3. As you can see from the image below the Drosophila life cycle is very short, meaning that experiments can be conducted very quickly


Source: Slideplayer

Drosophila are also very small and easy to house, which helps a company to reduce the costs associated with research.


Housing Drosophila in jars. Source: Crowdfundinsider

While working at Brainwave (and later with Parkure), Lysimachos and his colleagues generated a lot of different types of flies with human genes inserted into their DNA. That work resulted in this publication:


Title: Functional characterisation of human synaptic genes expressed in the Drosophila brain.
Authors: Zografos L, Tang J, Hesse F, Wanker EE, Li KW, Smit AB, Davies RW, Armstrong JD.
Journal: Biol Open. 2016 May 15;5(5):662-7. doi: 10.1242/bio.016261.
PMID: 27069252                  (This article is OPEN ACCESS if you would like to read it)

In this study, the researchers began by engineered 30 different strains of flies with human genes inserted into their DNA. These genes are specifically associated with having activity at a region of each neuron called the synapse. The synapse is where one neuron communicates with another by releasing a neurotransmitter, like the chemical dopamine. Most neurons have thousands of synapses and the proteins involved with activity in the synapse are critical for normal neurological functioning.


Neurotransmitters being released across a synapse from one neuron (on the right) to another. Source: Truelibido

The researchers selected three of the 30 strains to focus on for further investigation: one containing the human tyrosine protein kinase Fyn, another containing the human small GTPase Rap1a, and the third had the human gene Arc inserted into its DNA. The first strain of fly (human Fyn) demonstrated a ‘gain-of-function’ effect in learning, while the second strain (human Rap1a) exhibited a ‘gain-of-function’ effect in motor ability. Curiously, the third strain (human Arc) did not show any effect at all, but this may be due to the fact that Drosophila do not have an equivalent gene (also called an ortholog).

While generating these and other flies with human genes, Lysimachos and his colleagues noticed that genes associated with Parkinson’s disease in particular could be easily inserted into flies and those genes would result in the flies developing Parkinson’s disease like features (for example, the loss of dopamine neurons and locomotion motor issues).

These flies not only gave the researchers an interesting new fly model of a specific disease, but also a quantifiable method of screening drugs that could protect the flies from developing Parkinson’s disease. They could treat the flies with different drugs and then watch to see which flies didn’t develop locomotion motor issues. In the image below you can see a wild-type (WT) normal fly walking around in a petri dish in panel A&B, while the fly in panel C has had a gene removed (or knocked out – KO) which has resulted in movement issues:


An example of motor issues in a fly. Source: PMC

And this using flies to screen drug for Parkinson’s disease is not such a crazy idea – remember we have previously written a post about the amazing efforts of another biotech company called Yumanity Therapeutics which is using yeast to screen drugs for Parkinson’s disease (Click here to read more about that).

The problem for Yumanity: yeast cells don’t develop Parkinson’s-like motor issues.

Lysimachos and his research colleagues tested the feasibility of this idea and found that it worked. If fact it worked really well.

It resulted not only in the founding of Parkure, but also in the company’s second research report:


Title: Validating the Predicted Effect of Astemizole and Ketoconazole Using a Drosophila Model of Parkinson’s Disease.
Authors: Styczyńska-Soczka K, Zechini L, Zografos L.
Journal; Assay Drug Dev Technol. 2017 Apr;15(3):106-112.
PMID: 28418693

In this study, the researchers at Parkure wanted to validate two compounds derived from their screening process:

  1. Astemizole (an antihistamine drug)
  2. Ketoconazole (an anti-fungal drug)

They used flies that were genetically engineered to produce high levels of human alpha synuclein in the brain. Alpha synuclein is a protein that is closely associated with Parkinson’s disease. It is believed to be responsible for the loss of cells in the brain. As these genetically engineered flies aged, they developed motor problems and started to lose dopamine neurons in the brain – nicely modelling the human condition.

The investigators took two groups of these flies and treated them with the two drugs (one group received Astemizole, while the other group was treated with ketoconazole). The results of the study show that both drugs increased the survival rates of the flies and could also rescue the motor problems that developed in these flies with age. Only ketoconazole treatment, however, actually reversed the loss of dopaminergic neurons. The effect of ketoconazole treatment was also apparent earlier in the life-cycle of the flies.

Ketoconazole is an interesting drug with a wide range of targets particularly within pathways of androgen and estrogen metabolism, including the androgen receptor itself. The androgen receptor has been associated with some neuroprotective properties, particularly in newly born neurons (Click here for more on this).


Ketoconazole. Source: Drugs

Astemizole on the other hand is known to bind to the human histamine H1 receptor, and it is important to note here that there is no strong fly equivalent for this receptor which may explain the lack of neuroprotection in this study.


Astemizole. Source: Wikipedia

One interesting aspect of the Parkure study, however, is that another (independent) group in China also noted beneficial effects of Astemizole, but in a different kind of screening study:


Title: Identification of Non-Electrophilic Nrf2 Activators from Approved Drugs
Authors: Zhang QY, Chu XY, Jiang LH, Liu MY, Mei ZL, Zhang HY.
Journal: Molecules. 2017 May 26;22(6).
PMID: 28587109              (This article is OPEN ACCESS if you would like to read it)

In this study, the investigators conducted a screen for drugs that activated the Nuclear Factor Erythroid 2-Related Factor 2 (Nrf2) pathway (We have previously discussed Nrf2 – click here to see that post). The researchers found that astemizole increased the activity of antioxidant genes NQO1, HO-1, and GCLM (which are all part of the Nrf2 pathway).

Interesting. So where is the company now?

The company recently announced that they have two lead compounds that it is now trying to take to the clinic (Click here to read more about this). The two drugs in question are repurposed (so we know that they are safe in humans), but Parkure has been able to isolate the active part of the drug that is causing the beneficial effects and make a whole new drug out of it. And they have now tested those novel chemical derivatives in preclinical studies.

The company currently seeking to take one of these preclinically validated seed molecules to the investigational new drug application (or IND) stage. Over the last year, Parkure has secured an Innovation Voucher from Interface, as well as some seed funding from Deepbride Capital LLP. In addition, the company also has contracts for the testing of a number of compounds for third party pharmaceutical companies using the Parkure’s unique approach and platform.

What does it all mean?

The better question is: do I still think Lysimachos is crazy? And the answer is no. The company has a very clear mission and they are taking very prudent steps towards achieving their goals. More importantly, he and his team are off on a fantastic adventure that may have tremendous benefits for the whole Parkinson’s community.

Yes, I’m still jealous.

It will be very interesting to watch the progress of this company over the next few years, and if you would like to contact Lysimachos to ask any questions or offer any help, he is happy to hear from you – his email address is lzografos@parkure.co.uk).

Editorial Note:  This post highlights the activities of a privately owned biotech company. The folks at SoPD have no equity in the company, nor were we asked or paid by the company to write this post. We simply believe that what they are doing is really interesting (the science, the business model, the ultimate goal), and we thought we would make readers aware of them and their mission. SoPD initiated the production of this post, and we were very grateful to Lysimachos for providing us with his time to answer some questions when we reached out to him.

The banner for todays post was sourced from Nature

Cholesterol, statins, and Parkinson’s disease

Eraser deleting the word Cholesterol

A new research report looking at the use of cholesterol-reducing drugs and the risk of developing Parkinson’s disease has just been published in the scientific journal Movement disorders.

The results of that study have led to some pretty startling headlines in the media, which have subsequently led to some pretty startled people who are currently taking the medication called statins.

In todays post, we will look at what statins are, what the study found, and discuss what it means for our understanding of Parkinson’s disease.


Cholesterol forming plaques (yellow) in the lining of arteries. Source: Healthguru

Cholesterol gets a lot of bad press.

Whether it’s high and low, the perfect balance of cholesterol in our blood seems to be critical to our overall health and sense of wellbeing. At least that is what we are constantly being told this by media and medical professionals alike.

But ask yourself this: Why? What exactly is cholesterol?

Good question. What is cholesterol?

Cholesterol (from the Greek ‘chole‘- bile and ‘stereos‘ – solid) is a waxy substance that is circulating our bodies. It is generated by the liver, but it is also found in many foods that we eat (for example, meats and egg yolks).


The chemical structure of Cholesterol. Source: Wikipedia

Cholesterol falls into one of three major classes of lipids – those three classes of lipids being TriglyceridesPhospholipids and Steroids (cholesterol is a steroid). Lipids are major components of the cell membranes and thus very important. Given that the name ‘lipids’ comes from the Greek lipos meaning fat, people often think of lipids simply as fats, but fats more accurately fall into just one class of lipids (Triglycerides).

Like many fats though, cholesterol dose not dissolve in water. As a result, it is transported within the blood system encased in a protein structure called a lipoprotein.


The structure of a lipoprotein; the purple C inside represents cholesterol. Source: Wikipedia

Lipoproteins have a very simple classification system based on their density:

  • very low density lipoprotein (VLDL)
  • low density lipoprotein (LDL)
  • intermediate density lipoprotein (IDL)
  • high density lipoprotein (HDL).

Now understand that all of these different types of lipoproteins contain cholesterol, but they are carrying it to different locations and this is why some of these are referred to as good and bad.

The first three types of lipoproteins carry newly synthesised cholesterol from the liver to various parts of the body, and thus too much of this activity would be bad as it results in an over supply of cholesterol clogging up different areas, such as the arteries.

LDLs, in particular, carry a lot of cholesterol (with approximately 50% of their contents being cholesterol, compared to only 20-30% in the other lipoproteins), and this is why LDLs are often referred to as ‘bad cholesterol’. High levels of LDLs can result in atherosclerosis (or the build-up of fatty material inside your arteries).

Progressive and painless, atherosclerosis develops as cholesterol silently and slowly accumulates in the wall of the artery, in clumps that are called plaques. White blood cells stream in to digest the LDL cholesterol, but over many years the toxic mess of cholesterol and cells becomes an ever enlarging plaque. If the plaque ever ruptures, it could cause clotting which would lead to a heart attack or stroke.


Source: MichelsonMedical

So yeah, some lipoproteins can be considered bad.

HDLs, on the other hand, collects cholesterol and other lipids from cells around the body and take them back to the liver. And this is why HDLs are sometimes referred to as “good cholesterol” because higher concentrations of HDLs are associated with lower rates of atherosclerosis progression (and hopefully regression).

But why is cholesterol important?

While cholesterol is usually associated with what is floating around in your bloodstream, it is also present (and very necessary) in every cell in your body. It helps to produce cell membranes, hormones, vitamin D, and the bile acids that help you digest fat.

It is particularly important for your brain, which contains approximately 25 percent of the cholesterol in your body. Numerous neurodegenerative conditions are associated with cholesterol disfunction (such as Alzheimer’s disease and Huntington’s disease – Click here for more on this). In addition, low levels of cholesterol is associated with violent behaviour (Click here to read more about this).

Are there any associations between cholesterol and Parkinson’s disease?

The associations between cholesterol and Parkinson’s disease is a topic of much debate. While there have been numerous studies investigating cholesterol levels in blood in people with Parkinson’s disease, the results have not been consistent (Click here for a good review on this topic).

Rather than looking at cholesterol directly, a lot of researchers have chosen to focus on the medication that is used to treat high levels of cholesterol – a class of drugs called statins.


Title: Prospective study of statin use and risk of Parkinson disease.
Authors: Gao X, Simon KC, Schwarzschild MA, Ascherio A.
Journal: Arch Neurol. 2012 Mar;69(3):380-4.
PMID: 22410446              (This article is OPEN ACCESS if you would like to read it)

In this study the researchers conduced a prospective study involving the medical details of 38 192 men and 90 874 women from two huge US databases: the Nurses’ Health Study (NHS) and the Health Professionals Follow-Up Study (HPFS).

NHS study was started in 1976 when 121,700 female registered nurses (aged 30 to 55 years) completed a mailed questionnaire. They provided an overview of their medical histories and health-related behaviours. The HPFS study was established in 1986, when 51,529 male health professionals (40 to 75 years) responded to a similar questionnaire. Both the NHS and the HPFS send out follow-up questionnaires every 2 years.

By analysing all of that data, the investigators found 644 cases of Parkinson’s disease (338 women and 306 men). They noticed that the risk of Parkinson’s disease was approximately 25% lower among people currently taking statins when compared to people not using statins. And this association was significant in statin users younger than 60 years of age (P = 0.02).

What are statins?

Also known as HMG-CoA reductase inhibitors, statins are a class of drug that inhibits/blocks an enzyme called 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase.

HMG-CoA reductase is the key enzyme regulating the production of cholesterol from mevalonic acid in the liver. By blocking this process statins help lower the total amount of cholesterol available in your bloodstream.


Source: Myelomacrowd

Statins are used to treat hypercholesterolemia (also called dyslipidemia) which is high levels of cholesterol in the blood. And they are one of the most widely prescribed classes of drugs currently available, with approximately 23 percent of adults in the US report using statin medications (Source).

Now, while the study above found an interesting association between statin use and a lower risk of Parkinson’s disease, the other research published on this topic has not been very consistent. In fact, a review in 2009 found a significant associations between statin use and lower risk of Parkinson’s disease was observed in only two out of five prospective studies (Click here to see that review).

New research published this week has attempted to clear up some of that inconsistency, by starting with a huge dataset and digging deep into the numbers.

So what new research has been published?


Title: Statins may facilitate Parkinson’s disease: Insight gained from a large, national claims database
Authors: Liu GD, Sterling NW, Kong L, Lewis MM, Mailman RB, Chen H, Leslie D, Huang X
Journal: Movement Disorder, 2017 Jun;32(6):913-917.
PMID: 28370314

Using the MarketScan Commercial Claims and Encounters database which catalogues the healthcare use and medical expenditures of more than 50 million employees and their family members each year, the researcher behind that study identified 30,343,035 individuals that fit their initial criteria (that being “all individuals in the database who had 1 year or more of continuous enrolment during January 1, 2008, to December 31, 2012, and were 40 years of age or older at any time during their enrolment”). From this group, the researcher found a total of 21,599 individuals who had been diagnosed with Parkinson’s disease.

In their initial analysis, the researchers found that Parkinson’s disease was positively associated with age, male gender, hypertension, coronary artery disease, and usage of cholesterol-lowering drugs (both statins and non-statins). The condition was negatively associated with hyperlipidemia (or high levels of cholesterol). This result suggests not only that people with higher levels of cholesterol have a reduced chance of developing Parkinson’s disease, but taking medication to lower cholesterol levels may actually increase ones risk of developing the condition.

One interesting finding in the data was the effect that different types of statins had on the association.

Statins can be classified into two basic groups: water soluble (or hydrophilic) and lipid soluble (or lipophilic) statins. Hydrophilic molecule have more favourable interactions with water than with oil, and vice versa for lipophilic molecules.


Hydrophilic vs lipophilic molecules. Source: Riken

Water soluble (Hydrophilic) statins include statins such as pravastatin and rosuvastatin; while all other available statins (eg. atorvastatin, cerivastatin, fluvastatin, lovastatin and simvastatin) are lipophilic.

In this new study, the researchers found that the association between statin use and increased risk of developing Parkinson’s disease was more pronounced for lipophilic statins (a statistically significant 58% increase – P < 0.0001), compared to hydrophilic statins (a non-significant 19% increase – P = 0.25). One possible explanation for this difference is that lipophilic statins (like simvastatin and atorvastatin) cross the blood-brain barrier more easily and may have more effect on the brain than hydrophilic ones.

The investigators also found that this association was most robust during the initial phase of statin treatment. That is to say, the researchers observed a 82% in risk of PD within 1 year of having started statin treatment, and only a 37% increase five years after starting statin treatment.; P < 0.0001). Given this finding, the investigators questioned whether statins may be playing a facilitatory role in the development of Parkinson’s disease – for example, statins may be “unmasking” the condition during its earliest stages.

So statins are bad then?

Can I answer this question with a diplomatic “I don’t know”?

It is difficult to really answer that question based on the results of just this one study. This is mostly because this new finding is in complete contrast to a lot of experimental research over the last few years which has shown statins to be neuroprotective in many models of Parkinson’s disease. Studies such as this one:

Title: Simvastatin inhibits the activation of p21ras and prevents the loss of dopaminergic neurons in a mouse model of Parkinson’s disease.
Authors: Ghosh A, Roy A, Matras J, Brahmachari S, Gendelman HE, Pahan K.
Journal: J Neurosci. 2009 Oct 28;29(43):13543-56.
PMID: 19864567              (This study is OPEN ACCESS if you would like to read it)

In this study, the researchers found that two statins (pravastatin and simvastatin – one hydrophilic and one lipophilic, respectively) both exhibited the ability to suppress the response of helper cells in the brain (called microglial) in a neurotoxin model of Parkinson’s disease. This microglial suppression resulted in a significant neuroprotective effect on the dopamine neurons in these animals.

Another study found more Parkinson’s disease relevant effects from statin treatment:


TItle: Lovastatin ameliorates alpha-synuclein accumulation and oxidation in transgenic mouse models of alpha-synucleinopathies.
Authors: Koob AO, Ubhi K, Paulsson JF, Kelly J, Rockenstein E, Mante M, Adame A, Masliah E.
Journal: Exp Neurol. 2010 Feb;221(2):267-74.
PMID: 19944097            (This study is OPEN ACCESS if you would like to read it)

In this study, the researchers treated two different types of genetically engineered mice (both sets of mice produce very high levels of alpha synuclein – the protein closely associated with Parkinson’s disease) with a statin called lovastatin. In both groups of alpha synuclein producing mice, lovastatin treatment resulted in significant reductions in the levels of cholesterol in their blood when compared to the saline-treated control mice. The treated mice also demonstrated a significant reduction in levels of alpha synuclein clustering (or aggregation) in the brain than untreated mice, and this reduction in alpha synuclein accumulation was associated with a lessening of pathological damage in the brain.

So statins may not be all bad?

One thing many of these studies fail to do is differentiate between whether statins are causing the trouble (or benefit) directly or whether simply lowering cholesterol levels is having a negative impact. That is to say, do statins actually do something else? Other than lowering cholesterol levels, are statins having additional activities that could cause good or bad things to happen?



Source: Liverissues

The recently published study we are reviewing in this post suggested that non-statin cholesterol medication is also positively associated with developing Parkinson’s disease. Thus it may be that statins are not bad, but rather the lowering of cholesterol levels that is. This raises the question of whether high levels of cholesterol are delaying the onset of Parkinson’s disease, and one can only wonder what a cholesterol-based process might be able to tell us about the development of Parkinson’s disease.

If the findings of this latest study are convincingly replicated by other groups, however, we may need to reconsider the use of statins not in our day-to-day clinical practice. At the very least, we will need to predetermine which individuals may be more susceptible to developing Parkinson’s disease following the initiation of statin treatment. It would actually be very interesting to go back to the original data set of this new study and investigate what addition medical features were shared between the people that developed Parkinson’s disease after starting statin treatment. For example, were they all glucose intolerant? One would hope that the investigators are currently doing this.

Are Statins currently being tested in the clinic for Parkinson’s disease?

(Oh boy! Tough question) Yes, they are.

There is currently a nation wide study being conducted in the UK called PD STAT.


The study is being co-ordinated by the Plymouth Hospitals NHS Trust (Devon). For more information, please see their website or click here for the NHS Clinical trials gateway website.

Is this dangerous given the results of the new research study?

(Oh boy! Even tougher question!)

Again, we are asking this question based on the results of one recent study. Replication with independent databases is required before definitive conclusions can be made.

There have, however, been previous clinical studies of statins in neurodegenerative conditions and these drugs have not exhibited any negative effects (that I am aware of). In fact, a clinical trial for multiple sclerosis published in 2014 indicated some positive results for sufferers taking simvastatin:

Title: Effect of high-dose simvastatin on brain atrophy and disability in secondary progressive multiple sclerosis (MS-STAT): a randomised, placebo-controlled, phase 2 trial.
Authors: Chataway J, Schuerer N, Alsanousi A, Chan D, MacManus D, Hunter K, Anderson V, Bangham CR, Clegg S, Nielsen C, Fox NC, Wilkie D, Nicholas JM, Calder VL, Greenwood J, Frost C, Nicholas R.
Journal: Lancet. 2014 Jun 28;383(9936):2213-21.
PMID: 24655729             (This article is OPEN ACCESS if you would like to read it)

In this double-blind clinical study (meaning that both the investigators and the subjects in the study were unaware of which treatment was being administered), 140 people with multiple sclerosis were randomly assigned to receive either the statin drug simvastatin (70 people; 40 mg per day for the first month and then 80 mg per day for the remainder of 18 months) or a placebo treatment (70 people).

Patients were seen at 1, 6, 12, and 24 months into the study, with telephone follow-up at months 3 and 18. MRI brain scans were also made at the start of the trial, and then again at 12 months and 25 months for comparative sake.

The results of the study indicate that high-dose simvastatin was well tolerated and reduced the rate of whole-brain shrinkage compared with the placebo treatment. The mean annualised shrinkage rate was significantly lower in patients in the simvastatin group. The researchers were very pleased with this result and are looking to conduct a larger phase III clinical trial.

Other studies have not demonstrated beneficial results from statin treatment, but they have also not observed a worsening of the disease conditions:

Title: A randomized, double-blind, placebo-controlled trial of simvastatin to treat Alzheimer disease.
Authors:Sano M, Bell KL, Galasko D, Galvin JE, Thomas RG, van Dyck CH, Aisen PS.
Journal: Neurology. 2011 Aug 9;77(6):556-63.
PMID: 21795660            (This article is OPEN ACCESS if you would like to read it)

In this study, the investigators recruited a total of 406 individuals were mild to moderate Alzheimer’s disease, and they were randomly assigned to two groups: 204 to simvastatin (20 mg/day, for 6 weeks then 40 mg per day for the remainder of 18 months) and 202 to placebo control treatment. While Simvastatin displayed no beneficial effects on the progression of symptoms in treated individuals with mild to moderate Alzheimer’s disease (other than significantly lowering of cholesterol levels), the treatment also exhibited no effect on worsening the disease.


So what does it all mean?

Research investigating cholesterol and its association with Parkinson’s disease has been going on for a long time. This week a research report involving a huge database was published which indicated that using cholesterol reducing medication could significantly increase one’s risk of developing Parkinson’s disease.

These results do not mean that someone being administered statins is automatically going to develop Parkinson’s disease, but – if the results are replicated – it may need to be something that physicians should consider before prescribing this class of drug.

Whether ongoing clinical trials of statins and Parkinson’s disease should be reconsidered is a subject for debate well above my pay grade (and only if the current results are replicated independently). It could be that statin treatment (or lowering of cholesterol) may have an ‘unmasking’ effect in some individuals, but does this mean that any beneficial effects in other individuals should be discounted? If preclinical data is correct, for example, statins may reduce alpha synuclein clustering in some people which could be beneficial in Parkinson’s.

As we have said above, further research is required in this area before definitive conclusions can be made. This is particularly important given the inconsistencies of the previous research results in the statin and Parkinson’s disease field of investigation.

EDITORIAL NOTE: The information provided by the SoPD website is for information and educational purposes only. Under no circumstances should it ever be considered medical or actionable advice. It is provided by research scientists, not medical practitioners. Any actions taken – based on what has been read on the website – are the sole responsibility of the reader. Any actions being contemplated by readers should firstly be discussed with a qualified healthcare professional who is aware of your medical history. While some of the information discussed in this post may cause concern, please speak with your medical physician before attempting any change in an existing treatment regime.

The banner for today’s post was sourced from HarvardHealth

BioRxiv – open access preprints


For the vast majority of the general population, science is consumed via mass media head lines and carefully edited summaries of the research.

The result of this simplified end product is an ignorance of the process that researchers need to deal with in order to get their research in the public domain.

As part of our efforts to educate the general public about the scientific research of Parkinson’s disease, it is necessary to also make them aware of that process, the issues associated with it, and how it is changing over time.

In todays post, we will look at how new research reports are being made available to the public domain before they are published.


Getting research into the public domain. Source: STAT

Every morning here at the SoPD, we look at what new research has entered the public domain over night and try to highlight some of the Parkinson’s disease relevant bits on our Twitter account (@ScienceofPD).

To the frustration of many of our followers, however, much of that research sits behind the pay-to-view walls of big publishing houses. One is allowed to read the abstract of the research report in most cases, but not the full report.

Given that charity money and tax payer dollars are paying for much of the research being conducted, and for the publication fee (approx. $1500 per report on average) to get the report into the journal, there is little debate as to the lack of public good in such a system. To make matter worse, many of the scientists doing the research can not access the published research reports, because their universities and research institutes can not afford the hefty access fees for all of the journals.


Source: Libguides

To be fair, the large publishing houses have recognised that this is not a sustainable business model, and they have put forward the development of open-access web-based science journals, such as Nature communications, Scientific reports, and Cell reports. But the fees for publishing in these journals can in some cases be higher than the closed access publications.

This is crazy. What can we do about it?

Well, there have been efforts for some time to improve the situation.

Projects like the Public Library of Science (or PLOS) have been very popular and are now becoming a real force on the scientific publishing landscape (they recently celebrated their 10 year anniversary and during that time they have published more than 165,000 research articles). But they too have costs associated with maintaining their service and publications fees can still be significant.


Is there an easier way of making this research available?

So this is Prof Paul Ginsparg.


Source: Wikipedia

Looks like the mad scientist type right? Don’t be fooled. He’s awesome! Prof Ginsparg is a professor of Physics and Computing & Information Science at Cornell University.

Back in 1991, he started a repository of pre-print publications in the field of physics. The repository was named arXiv.org, and it allowed physics researchers to share and comment on each others research reports before they were actually published.

The site slowly became an overnight sensation.

The number of manuscripts deposited at arXiv passed the half-million mark on October 3, 2008, the million manuscript mark by the end of 2014 (with a submission rate of more than 8,000 manuscripts per month). The site currently has 1,257,315 manuscripts that are freely available to access. A future nobel prize winning bit of research is probably in there!

Now, by their very nature, and in a very general sense, biomedical researchers are a jealous bunch.

For many years they looked on with envy at the hive of activity going on at arXiv and wished that they had something like it themselves. And now they do! In November 2013, Cold Spring Harbor Laboratory in New York launched BioRxiv.


Source: BioRxiv

And the website is very quickly becoming a popular destination: by April 21, 2017, >10,000 manuscript had been posted, at a current rate of over 800 manuscripts per month (Source).

Recently they got a huge nod of financial support from the Chan Zuckerberg Initiative – a foundation set up by Facebook founder Mark Zuckerberg and his wife Priscilla Chan to “advance human potential and promote equality in areas such as health, education, scientific research and energy” (Wikipedia).


Source: ChangZuckerberg

In April of this year, the Chan Zuckerberg Initiative announced a partnership with Cold Spring Harbor Laboratory to help support the site (Click here to see the press release).

So what is bioRxiv?

bioRxiv is a free OPEN ACCESS service that allows researchers to submit draft copies of scientific papers — called preprints — for their colleagues to read and comment on before they are actually published in peer-reviewed scientific journals.

Here are two videos explaining the idea:

Sounds great right?

To demonstrate how the bioRxiv process works, we have selected an interesting manuscript from the database that we would like to review here on the SoPD.

This is the article:


Title: In Vivo Phenotyping Of Parkinson-Specific Stem Cells Reveals Increased a-Synuclein Levels But No Spreading
Authors: Hemmer K, Smits LM, Bolognin S, Schwamborn JC
Database: BioRxiv
DOI: https://doi.org/10.1101/140178
PMID: N/A                   (You can access the manuscript by clicking here)

In this study (which was posted on bioRxiv on the 19th May, 2017), the researchers have acquired skin cells from an 81 year old female with Parkinson’s disease who carries a mutation (G2019S) in the LRRK2 gene.

Mutations in the Leucine-rich repeat kinase 2 (or Lrrk2) gene are associated with an increased risk of developing Parkinson’s disease. The most common mutation of LRRK2 gene is G2019S, which is present in 5–6% of all familial cases of Parkinson’s disease, and is also present in 1–2% of all sporadic cases. We have previously discussed Lrrk2 (Click here to read that post).


The structure of Lrrk2 and where various mutations lie. Source: Intech

The skin cells were transformed using a bit of biological magic in induced pluripotent stem (or IPS) cells. We have previously discussed IPS cells and how they are created (Click here to read that post). By changing a subjects skin cell into a stem cell, researchers can grow the cell into any type of cell and then investigate a particular disease on a very individualised basis (the future of personalised medicine don’t you know).


IPS cell options available to Parkinson’s disease. Source: Nature

Using this IPS cell with a mutation in the LRRK2 gene, the researchers behind todays manuscript next grew the cells in culture and encouraged the cells to become dopamine producing cells (these are some of the most vulnerable cells in Parkinson’s disease). The investigators had previously shown that neurons grown in culture from cells with the G2019S mutation in the LRRK2 gene have elevated levels of of the Parkinson’s disease protein alpha Synuclein (Click here to read that OPEN ACCESS paper).

In this present study, the investigators wanted to know if these cells would also have elevated levels of alpha synuclein when transplanted into the brain. Their results indicate that the cells did. Next, the investigators wanted to use this transplantation model to see if the high levels of alpha synuclein in the transplanted cells would lead to the protein being passed to neighbouring cells.

Why did they want to do that?

One of the current theories regarding the mechanisms underlying the progressive spread of Parkinson’s disease is that the protein alpha synuclein is lead culprit. Under normal conditions, alpha synuclein usually floats around as an individual protein (or monomer), but sometime it starts to cluster (or aggregate) with other monomers of alpha synuclein and these form what we call oligomers. These oligomers are believed to be a toxic form of alpha synuclein that is being passed from cell to cell. And it ‘seeds’ the disease in each cell it is passed on to (Click here for a very good OPEN ACCESS review of this topic).

Mechanism of syunuclein propagation and fibrillization

The passing of alpha synuclein between brain cells. Source: Nature

There have been postmortem analysis studies of the brains from people with Parkinson’s who have had cell transplantation therapy back in the 1990s. The analysis shows that some of the transplanted cells have evidence of toxic alpha synuclein in them – some of those cells have Lewy bodies in them, suggesting that the disease has been passed on to the healthy introduced cells from the diseased brain (Click here for the OPEN ACCESS research report about this).

In the current bioRxiv study, the investigators wanted to ask the reverse question:

Can unhealthy, toxic alpha synuclein producing cells cause the disease to spread into a healthy brain?

So after transplanted the Lrrk2 mutant cells into the brains of mice, they waited 11 weeks to see if the alpha synuclein would be passed on to the surrounding brain. According to their results, the unhealthy alpha synuclein did not transfer. They found no increase in levels of alpha synuclein in the cells surrounding the transplanted cells. The researchers concluded that within the parameters of their experiment, Parkinson’s disease-associated alpha synuclein spreading was not detected.

Interesting. When will this manuscript be published in a scientific journal?

We have no idea.

One sad truth of the old system of publication is: it may never be.

And this illustrates one of the beautiful features of bioRxiv.

This manuscript is probably going through the peer-review process at a particular scientific journal at the moment in order for it to be properly published. It is a process that will take several months. Independent reviewers will provide a critique of the work and either agree that it is ready for publication, suggest improvements that should be made before it can be published, or reject it outright due to possible flaws or general lack of impact (depending on the calibre of the journal – the big journals seem to only want sexy science). It is a brutal procedure and some manuscripts never actually survive it to get published, thus depriving the world of what should be freely available research results.

And this is where bioRxiv provides us with a useful forum to present scientific biological research that may never reach publication. Perhaps the researchers never actually intended to publish their findings, and just wanted to let the world know that someone had attempted the experiment and these are the results they got (there is a terrible bias in the world of research publishing to only publish positive results).

The point is: with bioRxiv we can have free access to the research before it is published and we do not have to wait for the slow peer-review process.

And there is definitely some public good in that.

EDITORS NOTE HERE: We are not suggesting for a second that the peer-review process should be done away with. The peer-review process is an essential and necessary aspect of scientific research, which helps to limit fraud and inaccuracies in the science being conducted.

What does it all mean?

This post may be boring for some of our regular readers, but it is important for everyone to understand that there are powerful forces at work in the background of scientific research that will determine the future of how information is disseminated to both the research community and general population. It is useful to be aware of these changes.

We hope that some of our readers will be bold/adventurous and have a look at some of what is on offer in the BioRxiv database. Maybe not now, but in the future. It will hopefully become a tremendous resource.

And we certainly encourage fellow researchers to use it (most of the big journals now accept preprint manuscripts being made available on sites like bioRxiv – click here to see a list of the journals that accept this practise) and some journals also allow authors to submit their manuscript directly to a journal’s submission system through bioRxiv via the bioRxiv to Journals (B2J) initiative (Click here for a list of the journals accepting this practise).

The times they are a changing…

The banner for today’s post was sourced from ScienceMag

The Melanoma drug from MODAG


A build up of a protein called alpha synuclein inside neurons is one of the characteristic feature of the Parkinsonian brain. This protein is believed to be partly responsible for the loss of dopamine neurons in this condition.

A similar build up of alpha synuclein is also seen in the deadly skin cancer, Melanoma… but those cells don’t die (?!?)… in fact, they just keep on dividing.

Why is there this critical difference?

In today’s post we look at an interesting new study that may have solved this mystery.


A melanoma. Source: Huffington Post

Parkinson’s disease has a very strange relationship with the skin cancer melanoma.

As we have stated in previous posts (Click here, herehere and here to read those posts) people with Parkinson’s disease are 2-8 times more likely to develop melanoma than people without Parkinson’s (And this finding has been replicated a few times: Olsen et al, 2005; Olsen et al, 2006; Driver et al 2007; Gao et al 2009; Lo et al 2010; Bertoni et al 2010;Schwid et al 2010; Ferreira et al, 2010Inzelberg et al, 2011; Liu et al 2011; Kareus et al 2012; Wirdefeldt et al 2014; Catalá-López et al 2014; Constantinescu et al 2014; Ong et al 2014).

The truly baffling detail in this story, however, is that this relationship is reciprocal – if you have melanoma you are almost 3 times more likely to develop Parkinson’s disease than someone without melanoma (Source: Baade et al 2007; Gao et al 2009).

What is melanoma exactly?

Melanoma is a type of skin cancer.

It develops from the pigment-containing cells known as melanocytes. Melanocytes are melanin-producing cells located in the bottom layer (the stratum basale) of the skin’s outer layer (or epidermis).


The location of melanocytes in the skin. Source: Wikipedia

Melanocytes produce melanin, which is a pigment found in the skin, eyes, and hair. It is also found in the brain in certain types of cells, such as dopamine neurons (where it is referred to as neuromelanin).


Neuromelanin (brown) in dopamine neurons. Source: Schatz

Melanomas are usually caused by DNA damage resulting from exposure to ultraviolet radiation. Ultraviolet radiation from tanning beds increases the risk of melanoma (Source), as does excessive air travel (Source), or simply spending to much time sun bathing.

Approximately 2.2% of men and women will be diagnosed with melanoma at some point during their lives (Source). In women, melanomas most commonly occur on the legs, while in men they are most common on the back. Melanoma makes up 5% of all cancers (Source).

Generally, melanomas is one of the safer cancers, as it can usually be detected early by visual inspection. This cancer is made dangerous, however, by its ability to metastasise (or spread to other organs in the body).


The stages of melanoma. Source: Pathophys

Are there any genetic associations between Parkinson’s disease and melanoma?


When the common genetics mutations that increase the risk of both conditions were previously analysed, it was apparent that none of the known Parkinson’s mutations make someone more susceptible to melanoma, and likewise none of the melanoma-associated genetic mutations make a person vulnerable to Parkinson’s disease (Meng et al 2012;Dong et al 2014; Elincx-Benizri et al 2014).

In fact, researchers have only found very weak genetic connections between two conditions (Click here to read our previous post on this). It’s a real mystery.

Are there any other connections between Parkinson’s disease and melanoma?


Another shared feature of both Parkinson’s disease and melanoma is the build up of a protein called alpha synuclein. Alpha synuclein is believed to be one of the villains in Parkinson’s disease – building up inside a cell, becoming toxic, and eventually killing that cell.

But recently researchers noticed that melanoma also has a build up of alpha synuclein, but those cells don’t die:


Title: Parkinson’s disease-related protein, alpha-synuclein, in malignant melanoma
Authors: Matsuo Y, Kamitani T.
Journal: PLoS One. 2010 May 5;5(5):e10481.
PMID: 20463956               (This article is OPEN ACCESS if you would like to read it)

In this study, researchers from Japan found that alpha synuclein was detected in 86% of the primary and 85% of the metastatic melanoma. Understand that the protein is not detectable in the non-melanoma cancer cells.

So what is it doing in melanoma cells?

Recently, researchers from Germany believe that they have found the answer to this question:


Title: Treatment with diphenyl-pyrazole compound anle138b/c reveals that α-synuclein protects melanoma cells from autophagic cell death
Authors: Turriani E, Lázaro DF, Ryazanov S, Leonov A, Giese A, Schön M, Schön MP, Griesinger C, Outeiro TF, Arndt-Jovin DJ, Becker D
Journal: Proc Natl Acad Sci U S A. 2017 Jun 5. pii: 201700200. doi: 10.1073/pnas.1700200114
PMID: 28584093

In their study, the German researchers looked at levels of alpha synuclein in melanoma cells. They took the melanoma cells that produced the most alpha synuclein and treated those cells with a chemical that inhibits the toxic form of alpha synuclein (which results from the accumulation of the protein).

What they observed next was fascinating: the cell morphology (or physically) changed, leading to massive melanoma cell death. The investigators found that this cell death was caused by instability of mitochondria and a major dysfunction in the autophagy process.

Mitochondria, you may recall, are the power house of each cell. They keep the lights on. Without them, the lights go out and the cell dies.


Mitochondria and their location in the cell. Source: NCBI

Autophagy is the garbage disposal/recycling process within each cell, which is an absolutely essential function. Without autophagy, old proteins and mitochondria will pile up making the cell sick and eventually it dies. Through the process of autophagy, the cell can break down the old protein, clearing the way for fresh new proteins to do their job.


The process of autophagy. Source: Wormbook

Waste material inside a cell is collected in membranes that form sacs (called vesicles). These vesicles then bind to another sac (called a lysosome) which contains enzymes that will breakdown and degrade the waste material. The degraded waste material can then be recycled or disposed of by spitting it out of the cell.

What the German research have found is that the high levels of alpha synuclein keep the mitochondria stable and the autophagy process working at a level that helps to keeps the cancer cell alive.

Next, they replicated this cell culture research in mice with melanoma tumors. When the mice were treated with the chemical that inhibits the toxic form of alpha synuclein, the cancer cancer became malformed and the autophagy process was blocked.

The researchers concluded that “alpha synuclein, which in PD exerts severe toxic functions, promotes and thereby is highly beneficial to the survival of melanoma in its advanced stages”.

So what does all of this mean for Parkinson’s disease?

Well, this is where the story gets really interesting.

You may be pleased to know that the chemical (called Anle138b) which was used to inhibit the toxic form of alpha synuclein in the melanoma cells, also works in models of Parkinson’s disease:


Title: Anle138b: a novel oligomer modulator for disease-modifying therapy of neurodegenerative diseases such as prion and Parkinson’s disease.
Authors: Wagner J, Ryazanov S, Leonov A, Levin J, Shi S, Schmidt F, Prix C, Pan-Montojo F, Bertsch U, Mitteregger-Kretzschmar G, Geissen M, Eiden M, Leidel F, Hirschberger T, Deeg AA, Krauth JJ, Zinth W, Tavan P, Pilger J, Zweckstetter M, Frank T, Bähr M, Weishaupt JH, Uhr M, Urlaub H, Teichmann U, Samwer M, Bötzel K, Groschup M, Kretzschmar H, Griesinger C, Giese A.
Journal: Acta Neuropathol. 2013 Jun;125(6):795-813
PMID: 23604588              (This article is OPEN ACCESS if you would like to read it)

In this first study the researchers discovered Anle138b by conducted a large screening study to identify for molecules that could inhibit the toxic form of alpha synuclein.

They next tested Anle138b in both cell culture and rodent models of Parkinson’s disease and found it to be neuroprotective and very good at inhibiting the toxic form of alpha synuclein. And the treatment looks to be very effective. In the image below you can see dark staining of toxic alpha synuclein in the left panel from the brain of an untreated mouse, but very little staining in the right panel from an Anle138b treated mouse.



Toxic form of alpha synuclein (dark staining). Source: Max-Planck

Importantly, Anle138b does not interfere with normal behaviour of alpha synuclein in the mice (such as production of the protein, correct functioning, and eventual degradation/disposal of the protein), but it does act as an inhibitor of alpha synuclein clustering or aggregation (the toxic form of the protein). In addition, the investigators found no toxic effects of Anle138b in any of their experiments even after long-term high-dose treatment (more than one year).

And in a follow up study, the drug was effective even if it was given after the disease model had started:


Title: The oligomer modulator anle138b inhibits disease progression in a Parkinson mouse model even with treatment started after disease onset
Authors: Levin J, Schmidt F, Boehm C, Prix C, Bötzel K, Ryazanov S, Leonov A, Griesinger C, Giese A.
Journal: Acta Neuropathol. 2014 May;127(5):779-80.
PMID: 24615514                (This article is OPEN ACCESS if you would like to read it)

During the first study, the researchers had started Anle138b treatment in the mouse model of Parkinson’s disease at a very young age. In this study, however, the investigators began treatment only as the symptoms were starting to show, and Anle138b was found to significantly improve the overall survival of the mice.

One particularly interesting aspect of Anle138b function in the brain is that it does not appear to change the level of the autophagy suggesting that the biological effects of treatment with Anle138b is cell-type–specific (Click here to read more about this). In cancer cells, it is having a different effect to that in brain cells. These differences in effect may also relate to disease conditions though, as Anle138b was not neuroprotective in a mouse model of Multiple System Atrophy (MSA; Click here to read more about this).

Is Anle138b being tested in the clinic?

Not yet.

Ludwig-Maximilians-Universität München and the Max Planck Institute for Biophysical Chemistry (Göttingen) have spun off a company called MODAG GmbH that is looking to advance Anle138b to the clinic (Click here for the press release). The Michael J Fox Foundation are helping to fund more preclinical development of this treatment (Click here to read more about this).

We will be watching their progress with interest.

What does it all mean?

Summing up: There are many mysteries surrounding Parkinson’s disease, but some researchers from Germany may have just solved one of them and at the same time developed a potentially useful new treatment.

They have discovered that the Parkinson’s associated protein, alpha synuclein, which is produced in large amounts in the skin cancer melanoma, is actually playing an important role in keeping those cancer cells alive. By finding a molecule that can block the build up of alpha synuclein, they have not only found a treatment for melanoma, but also potentially one for Parkinson’s disease.

And given that both diseases are closely associated, this could be seen as a great step forward. Two birds with one stone as the saying goes.

The banner for today’s post was sourced from Wikipedia

A connection between ALS & Parkinson’s disease? Oh’ll, SOD it!


Please excuse our use of UK slang in the title of this post, but a group of Australian researchers have recently discovered something really interesting about Parkinson’s disease.

And being a patriotic kiwi, it takes something REALLY interesting for me to even acknowledge that other South Pacific nation. This new finding, however, could be big.

In today’s post, we will review new research dealing with a protein called SOD1, and discuss what it could mean for the Parkinson’s community.


The number of dark pigmented dopamine cells in the substantia nigra are reduced in the Parkinson’s disease brain (right). Source: Adaptd from Memorangapp

Every Parkinson’s-associated website and every Parkinson’s disease researchers will tell you exactly the same thing when describing the two cardinal features in the brain of a person who died with Parkinson’s disease:

  1. The loss of certain types of cells (such as the dopamine producing cells of the substantia nigra region of the brain – see the image above)
  2. The clustering (or aggregation) of a protein called Alpha synuclein in tightly packed, circular deposits, called Lewy bodies (see image below).


A Lewy body inside a cell. Source: Adapted from Neuropathology-web

The clustered alpha synuclein protein, however, is not limited to just the Lewy bodies. In the affected areas of the brain, aggregated alpha synuclein can be seen in the branches of cells – see the image below where alpha synuclein has been stained brown on a section of brain from a person with Parkinson’s disease.


Examples of Lewy neurites (indicated by arrows). Source: Wikimedia

Now, one of the problems with our understanding of Parkinson’s disease is disparity between the widespread presence of clustered alpha synuclein and very selective pattern of cell loss. Alpha synuclein aggregation can be seen distributed widely around the affected areas of the brain, but the cell loss will be limited to specific populations of cells.

If the disease is killing a particular population of cells, why is alpha synuclein clustering so wide spread?

So why is there a difference?

We don’t know.

It could be that the cells that die have a lower threshold for alpha synuclein toxicity (we discussed this is a previous post – click here?).

But this question regarding the difference between these two features has left many researchers wondering if there may be some other protein or agent that is actually killing off the cells and then disappearing quickly, leaving poor old alpha synuclein looking rather guilty.


Poor little Mr “A Synuclein” got the blame, but his older brother actually did it! Source: Youtube

And this is a very serious discussion point.

This year of 2017 represents the 200th anniversary of James Parkinson’s first description of Parkinson’s disease, but it also represents the 20th anniversary since the association between alpha synuclein and PD was first established. We have produced almost 7,000 research reports on the topic of alpha synuclein and PD during that time, and we currently have ongoing clinical trials targetting alpha synuclein.

But what if our basic premise – that alpha synuclein is the bad guy – is actually wrong?

Is there any evidence to suggest this?

We are just speculating here, but yes there is.

For example, in a study of 904 brains, alpha synuclein deposits were observed in 11.3% of the brains (or 106 cases), but of those cases only 32 had been diagnosed with a neurodegenerative disorder (Click here to read more on this). The remaining 74 cases had demonstrated none of the clinical features of Parkinson’s disease.

So what else could be causing the cell death?

Well, this week some scientists from sunny Sydney (Australia) reported a protein that could fit the bill.


Sydney. Source: Vagabond

The interesting part of their finding is that the protein is also associated with another neurodegenerative condition: Amyotrophic lateral sclerosis.

Remind me again, what is Amyotrophic lateral sclerosis?

Parkinson’s disease and Amyotrophic lateral sclerosis (ALS) are the second and third most common adult-onset neurodegenerative conditions (respectively) after Alzheimer’s disease. We recently discussed ALS in a previous post (Click here to read that post).

ALS, also known as Lou Gehrig’s disease and motor neuron disease, is a neurodegenerative condition in which the neurons that control voluntary muscle movement die. The condition affects 2 people in every 100,000 each year, and those individuals have an average survival time of two to four years.

You may have heard of ALS due to it’s association with the internet ‘Ice bucket challenge‘ craze that went viral in 2014-15.


The Ice bucket challenge. Source: Forbes

What is the protein associated with ALS?

In 1993, scientists discovered that mutations in the gene called SOD1 were associated with familial forms of ALS (Click here to read more about this). We now know that mutations in the SOD1 gene are associated with around 20% of familial cases of ALS and 5% of sporadic ALS.

The SOD1 gene produces an enzyme called Cu-Zn superoxide dismutase.

This enzyme is a very powerful antioxidant that protects the body from damage caused by toxic free radical generated in the mitochondria.


SOD1 protein structure. Source: Wikipedia

One important note here regarding ALS: the genetic mutations in the SOD1 gene do not cause ALS by affecting SOD1’s antioxidant properties (Click here to read more about this). Rather, researchers believe that the cell death seen in SOD1-associated forms of ALS is the consequences of some kind of toxic effect caused by the mutant protein.

So what did the Aussie researchers find about SOD1 in Parkinson’s disease?

This week, the Aussie researchers published this research report:

Title: Amyotrophic lateral sclerosis-like superoxide dismutase 1 proteinopathy is associated withneuronal loss in Parkinson’s disease brain.
Authors: Trist BG, Davies KM, Cottam V, Genoud S, Ortega R, Roudeau S, Carmona A, De Silva K, Wasinger V, Lewis SJG, Sachdev P, Smith B, Troakes C, Vance C, Shaw C, Al-Sarraj S, Ball HJ, Halliday GM, Hare DJ, Double KL.
Journal: Acta Neuropathol. 2017 May 19. doi: 10.1007/s00401-017-1726-6.
PMID: 28527045

Given that oxidative stress is a major feature of Parkinson’s disease, the Aussie researchers wanted to investigate the role of the anti-oxidant enzyme, SOD1 in this condition. And what they found surprised them.

Heck, it surprised us!

Two areas affected by Parkinson’s disease – the substantia nigra (where the dopamine neurons reside; SNc in the image below) and the locus coeruleus (an area in the brain stem that is involved with physiological responses to stress; LC in the image below) – exhibited little or no SOD1 protein in the control brains.

But in the Parkinsonian brains, there was a great deal of SOD1 protein (see image below).


SO1 staining in PD brain and Control brains. Source: Springer

In the image above, you can see yellowish-brown stained patches in both the PD and control images. This a chemical called neuromelanin and it can be used to identify the dopamine-producing cells in the SNc and LC. The grey staining in the PD images (top) are cells that contain SOD1. Note the lack of SOD1 (grey staining) in the control images (bottom).

Approximately 90% of Lewy bodies in the Parkinson’s affected brains contained SOD1 protein. The investigators did report that the levels of SOD1 protein varied between Lewy bodies. But the clustered (or ‘aggregated’) SOD1 protein was not just present with alpha synuclein, often it was found by itself in the degenerating regions.

The researchers occasional saw SOD1 aggregation in regions of age-matched control brains, and they concluded that a very low level of SOD1 must be inherent to the normal ageing process.

But the density of SOD1 clustering was (on average) 8x higher in the SNc and 4x higher in the LC in the Parkinsonian brain compared to age-matched controls. In addition, the SOD1 clustering was significantly greater in these regions than all of the non-degenerating regions of the same Parkinson’s disease brains.

The investigators concluded that these data suggest an association between SOD1 aggregation and neuronal loss in Parkinson’s disease. Importantly, the presence of SOD1 aggregations “closely reflected the regional pattern of neuronal loss”.

They also demonstrated that the SOD1 protein in the Parkinsonian brain was not folded correctly, a similar characteristic to alpha synuclein. A protein must fold properly to be able to do it’s assigned jobs. By not folding into the correct configuration, the SOD1 protein could not do it’s various functions – and the investigators observed a 66% reduction in SOD1 specific activity in the SNc of the Parkinson’s disease brains.

Interestingly, when the researchers looked at the SNc and LC of brains from people with ALS, they identified SOD1 aggregates matching the SOD1 clusters they had seen in these regions of the Parkinson’s disease brain.

Is this the first time SOD1 has been associated with Parkinson’s disease?

No, but it is the first major analysis of postmortem Parkinsonian brains. SOD1 protein in Lewy bodies has been reported before:


Title: Cu/Zn superoxide dismutase-like immunoreactivity is present in Lewy bodies from Parkinson disease: a light and electron microscopic immunocytochemical study
Authors: Nishiyama K, Murayama S, Shimizu J, Ohya Y, Kwak S, Asayama K, Kanazawa I.
Journal: Acta Neuropathol. 1995;89(6):471-4.
PMID: 7676802

The investigators behind this study reported SOD1 protein was present in Lewy bodies, in the substantia nigra and locus coeruleus of brains from five people with Parkinson’s disease. Interestingly, they showed that SOD1 is present in the periphery of the Lewy body, similar to alpha synuclein. Both of these protein are present on the outside of the Lewy body, as opposed to another Parkinson’s associated protein, Ubiquitin, which is mainly present in the centre (or the core) of Lewy bodies (see image below).


A more recent study also demonstrated SOD1 protein in the Parkinsonian brain, including direct interaction between SOD1 and alpha synuclein:


Title: α-synuclein interacts with SOD1 and promotes its oligomerization
Authors: Helferich AM, Ruf WP, Grozdanov V, Freischmidt A, Feiler MS, Zondler L, Ludolph AC, McLean PJ, Weishaupt JH, Danzer KM.
Journal: Mol Neurodegener. 2015 Dec 8;10:66.
PMID: 26643113              (This article is OPEN ACCESS if you would like to read it)

These researchers found that alpha synuclein and SOD1 interact directly, and they noted that Parkinson’s disease related mutations in alpha synuclein (A30P, A53T) and ALS associated mutation in SOD1 (G85R, G93A) modify the binding of the two proteins to each other. They also reported that alpha synuclein accelerates SOD1 aggregation in cell culture. This same group of researchers published another research report last year in which they noted that aggregated alpha synuclein increases SOD1 clustering in a mouse model of ALS (Click here for more on this).

We should add that alpha synuclein aggregations in ALS are actually quite common (click here and here to read more on this).

Are there any genetic mutations in the SOD1 gene that are associated with Parkinson’s disease?

Two studies have addressed this question:


Title: Sequence of the superoxide dismutase 1 (SOD 1) gene in familial Parkinson’s disease.
Authors: Bandmann O, Davis MB, Marsden CD, Harding AE.
Journal: J Neurol Neurosurg Psychiatry. 1995 Jul;59(1):90-1.
PMID: 7608718                   (This article is OPEN ACCESS if you would like to read it)

And then in 2001, a second analysis:


Title: Genetic polymorphisms of superoxide dismutase in Parkinson’s disease.
Authors: Farin FM, Hitosis Y, Hallagan SE, Kushleika J, Woods JS, Janssen PS, Smith-Weller T, Franklin GM, Swanson PD, Checkoway H.
Journal: Mov Disord. 2001 Jul;16(4):705-7.
PMID: 11481695

Both studies found no genetic variations in the SOD1 gene that were more frequent in the Parkinson’s affected community than the general population. So, no, there are no SOD1 genetic mutations that are associated with Parkinson’s disease.

Are there any treatments targeting SOD1 that could be tested in Parkinson’s disease?

Great question. Yes there are. And they have already been tested in models of PD:


Title: The hypoxia imaging agent CuII(atsm) is neuroprotective and improves motor and cognitive functions in multiple animal models of Parkinson’s disease.
Authors: Hung LW, Villemagne VL, Cheng L, Sherratt NA, Ayton S, White AR, Crouch PJ, Lim S, Leong SL, Wilkins S, George J, Roberts BR, Pham CL, Liu X, Chiu FC, Shackleford DM, Powell AK, Masters CL, Bush AI, O’Keefe G, Culvenor JG, Cappai R, Cherny RA, Donnelly PS, Hill AF, Finkelstein DI, Barnham KJ.
Title: J Exp Med. 2012 Apr 9;209(4):837-54.
PMID: 22473957               (This article is OPEN ACCESS if you would like to read it)

CuII(atsm) is a drug that is currently under clinical investigation as a brain imaging agent for detecting hypoxia (damage caused by lack of oxygen – Click here to read more about this).

The researchers conducting this study, however, were interested in this compound for other reasons: CuII(atsm) is also a highly effective scavenger of a chemical called ONOO, which can be very toxic. CuII(atsm) not only inhibits this toxicity, but it also blocks the clustering of alpha synuclein. And given that CuII(atsm) is capable of crossing the blood–brain barrier, these investigators wanted to assess the drug for its ability to rescue model of Parkinson’s disease.

And guess what? It did!

And not just in one model of Parkinson’s disease, but FOUR!

The investigators even waited three days after giving the neurotoxins to the mice before giving the CuII(atsm) drug, and it still demonstrated neuroprotection. It also improved the behavioural features of these models of Parkinson’s disease.

Is CuII(atsm) being tested for anything else in Clinical trials?

Yes, there is a clinical trial ongoing for ALS in Australia.

The Phase I study, being run by Collaborative Medicinal Development Pty Limited, is a dose escalating study of Cu(II)ATSM to determine if this drug is safe for use in ALS (Click here for more on this study).


Cu(II)ATSM is an orally administered drug that inhibits the activity of misfolded SOD1 protein. It has been shown to paradoxically increase mutant SOD1 protein in a mouse model of ALS, but it also provides neuroprotection and improves the outcome for these mice (Click here to read more on this).

If this trial is successful, it would be interesting to test this drug on a cohort of people with Parkinson’s disease. Determining which subgroup of the Parkinson’s affected community would most benefit from this treatment is still to be determined. There is some evidence published last year that suggests people with genetic mutations in the Parkinson’s associated gene PARK2 could benefit from the approach (Click here to read more on this). More research, however, is needed in this area.

So what does it all mean?

Right, so summing up, a group of Australian researchers have reported that the ALS associated protein SOD1 is closely associated with the cell death that we observe in the brains of people with Parkinson’s disease.

They suggest that this could highlight a common mechanisms of toxic SOD1 aggregation in both Parkinson’s disease and ALS. Individuals within the Parkinson’s affected community do not appear to have any genetic mutations in the SOD1 gene, which makes this finding is very interesting.

What remains to be determined is whether SOD1 aggregation is a “primary pathological event”, or if it is secondary to some other disease causing agent. We are also waiting to see if a clinical trial targeting SOD1 in ALS is successful. If it is, there may be good reasons for targeting SOD1 as a novel treatment for Parkinson’s disease.

The banner for today’s post was sourced from Pinterest

Old dogs, new tricks – repurposing drugs for Parkinson’s



Exciting news this week from the world of neurodegenerative research. Researchers have identified two clinically available drugs that display neuroprotective properties.

The drugs – Dibenzoylmethane and Trazodone – are currently used to treat cancer and depression, respectively.

In this post, we will review the research and discuss what it could mean for folks with Parkinson’s disease.


Old drugs – new tricks? Source: Repurposingdrugs101

As you may have heard from media reports (for examples, click here, here and here), researchers have identified two clinically available drugs that may help in the fight against neurodegenerative conditions, like Parkinson’s disease.

The re-purposing of clinically available drugs is the focus of much attention within the Parkinson’s community as it represents a means of bringing treatments to the clinic faster. The traditional lengthy clinical trial process that is required in the development of new medications means getting a new drug to market for neurodegeneration can take up to 15 years, as the trials run over several years each (and there are three phases to pass through).


Shortening the wait. Source: Austinpublishing

In an age of smart phones and instant gratification, who has that kind of patience? ( #Wewontwait ).

Thus, re-purposing of available drugs represents a more rapid means of bringing new treatments/therapies to the Parkinson’s community.

So what is the new research all about?

This is Professor Giovanna Mallucci.


Prof Giovanna Mallucci. Source: MRC

She’s awesome.

She led the team from the Medical Research Council’s (MRC) Toxicology Unit (University of Leicester) that conducted the research and she is now based at the University of Cambridge.

Her area of research interest is understanding mechanisms of neurodegeneration, with a particular focus on prion and Alzheimer’s disease.

A few years ago, her group published this report:


Title: Sustained translational repression by eIF2α-P mediates prion neurodegeneration.
Authors: Moreno JA, Radford H, Peretti D, Steinert JR, Verity N, Martin MG, Halliday M, Morgan J, Dinsdale D, Ortori CA, Barrett DA, Tsaytler P, Bertolotti A, Willis AE, Bushell M, Mallucci GR.
Journal: Nature. 2012 May 6;485(7399):507-11.
PMID: 22622579              (This article is OPEN ACCESS if you would like to read it)

In this study, Prof Mallucci’s group were interested in the biological events that were occurring in the brain following infection of mice with prion disease – another neurodegenerative condition. They found that a sudden loss of protein associated with the connections between neurons (those connections being called synapses) occurred at 9 weeks post infection. This led them to investigate the production of protein and they found that an increase in the levels of phosphorylation of a protein called eIF2alpha was associated with the reduction in protein synthesis occurring at 9 weeks post infection.

What is Phosphorylation?

Phosphorylation of a protein is basically the process of turning it on or off – making it active or inactive – for a particular function.


Phosphorylation of a kinase protein. Source: Nature

And what is eIF2alpha?

Eukaryotic Translation Initiation Factor 2 Alpha is (as the label on the can suggests) a translation initiation factor. This means that this particular protein functions in the early steps of the production of protein. That is to say, eIF2alpha has important roles in the first steps – the initiation – of making other proteins.

Roles of eIF2 kinases in the pathogenesis of Alzheimer's disease

eIF2alpha’s role in neurodegeneration. Source: Frontiers

The increased phosphorylation of eIF2alpha results in the inactivation of eIF2alpha and therefore the transient shutdown of protein production.

This shutdown in protein production can serve as an important ‘checkpoint’ when a cell is stressed. By blocking general protein production, a damaged or stressed cell can have the opportunity to either recuperate or be eliminated (if the damage is beyond repair).

The shutdown can also be caused by the unfolded protein response (or UPR). The unfolded protein response is a protective mechanism triggered by rising levels of misfolded proteins.

What are misfolded proteins?

When proteins are being produced, they need to be folded into the correct shape to do their job. Things can turn ugly very quickly for a cell if protein are being misfolded or only partially folded.


Two proteins. Guess which is the misfolded protein. Source: Biogeekery

In fact, misfolded proteins are suspected of being responsible for many of the neurodegenerative conditions we know of (including Parkinson’s, Alzheimer’s, etc). Thus the unfolded protein response gives a cell time to stop protein production, degrade & dispose of any misfolded proteins, and then re-activate proteins involved with increasing the production again.

And Prof Mallucci’s group found an increase in the phosphorylation of eIF2alpha?

Yes. At 9 weeks post infection with prions, there is a decrease in the proteins required for maintaining the connections between neurons and an increase in the phosphorylation of eIF2alpha.

The interesting thing is that the researchers found that levels of phosphorylated eIF2alpha increased throughout the course of study.

So, the researchers asked themselves if promoting a recovery in protein production in the cells in neuroprotective. To test this they used a protein called GADD34, which is a specific eIF2alpha phosphatase (a phosphatase is a protein that dephosphates a protein). By introducing a lot of GADD34 in the cells, the researchers were able to re-activate eIF2alpha, rescue the connectivity between neurons and protect the cells from dying.

A cool trick, huh?

This report established the importance of eIF2alpha in the early stages of neurodegeneration, and Prof Mallucci and her group next decided to conduct a massive screening study of currently available medications to see which could be used to target eIF2alpha levels.

And that research gave rise to the report that caused so much excitement this week. This report here:

Title: Repurposed drugs targeting eIF2α-P-mediated translational repression prevent neurodegeneration in mice
Authors: Halliday M, Radford H, Zents KAM, Molloy C, Moreno JA, Verity NC, Smith E, Ortori CA, Barrett DA, Bushell M, Mallucci GR.
Journal: Brain, 2017 Epub early online publication
PMID: N/A         (This article is OPEN ACCESS if you would like to read it)

The investigators began by testing 1,040 compounds (that represent many of the clinically available drugs we have) on tiny microscopic worms (called C.elegans). These worms represent a useful experimental model for screening drugs as many aspects of biology can be examined. These worms were exposed to both a chemical (called tunicamycin, which induces the unfolded protein response we were talking about above) and one of the 1040 compounds.

Of the 1040 compounds tested, the investigators selected the 20 that provided the best protection to the worms. They next analysed those top 20 compounds for their ability to reduce levels of phosphorylated eIF2alpha in cells. Cells were engineered to produce a bioluminescent signal when eIF2alpha was phosphorylated. The researchers used a potent blocker of the unfolded protein response (called GSK2606414) and a drug called ISRIB (which is an experimental drug which reverses the effects of eIF2alpha phosphorylation) as controls for the experiment.

Their results were interesting:


The results of the top 20 drugs screened. Source: Brain

As you can see from the graph above, there were five compounds (highlighted with ***) that provided a similar level of reduction as the ISRIB (control) drug:

  • Azadirachtin – which is the active ingredient in many pesticides.
  • Dibenzoylmethane – a cancer treatment.
  • Proguanil – a medication used to treat and prevent malaria.
  • Trazodone – an antidepressant used to treat depression and anxiety disorders.
  • Trifluoperazine – an antipsychotic of the phenothiazine chemical class.

The investigators decided not to further investigate Azadirachtin as it is a pesticide and displays a poor ability to penetrant the blood-brain-barrier – the protective layer surrounding the brain. They also rejected Proguanil because while it is safe to use in humans, it is toxic in mice. This detail limited the amount of preclinical testing for neurodegeneration that the researchers could do. And finally Trifluoperazine was eliminated as it should not be used in the elderly populations (apparently it ‘increases the risk of death’!), which obviously limited it’s further utility given that age is a major determinant of neurodegeneration.

This selection process left the researchers with Dibenzoylmethane and Trazodone.

The researchers found that both of these drugs can cross the blood-brain-barrier and were able to prevent neurodegeneration and rescue behavioural deficits in prion-infected mice. And they observed no toxic effects of these treatments in other organs (such as the pancreas). The drugs restore correct protein production and increased the survival of the prion-infected mice.

Taking the study one step further, Prof Mallucci and her group asked if the drugs could be effective in a model of another neurodegenerative condition, such as Alzheimer’s disease. To investigated this, they treated rTg4510 mice with both of the drugs. rTg4510 mice produce a lot of a human protein (called tau) that has a particular mutation (known as P301L), which results in the onset of Alzheimer’s like pathology at an early age. The rTg4510 mice received either trazodone or Dibenzoylmethane on a daily basis from 4 months of age and were examined at 8 months of age. The researchers found significantly less cell loss and shrinkage in the brains of the mice treated with one of the two drugs when compared to rTg4510 mice that received no treatment.

The researchers concluded that “these compounds therefore represent potential new disease-modifying treatments for dementia. Trazodone in particular, a licensed drug, should now be tested in clinical trials in patients”.

As Professor Mallucci suggested to the press: “We know that trazodone is safe to use in humans, so a clinical trial is now possible to test whether the protective effects of the drug we see on brain cells in mice with neurodegeneration also applies to people in the early stages of Alzheimer’s disease and other dementias. We could know in 2-3 years whether this approach can slow down disease progression, which would be a very exciting first step in treating these disorders. Interestingly, trazodone has been used to treat the symptoms of patients in later stages of dementia, so we know it is safe for this group.  We now need to find out whether giving the drug to patients at an early stage could help arrest or slow down the disease through its effects on this pathway.”

This is great for Alzheimer’s disease, but what about Parkinson’s?

Well, the researchers did not test the drugs in models of Parkinson’s disease. But we can assume that several research groups are going to be testing this drug in the near future… if they aren’t already!

But have increased levels of eIF2alpha been seen in Parkinson’s disease?

Great question. And the answer is: Yes.


Title: Activation of the unfolded protein response in Parkinson’s disease.
Authors: Hoozemans JJ, van Haastert ES, Eikelenboom P, de Vos RA, Rozemuller JM, Scheper W.
Journal: Biochem Biophys Res Commun. 2007 Mar 16;354(3):707-11.
PMID: 17254549

In this study the investigators analysed the levels of Unfolded Protein Response activation in the postmortem brains of people who passed away with or without Parkinson’s disease. Specifically, they focused their analysis on the substantia nigra (the region where the dopamine neurons reside and which is most severely affected in Parkinson’s).

The researchers found that both eIF2alpha and a protein called PERK (also known as protein kinase-like ER kinase – which phosphalates eIF2alpha) are present in the dopamine neurons in the substantia nigra of brains from people with Parkinson’s disease, but not in healthy control brains. And as the graph below shows, the investigators noted that there was a trend towards the levels of these proteins peaking within the first five years after diagnosis.


eIF2alpha & PERK levels in the brain. Source: ScienceDirect

Similar postmortem analysis studies have also highlighted the increased levels of Unfolded Protein Response activation in the Parkinsonian brain (Click here to read more on this).

The increase in Unfolded Protein Response activation could be a common feature across different neurodegenerative conditions, suggesting that trazodone and dibenzoylmethane could be used widely to slow the progress of various conditions.

Another connection to Parkinson’s disease is the finding that high levels of the Parkinson’s associated protein alpha synuclein can cause the Unfolded Protein Response:

Title: Induction of the unfolded protein response by α-synuclein in experimental models of Parkinson’s disease.
Authors: Bellucci A, Navarria L, Zaltieri M, Falarti E, Bodei S, Sigala S, Battistin L, Spillantini M, Missale C, Spano P.
Journal: J Neurochem. 2011 Feb;116(4):588-605.
PMID: 21166675       (This article is OPEN ACCESS if you would like to read it)

The researchers in this study found that introducing large amounts of alpha synuclein into cell cultures results in the initiation of the unfolded protein response. They also observed this phenomenon in genetically engineered mice that produce large amounts of alpha synuclein.

Thus, there is some evidence for eIF2alpha and unfolded protein response-related activities in Parkinson’s disease

So is there are evidence that Dibenzoylmethane might be neuroprotective for Parkinson’s disease?

Yes there is (sort of):

Basic RGB

Title: A dibenzoylmethane derivative protects dopaminergic neurons against both oxidative stress and endoplasmic reticulum stress.
Authors: Takano K, Kitao Y, Tabata Y, Miura H, Sato K, Takuma K, Yamada K, Hibino S, Choshi T, Iinuma M, Suzuki H, Murakami R, Yamada M, Ogawa S, Hori O.
Journal: Am J Physiol Cell Physiol. 2007 Dec;293(6):C1884-94. Epub 2007 Oct 3.
PMID: 17913843             (This article is OPEN ACCESS if you would like to read it)

The investigators of this study found a derivative of dibenzoylmethane which they called 14-26 (chemical name 2,2′-dimethoxydibenzoylmethane) displayed neuroprotective functions both in cell culture and animal models of Parkinson’s disease. The researchers did not look at the unfolded protein response or eIF2alpha and PERK levels, nor did they determine if dibenzoylmethane itself exhibits neuroprotective properties.

This may now need to be re-addressed.

And is there any evidence trazodone having neuroprotective effects in other neurodegenerative conditions?


For a review of the neuroprotective effects of trazodone (and other anti-psychotic/anti-depressant drugs) in Huntington’s Disease – Click here.

This sounds very positive for Parkinson’s disease then, no?

Weeeeeell, there is a word of caution to be thrown in here:

There have been reports in the past of trazodone causing motor-related issues in the elderly. Such as this one:


Title: Can trazodone induce parkinsonism?
Authors: Albanese A, Rossi P, Altavista MC.
Journal: Clin Neuropharmacol. 1988 Apr;11(2):180-2.
PMID: 3378227

This report was a single case study of a 74 year old lady who developed depression after losing her sister with whom she lived. She was prescribed trazodone, which was effective in improving her mood. Just several months later, however, she began presenting Parkinsonian symptoms.

Firstly the onset of a resting tremor in the left arm, then a slowing of movement and a masking of the face. The attending physician withdrew the trazodone treatment and within two months the symptoms began to disappear, with no symptoms apparent 12 months later.

And unfortunately this is not an isolated case – other periodic reports of trazodone-induced motor issues have been reported (Click here and here for examples). And this is really strange as Trazodone apparently has no dopaminergic activity that we are aware of. It is a serotonin antagonist and reuptake inhibitor (SARI); it should not affect the re-uptake of norepinephrine or dopamine within the brain.

Thus, we may need to proceed with caution with the use of Trazodone for Parkinson’s disease.

So what does it all mean?

The repurposing of old drugs to treat alternative conditions is a very good idea. It means that we can test treatments that we usually know a great deal about (with regards to human usage) on diseases that they were not initially designed for, in a rapid manner.

Recently, scientists have identified two clinically available drugs that have displayed neuroprotection in two different models of neurodegeneration. Without doubt there will now be follow up investigations, before rapid efforts are made to set up clinical trials to test the efficacy of these drugs in humans suffering from dementia.

Whether these two treatments are useful for Parkinson’s disease still needs to be determined. There is evidence supporting the idea that they may well be, but caution should always be taken in how we proceed. This does not mean that other clinically available drugs can not be tested for Parkinson’s disease, however, and there are numerous clinical trials currently underway testing several of them (Click here to read more on this).

We’ll let you know when we hear anything about these efforts.

EDITOR’S NOTE: Under absolutely no circumstances should anyone reading this material consider it medical advice. The material provided here is for educational purposes only. Before considering or attempting any change in your treatment regime, PLEASE consult with your doctor or neurologist. While some of the drugs discussed on this website are clinically available, they may have serious side effects. We urge caution and professional consultation before altering any treatment regime. SoPD can not be held responsible for any actions taken based on the information provided here. 

The banner for today’s post was sourced from Linkedin

Iron, life force, and Parkinson’s disease


‘Prana’ is a Hindu Sanskrit word meaning “life force”.

An Australian biotech company has chosen this word for their name.

Recently Prana Biotechnology Ltd announced some exciting results from their Parkinson’s disease research programme.

In today’s post we will look at what the company is doing, the science underlying the business plan, and review the results they have so far.


Source: ADPD2017

At the end of March, over 3000 researchers in the field of neurodegeneration gathered in the Austrian capital of Vienna for the 13th International Conference on Alzheimer’s and Parkinson’s Diseases and Related Neurological Disorders (also known as ADPD2017).


The Vienna city hall. Source: EUtourists

A lot of interesting new research in the field of Parkinson’s disease was presented at the conference (we will look at some other presentation in future posts), but one was of particular interest to us here at SoPD HQ.

The poster entitled: Abstract: 104 – PBT434 prevents neuronal loss, motor function and cognitive impairment in preclinical models of movement disorders by modulation of intracellular iron’, was presented by Associate Professor David Finkelstein, of the Florey Institute of Neuroscience and Mental Health (Melbourne, Australia).

Unfortunately the ADPD2017 conference’s scientific programme search engine does not allow for individual abstracts to be linked to on the web so if you would like to read the abstract, you will need to click here for the search engine page and search for ‘PBT434’ or ‘Finkelstein’ in the appropriate boxes.

Prof Finkelstein was presenting preclinical research that had been conducted by an Australian biotech company called Prana Biotechnology Ltd.


Source: Prana Biotechnology Ltd

What does the company do?

Prana Biotechnology Ltd has a large portfolio of over 1000 small chemical agents that they have termed ‘MPACs’ (or Metal Protein Attenuating Compounds). These compounds are designed to interrupt the interactions between particular metals and target proteins in the brain. The goal of this interruption is to prevent deterioration of brain cells in neurodegenerative conditions.

For Parkinson’s disease, the company is proposing a particular iron chelator they have called PBT434.

What is an iron chelator?

Iron chelator therapy involves the removal of excess iron from the body with special drugs. Chelate is from the Greek word ‘chela’ meaning “claw”.


Chelator therapy. Source: Stanford

Iron overload in the body is a common medical problem, sometimes arising from disorders of increased iron absorption such as hereditary haemochromatosis. Iron chelator therapy represents one method of reducing the levels of iron in the body.

But why is iron overload a problem?


Iron. Source: GlobalSpec

Good question. It involves the basic properties of iron.

Iron is a chemical element (symbol Fe). It has the atomic number 26 and by mass it is the most common element on Earth (it makes up much of Earth’s outer and inner core). It is absolutely essential for cellular life on this planet as it is involved with the interactions between proteins and enzymes, critical in the transport of oxygen, and required for the regulation of cell growth and differentiation.

So why then – as Rosalind asked in Shakespeare’s As You Like It – “can one desire too much of a good thing?”

Well, if you think back to high school chemistry class you may recall that there are these things called electrons. And if you have a really good memory, you will recall that the chemical hydrogen has one electron, while iron has 26 (hence the atomic number 26).


The electrons of iron and hydrogen. Source: Hypertonicblog

Iron has a really interesting property: it has the ability to either donate or take electrons. And this ability to mediate electron transfer is one of the reasons why iron is so important in the body.

Iron’s ability to donate and accept electrons means that when there is a lot of iron present it can inadvertently cause the production of free radicals. We have previously discussed free radicals (Click here for that post), but basically a free radical is an unstable molecule – unstable because they are missing electrons.


How free radicals and antioxidants work. Source: h2miraclewater

In an unstable format, free radicals bounce all over the place, reacting quickly with other molecules, trying to capture the much needed electron to re-gain stability. Free radicals will literally attack the nearest stable molecule, to steal an electron. This leads to the “attacked” molecule becoming a free radical itself, and thus a chain reaction is started. Inside a living cell this can cause terrible damage, ultimately killing the cell.

Antioxidants can help try and restore the balance, but in the case of iron overload iron doctors will prescribe chelator treatment to deal with the situation more efficiently. By soaking up excess iron, we can limit the amount of damage caused by the surplus of iron.

So what research has been done regarding iron content and the Parkinsonian brain?

Actually, quite a lot.

In 1968, Dr Kenneth Earle used an X-ray based technique to examine the amount of iron in the substantia nigra of people with Parkinson’s disease (Source). The substantial nigra is one of the regions in the brain most badly damaged by the condition – it is where most of the brain’s dopamine neurones resided.


The dark pigmented dopamine neurons in the substantia nigra are reduced in the Parkinson’s disease brain (right). Source:Memorangapp

Earle examined 11 samples and compared them to unknown number of control samples and his results were a little startling:

The concentration of iron in Parkinsonian samples was two times higher than that of the control samples.

Since that first study, approximately 30 investigations have been made into levels of iron in the Parkinsonian brain. Eleven of those studies have replicated the Earle study by looking at postmortem tissue. They have used different techniques and the results have varied somewhat:

  • Sofic et al. (1988)                             1.8x increase in iron levels
  • Dexter et al. (1989)                         1.3x increase in iron levels
  • Uitti et al. (1989)                              1.1x increase in iron levels
  • Riederer et al 1989                         1.3x increase in iron levels
  • Griffiths and Crossman (1993)     2.0x increase in iron levels
  • Mann et al. (1994)                           1.6x increase in iron levels
  • Loeffler et al. (1995)                       0.9   (lower)
  • Galazka-Friedman et al., 1996     1.0   (no difference)
  • Wypijewska et al. (2010)               1.0   (no difference)
  • Visanji et al, 2013                            1.7x increase in iron levels

Overall, however, there does appear to be a trend in the direction of higher levels of iron in the Parkinsonian brains. A recent meta-analysis of all this data confirmed this assessment as well as noting an increase in the caudate putamen (the region of the brain where the dopamine neuron branches release their dopamine – Click here for that study).

Brain imaging of iron (using transcranial sonography and magnetic resonance imaging (MRI)) has also demonstrated a strong correlation between iron levels in the substantia nigra region and Parkinson’s disease severity/duration (Click here and here to read more on this).

Thus, there appears to be an increase of iron in the regions most affected by Parkinson’s disease and this finding has lead researchers to ask whether reducing this increase in iron may help in the treatment of Parkinson’s disease.

How could iron overload be bad in Parkinson’s disease?

Well in addition to causing the production of free radicals, there are many possible ways in which iron accumulation could be aggravating cell loss in Parkinson’s disease.


Possible causes and consequences of iron overload in Parkinson’s disease. Source: Hindawi

High levels of iron can cause the oxidation of dopamine, which results in the production of hydrogen peroxide (H2O– a reactive oxygen species – the stuff that is used to bleach hair and is also used as a propellant in rocketry!). This reaction can cause further oxidative stress that can then lead to a range of consequences including protein misfolding, lipid peroxidation (which can cause the accumulation of the Parkinson’s associated protein alpha synuclein), mitochondrial dysfunction, and activation of immune cells in the brain.

And this is just a taster of the consequences.

For further reading on this topic we recommend two very good reviews – click here and here.

Ok, so iron overload is bad, but what was the research presented in Austria?

The abstract:

Title: PBT434 prevents neuronal loss, motor function and cognitive impairment in preclinical models of movement disorders by modulation of intracellular iron
Authors: D. Finkelstein, P. Adlard, E. Gautier, J. Parsons, P. Huggins, K. Barnham, R. Cherny
Location: C01.a Posters – Theme C – Alpha-Synucleinopathies

The researchers at Prana Biotechnology Ltd assessed the potential of one of their candidate drugs, PBT434, in both cell culture and animal models of Parkinson’s disease. The PBT434 drug was selected for further investigation based on its performance in cell culture assays designed to test the inhibition of oxidative stress and iron-mediated aggregation of Parkinson’s associated proteins like alpha synuclein.

PBT434 significantly reduced the accumulation of alpha synuclein and markers of oxidative stress, and prevented neuronal loss.

The investigators also demonstrated that orally administered PBT434 readily crossed the blood brain barrier and entered the brain. In addition the drug was well-tolerated in the experimental animals and improved motor function in toxin-induced (MPTP and 6-hydroxydopamine) and transgenic mouse models of Parkinson’s disease (alpha synuclein -A53T and tau – rTg4510).

These results are in agreement with previous studies that have looked at iron chelator therapy in models of Parkinson’s disease (Click here, here and here for some examples)

Interestingly, PBT434 also demonstrated neuroprotective properties in animal models of multiple systems atrophy (or MSA). Suggesting that perhaps iron chelation could be a broad neuroprotective approach.

The researchers concluded that this preclinical data demonstrates the efficacy of PBT434 as a clinical candidate for Parkinson’s disease. PBT434 shows a strong toxicology profile and favourable therapeutic activity.  Prana is preparing its pre-clinical development package for PBT434 to initiate human clinical trials.

Does Prana have any other drugs in clinical trials?

Yes, they do.


Source: Prana

Prana Biotechnology has another product called PBT2.

The company currently has two clinical trial programs for PBT2 focused on two other neurodegenerative diseases: Alzheimer’s disease and Huntington’s disease.

The Alzheimer’s study was called the IMAGINE Trial, but (there is always a ‘but’) recently PBT2 failed to meet its primary endpoint (significantly reducing levels of beta-amyloid  – the perceived bad guy in Alzheimer’s disease) in a phase III trial of mild Alzheimer’s disease. PBT2 was, however, shown to be safe and very well tolerated over the 52 week trial, with no difference in the occurrence of adverse events between the placebo and treated groups.

In addition, there was less atrophy (shrinkage) in the brains of those patients treated with PBT2 when compared to control brains, 2.6% and 4.0%, respectively (based on brain imaging).  The company is tracking measures of brain volume and cognition in a 12 month extension study. It could be interesting to continue that follow up long term to evaluate the consequences of long term use of this drug on Alzheimer’s disease – even if the effect is minimal, any drug that can slow the disease down is useful and could be used in conjunction with other neuroprotective medications.

For Huntington’s disease, the company is also using the PBT2 drug and this study has had a bit more success. The study, called Reach2HD, was a six month phase II clinical trial in 109 patients with early to mid-stage Huntington’s disease, across 20 sites in the US and Australia. The company was aiming to assess the safety profile of this drug in this particular condition, as well as determining the motor and behavioural benefits.

In the ReachHD study, PBT2 showed signs of improving some aspects of cognitive function in the study, which potentially represents a major event for a disease for which there is very little in the way of medical treatments.

For a full description of the PBT2 trials, see this wikipedia page on the topic.

Is Prana the only research group working on iron chelators technology for Parkinson’s disease?


There is a large EU-based consortium called FAIR PARK II, which is running a five year trial (2015 – 2020) of the iron chelator deferiprone (also known as Ferriprox). The study is a multi-centre, placebo-controlled, randomised clinical trial involving 338 people with recently diagnosed Parkinson’s disease.


The population will be divided into two group (169 subjects each). They will then be assigned either deferiprone (15 mg/kg twice a day) or a placebo. Each subject will be given 9-months of treatment followed by a 1-month post-treatment monitoring period, in order to assess the disease-modifying effect of deferiprone (versus placebo).


Deferiprone. Source: SGPharma

As far as we are aware, this FAIR PARK II clinical trial is still recruiting participants – please click here to read more about this – thus it will most likely be some time before we hear the results of this study.

Are there natural sources of chelators?

Yes there are. In fact, many natural antioxidants exert some chelating activities.

Prominent among the natural sources of chelators: Green tea has components of plant extracts, such as epigallocatechin gallate (EGCG – which we have previously discussed in regards to Parkinson’s disease, click here to read that post) which possess structures which infer metal chelating properties.

As we have said before people, drink more green tea!

cup and teapot of linden tea and flowers isolated on white

Anyone fancy a cuppa? Source: Expertrain

So what does it all mean?

Summing up: We do not know what causes Parkinson’s disease. Most of our experimental treatments are focused on the biological events that occur in the brain around and after the time of diagnosis. These include an apparent accumulation of iron in affected brain regions.

Research groups are currently experimenting with drugs that reduce the levels of iron in the brain as a potential treatment for Parkinson’s disease. Preclinical data certainly look positive. We will now have to wait and see if those results translate into the human.

Previous clinical trials of metal chelators in neurodegeneration have had mixed success in demonstrating positive benefits. It may well be, however, that this treatment approach should be used in conjunction with other neuroprotective approaches – as a supplement. It will be interesting to see how Prana Biotechnology’s drug PBT434 fares in human clinical trials for Parkinson’s disease.

Stay tuned for more on this.

UPDATE – 3rd May 2017

Today the results of a double-blind, phase II clinical trial of iron chelator deferiprone in Parkinson’s disease were published. The results of the study indicate a mildly positive effect (though not statistically significant) after 6 months of daily treatment.

Title: Brain iron chelation by deferiprone in a phase 2 randomised double-blinded placebo controlled clinical trial in Parkinson’s disease
Authors: Martin-Bastida A, Ward RJ, Newbould R, Piccini P, Sharp D, Kabba C, Patel MC, Spino M, Connelly J, Tricta F, Crichton RR & Dexter DT
Journal: Scientific Reports (2017), 7, 1398.
PMID: 28469157        (This article is OPEN ACCESS if you would like to read it)

In this Phase 2 randomised, double-blinded, placebo controlled clinical trial, the researchers recruited 22 people with early stage Parkinson’s disease (disease duration of less than 5 years; 12 males and 10 females; aged 50–75 years). They were randomly assigned to either a placebo group (8 participants), or one of two deferiprone treated groups: 20mg/kg per day (7 participants) or 30mg/kg per day (7 participants). The treatment was two daily oral doses (taken morning and evening), and administered for 6 months with neurological examinations, brain imaging and blood sample collections being conducted at 0, 3 and 6 months.

Deferiprone therapy was well tolerated and brain imaging indicated clearance of iron from various parts of the brain in the treatment group compared to the placebo group. Interestingly, the 30mg/kg deferiprone treated group demonstrated a trend for improvement in motor-UPDRS scores and quality of life (although this was not statistically significance). The researchers concluded that “more extensive clinical trials into the potential benefits of iron chelation in PD”.

Given the size of the groups (7 people) and the length of the treatment period (only 6 months) in this study it is not really a surprise that the researchers did not see a major effect. That said, it is very intriguing that they did see a trend towards motor score benefits in the  30mg/kg deferiprone group – remembering that this is a double blind study (so even the investigators were blind as to which group the subjects were in).

We will now wait to see what the FAIR PARK II clinical trial finds.

FULL DISCLOSURE: Prana Biotechnology Ltd is an Australasian biotechnology company that is publicly listed on the ASX. The information presented here is for educational purposes. Under no circumstances should investment decisions be made based on the information provided here. The SoPD website has no financial or beneficial connection to either company. We have not been approached/contacted by the company to produce this post, nor have we alerted them to its production. We are simply presenting this information here as we thought the science of what the company is doing might be of interest to other readers. 

In addition, under absolutely no circumstances should anyone reading this material consider it medical advice. The material provided here is for educational purposes only. Before considering or attempting any change in your treatment regime, PLEASE consult with your doctor or neurologist. Metal chelators are clinically available medications, but it is not without side effects (for more on this, see this website). We urge caution and professional consultation before altering a treatment regime. SoPD can not be held responsible for any actions taken based on the information provided here. 

The banner for today’s post was sourced from Prana

Editorial: Putting 200 years into context


Here at the SoPD we understand and are deeply sympathetic to the frustration felt by the Parkinson’s community regarding the idea of ‘200 years and still no cure’.

As research scientists, we are in the trench everyday – fighting the good fight – trying to find ways of alleviating this terrible condition. And some of us are also in the clinics, interacting with sufferers and their families, listening to their stories and trying to help. While we do not deal directly with the day-to-day trials of living with Parkinson’s disease, we are keenly aware of many of the issues and are fully invested in trying to correct this condition.


Source: Wikipedia

We do feel, however, that it is important to put some context into that ‘200 years’ time point that we are observing this week. It is too easy for people to think “wow, 200 years and still no cure?”

In our previous post – made in collaboration with Prof Frank Church of the Journey with Parkinson’s blog – we listed the major historical milestones and discoveries made in the Parkinson’s disease field during the last 200 years.

The most striking feature of that time line, however, is how just little actually happened during the first 100 years.

In fact for most of that period, Parkinson’s disease wasn’t even called ‘Parkinson’s disease’.

Of the 48 events that we covered on that time line, 37 of them have occurred in the last 50 years (26 since 2000).

Taking this line of thought one step further, 2017 is also the 20 year anniversary of the discovery of alpha synuclein‘s association with Parkinson’s disease. And what a remarkable 20 years that has been. In 1997, a group of researcher at the National institute of Health led by Robert Nussbaum reported the first genetic mutation in the alpha synuclein gene that infers vulnerability to Parkinson’s disease.

Since then, we have:

  • identified multiple additional mutations within that same gene that increase the risk of developing Parkinson’s disease.
  • determined which forms of alpha synuclein are toxic.
  • identified alpha synuclein as an important component of Lewy bodies – the dense clusters of protein found in the Parkinsonian brain.
  • discovered numerous methods by which alpha synuclein can be passed between cells – potentially aiding in the spread of Parkinson’s disease.
  • developed and validated models of Parkinson’s disease based on manipulations of alpha synuclein (including numerous genetically engineered mice, viral over-expression models, etc).
  • identified alpha synuclein in the lining of the gut of people with Parkinson’s disease and this has aided us in developing new theories as to how the condition may start.
  • set up and run numerous clinical trials targeting alpha synuclein (and we eagerly await the results of those trials).
  • published over 6200 scientific papers (don’t believe me? Click here) – that’s over 300 publications per year!


Alpha synuclein protein. Source: Wikipedia

And the truly amazing part? All of these particular achievements are only dealing with just the one gene: alpha synuclein.

Since the identification of the alpha synuclein mutations, we have subsequently discovered genetic mutations in over 20 other genes that increase the risk of developing Parkinson’s disease. And we have conducted the same activities/experiments for most of those genes as we have for alpha synuclein.

For example, in 2004 we discovered that people with genetic mutations in a gene called glucocerebrosidase (or GBA) had an increased risk of developing Parkinson’s disease. In 2016, just 12 years after that discovery we have started a clinical trial designed specifically for those people (Click here for more on this).


Source: Parkinson’s UK

We here at the SoPD are fully supportive of campaigns like #WeWontWait, and this post was not written (nor meant to be taken) as an excuse response to the ‘200 years and no cure’ frustration. I can understand how it may be read that way, but I did not know how else to write it. And I thought it needed to be written.

The point of this entire post is that those 200 years need to be put into context.

And while all of these words aren’t going to make life easier for someone living with Parkinson’s to deal with their situation, in addition to raising awareness this week I think it is important for the Parkinson’s community to also understand just how far we have come, and how fast we are currently progressing.

The question can be asked: will this be the last major anniversary we acknowledge with regards to Parkinson’s disease?

I sincerely think that there is cause to hope that it is.


Let me finish with a personal note:

I have a good friend – let’s call him Matt.

As a young boy, Matt remembers his grandfather having Parkinson’s disease. He remembers growing up watching the trials and tribulations that the old man went through with the condition. There were basically no treatment options when Matt’s grandfather was diagnosed and little in the way of support for the family. His grandfather’s body simply froze up as the disease progressed. L-dopa probably only became available to Matt’s grandfather during the latter stages of the disease.

Four years ago Matt’s father was diagnosed with Parkinson’s disease.

Thanks to scientific advances, however, Matt’s dad now has a wide range of treatment options on the medication side of things. The disease can be managed so that he can still play his golf and enjoy his retirement – in a way that his own father never could. He also has numerous surgical options once those medications lose their effectiveness (eg. deep brain stimulation, Pallidotomy, etc). The chances are very likely that Matt’s father will pass on by natural causes before he requires many of those additional options.

This is the progress that we have made.

But there is still a lot of work to be done of course.

During a lunch shortly after his father’s diagnosis, Matt looked squarely across the table at me. Me, the Parkinson’s researcher. All of the usual jovial nature was missing from his face and he simply muttered the words ‘hurry up’.

Whether he was speaking for his father, himself or his own young kids, I understood where his words were coming from and the sentiment.

And, as this post and the previous post point out, we are hurrying up.

The banner for today’s post was sourced from BMO

Hepatitis – Parkinson’s goes viral?


Last week a new piece of Parkinson’s disease research has been widely discussed in the media.

It involves Hepatitis – the viral version of it at least.

In today’s post we will review the research and discuss what it may mean for Parkinson’s disease.


A lewy body (brown with a black arrow) inside a cell. Source: Cure Dementia

A definitive diagnosis of Parkinson’s disease can only be made at the postmortem stage with an examination of the brain. Until that moment, all cases of Parkinson’s disease are ‘suspected’.

Critical to that postmortem diagnosis is the presence of circular shaped, dense clusters of proteins, called Lewy bodies (see the image above for a good example).

What causes Lewy bodies? We don’t know, but many people have theories.

This is Friedrich Heinrich Lewy (1885-1950).


Friedrich Lewy. Source: Lewy Body Society

As you can probably guess, Friedrich was the first to discover the ‘Lewy body’. His finding came by examining the brains of 85 people who died with Parkinson’s disease between 1908 – 1923.

In 1931, Friedrich Lewy read a paper at the International Congress of Neurology in Bern. During that talk he noted the similarities between the circular inclusions (called ‘negri bodies’) in the brains of people who suffered from rabies and his own Lewy bodies (observed in Parkinson’s disease).


A Negri body in a cell affected by rabies (arrow). Source: Nethealthbook

Given the similarities, Lewy proposed a viral cause for Parkinson’s disease.

Now, the idea that Parkinson’s disease could have a viral component has existed for a long time – even before Lewy made his conclusion. As we have previous mentioned, theories of viral causes for Parkinson’s have been circulating ever since the 1918 flu pandemic (Click here to read our post on this topic).


An example of post-encephalitic Parkinsonism. Source: Baillement

About the same time as the influenza virus was causing havoc around the world, another condition began to appear called ‘encephalitis lethargica‘ (also known as post-encephalitic Parkinsonism). This disease left many of the victims in a statue-like condition, both motionless and speechless – similar to Parkinson’s disease. Initially, it was assumed that the influenza virus was the causal factor, but more recent research has left us not so sure anymore.

Since then there, however, has been additional bits of evidence suggesting a viral role in Parkinson’s disease. Such as this report:


Title: Highly pathogenic H5N1 influenza virus can enter the central nervous system and induce neuroinflammation and neurodegeneration.
Author: Jang H, Boltz D, Sturm-Ramirez K, Shepherd KR, Jiao Y, Webster R, Smeyne RJ.
Journal: Proc Natl Acad Sci U S A. 2009 Aug 18;106(33):14063-8.
PMID: 19667183

The researchers in this study found that when they injected the highly infectious H5N1 influenza virus into mice, the virus progressed from the periphery (outside the brain) into the brain itself, where it induced Parkinson’s disease-like symptoms. The virus also caused a significant increase in the accumulation of the Parkinson’s associated protein Alpha Synuclein. Importantly, they witnessed the loss of dopamine neurons in the midbrain of the mice 60 days after resolution of the infection – that cell loss resembling what is observed in the brains of people with Parkinson’s disease.

The Parkinson’s associated protein alpha synuclein has also recently demonstrated anti-viral properties:


Title: Alpha-Synuclein Expression Restricts RNA Viral Infections in the Brain.
Authors: Beatman EL, Massey A, Shives KD, Burrack KS, Chamanian M, Morrison TE, Beckham JD.
Journal: J Virol. 2015 Dec 30;90(6):2767-82. doi: 10.1128/JVI.02949-15.
PMID: 26719256               (This article is OPEN ACCESS if you would like to read it)

David Beckham (not the football player) and his research colleagues introduced West nile virus to brain cells grown in cell culture and they observed an increase in alpha synuclein production. They also found that the brains of people with West nile infections had increased levels of alpha synuclein.

The researchers then injected West Nile virus into both normal mice and genetically engineered mice (which produced no alpha synuclein) and they found that the genetically engineered mice which produced no alpha synuclein died quicker than the normal mice. They reported that there was an almost 10x increase in viral production in the genetically engineered mice. This suggested to them that alpha synuclein may be playing a role in protecting cells from viral infections.

Interesting, but what about this new data involving Hepatitis?

Yes, indeed. Let’s move on.

Wait a minute, what is Hepatitis exactly?

The name Hepatitis comes from the Greek: Hepat – liver; and itis – inflammation, burning sensation. Thus – as the label suggests – Hepatitis is inflammation of liver tissue.


Hepatitis and the liver. Source: HealthandLovepage

It can be caused by infectious agents (such as viruses, bacteria, and parasites), metabolic changes (induced by drugs and alcohol), or autoimmune/genetic causes (involving a genetic predisposition).

The most common cause of hepatitis is viral.

There are five main types of viral hepatitis (labelled A, B, C, D, and E). Hepatitis A and E are mainly spread by contaminated food and water. Both hepatitis B and hepatitis C are commonly spread through infected blood (though Hepatitis B is mainly sexually transmitted). Curiously, Hepatitis D can only infect people already infected with hepatitis B.

Hepatitis A, B, and D are preventable via the use of immunisation. A vaccine for hepatitis E has been developed and is licensed in China, but is not yet available elsewhere

Hepatitis C, however, is different.

There is currently no vaccine for it, mainly because the virus is highly variable between strains and the virus mutates very quickly, making an effective vaccine a difficult task. A number of vaccines under development (Click here for more on this).

What is known about Hepatitis C and the brain?

Quite a bit.

Similar to HIV (which we discussed in a previous post), the hepatitis C virus (HCV) enters the brain via infected blood-derived macrophage cells. In the brain, it is hosted by microglial cells, which results in altered functioning of those microglial cells. This causes problems for neuronal cells – including dopamine neurons. For example, people infected with HCV have reduced dopamine transmission, based on brain imaging studies (Click here and here for more on this result).

Have there been connections between hepatitis C virus and Parkinson’s disease before?




Title: Hepatitis C virus infection: a risk factor for Parkinson’s disease.
Authors: Wu WY, Kang KH, Chen SL, Chiu SY, Yen AM, Fann JC, Su CW, Liu HC, Lee CZ, Fu WM, Chen HH, Liou HH.
Journal: J Viral Hepat. 2015 Oct;22(10):784-91.
PMID: 25608223

The researchers in this study used data collected from a community-based screening program in north Taiwan which involved 62,276 people. The World Health Organisation (WHO) estimates that the prevalence of hepatitis C viral infection worldwide is approximately 2.2–3%, representing 130–170 million people. Taiwan is a high risk area for hepatitis, with antibodies for hepatitis viruses in Taiwan present in 4.4% in the general population (Source).

The researchers found that the significant association between hepatitis C viral infections and Parkinson’s disease – that is to say, a previous infection of hepatitis C increased the risk of developing Parkinson’s disease (by 40%). The researchers then looked at what the hepatitis C and B viral infections do to dopamine neurons growing in cell culture. They found that hepatitis C virus induced 60% dopaminergic cell death, while hepatitis B had no effect.

This study was followed up a few months later, by a second study suggesting an association between Hepatitis C virus and Parkinson’s disease:

Hep title

Title: Hepatitis C virus infection as a risk factor for Parkinson disease: A nationwide cohort study.
Authors: Tsai HH, Liou HH, Muo CH, Lee CZ, Yen RF, Kao CH.
Journal: Neurology. 2016 Mar 1;86(9):840-6.
PMID: 26701382

The researchers in this study wanted to investigate whether hepatitis C could be a risk factor for Parkinson’s disease. They did this by analyzing data from 2000-2010 drawn again from the Taiwan National Health Insurance Research Database.

The database included 49,967 people with either hepatitis B, hepatitis C or both, in addition to 199,868 people without hepatitis. During the 12 year period, 270 participants who had a history of hepatitis developed Parkinson’s disease (120 still had hepatitis C). This compared with 1,060 participants who were free of hepatitis, but went on to develop Parkinson’s disease.

When the researchers controlled for potentially confounding factors (such as age, sex, etc), the researchers found participants with hepatitis C had a 30% greater risk of developing Parkinson’s disease than the controls.

So if this has been demonstrated, why is this new study last week so important?

Good question.

The answer is very simple: This study is not based on statistics from Taiwan – this new study has found the same result from a new population.


Title: Viral hepatitis and Parkinson disease: A national record-linkage study.
Authors: Pakpoor J, Noyce A, Goldacre R, Selkihova M, Mullin S, Schrag A, Lees A, Goldacre M.
Journal: Neurology. 2017 Mar 29. [Epub ahead of print]
PMID: 28356465

These researchers used the English National Hospital Episode Statistics database and linked it to mortality data collected from 1999 till 2011. They too have found a strong association between hepatitis C and Parkinson’s disease (standardized rate ratio 1.51, 95% CI 1.18–1.9).

Curiously (and different from the previous studies), the researchers in this study also found a strong association for hepatitis B and Parkinson’s disease (standardized rate ratio 1.76, 95% CI 1.28–2.37). And these associations appear to be specific to Hepatitis B and C, as the investigators did not find any association between autoimmune hepatitis, chronic hepatitis, or HIV.

One important caveat with this new study, however, is that the authors could not
control for lifestyle factors (such as smoking or alcohol consumption). In addition, their system of linking medical records may underestimate the numbers of patients with
Parkinson’s disease as it would not take into account people with Parkinson’s disease who do not seek medical advice or those who are misdiagnosed (given a wrong diagnosis – it does happen!).

Regardless of these cautionary notes, the results still add to the accumulating evidence of an association between the virus that causes Hepatitis and the neurodegenerative condition of Parkinson’s disease.

But what about those people with Parkinson’s disease who have never had Hepatitis?

Yeah, this is a good question.

But there is a rather uncomfortable answer to it.

Here’s the rub: “Approximately 70%–80% of people with acute Hepatitis C do not have any symptoms” (Source: Centre for Disease Control). That is to say, the majority of people infected with the Hepatitis C virus will not be aware that they are infected. Some of those people who are infected may think that they have a case of the flu (HCV symptoms include fever, fatigue, loss of appetite,…), while others will simply not display any symptoms at all.

So many people with Parkinson’s disease may have had HCV, but never been aware of it.

And this is the really difficult part of researching the causal elements of Parkinson’s disease.

The responsible agent may actually leave little or no sign that they were ever present. For a long time, people have suggested that Parkinson’s disease is caused by a thief in the night – some agent that comes in, causes a problem and disappears without detection.

Perhaps Hepatitis is that thief.

But hang on a second, 60–70% of HCV infected people will go on to develop chronic liver disease (Source). Do people with Parkinson’s disease have liver issue?

Umm, well actually, in some cases: yes.

There have been studies of liver function in Parkinson’s disease where abnormalities have been found (Click here for more on this). And dopamine cell dysfunction has been seen in people with cirrhosis issues (Click here for more on this). In fact, the prevalence of Parkinsonism in people with cirrhosis has been estimated to be as high as 20% (and Click here for more on that).

So what are we saying? Hepatitis causes Parkinson’s disease???

No, we are not saying that.

Proving causality is the hardest task in science.

In addition, there have been a few studies in the past that have looked at viral infections as the cause of Parkinson’s disease that found strong associations with other viruses. For example this study:

Title: Infections as a risk factor for Parkinson’s disease: a case-control study.
Authors: Vlajinac H, Dzoljic E, Maksimovic J, Marinkovic J, Sipetic S, Kostic V.
Journal: Int J Neurosci. 2013 May;123(5):329-32.
PMID: 23270425

In this study, the researchers found that Parkinson’s Disease was also significantly associated to mumps, scarlet fever, influenza, and whooping cough as well as herpes simplex 1 infections. They found no association between Parkinson’s disease and Tuberculosis, measles or chickenpox though.

This result raises the tantalizing possibility that other viruses may also be involved with the onset of Parkinson’s disease (it should be added though that this study was based on only 110 people with Parkinson’s (compared with 220 controls) in one particular geographical location (Belgrade, Serbia)).

So different viruses may cause Parkinson’s disease?

We are not saying that either, but we would like to see more research on this topic.

And the situation may actually be more complicated than we think.

Recently, it has been reported that previous infection with flaviviruses (such as dengue) actually enhances the effect of Zika virus infect (Click here to read more on this). That is to say, a prior infection by one particular virus may exacerbate the infection of another virus. It could be that a previous infection by one virus increases that chance that a later infection by another virus – a particular combination of viral infections – may result in Parkinsonian symptoms (we are simply speculating here). 

Add to this complicated situation, the sheer number of unknown viruses. It is estimated that there are a minimum of 320,000 mammalian viruses still awaiting discovery (Click here for the source of this statistic), thus it is possible that additional unknown viruses may be involved with disease initiation for conditions like Parkinson’s disease.

A gang of unknown thieves in the night perhaps?

So what does it all mean?

Summing up: last week a new study was published that supported previous results that Hepatitis C viral infections could increase the risk of developing Parkinson’s disease. The results are important because they replicate previous findings from a different population of people.

The findings do not immediately mean that people with Hepatitis C are going to develop Parkinson’s disease, but it does suggest that they may be more vulnerable. The findings also suggest that more research is needed on the role of viral/infectious agents in the development of Parkinson’s disease.

We would certainly like to see more research in this area.

The banner for today’s post was sourced from Youtube