Parkinson's disease: the digestive tract, an open window to the brain!

September 14 2010

Deducing the presence and size of brain lesions in patients afflicted with Parkinson's disease, from simple colon biopsies, is the latest result to emerge from from research performed by the Inserm teams at Nantes. Pascal Derkinderen, Michel Neunlist and Stanislas Bruley from Varannes and their collaborators from Inserm Unit 913 "Enteric nervous system neuropathies and digestive pathologies: the implication of enteric glial cells", from the Clinical Investigation Centre and from the CHU in Nantes have shown that the well-known anomalies in the neurons of Parkinson's patients are found identically in the digestive neurons. Moreover, the size of the observed lesions correlates with the severity of the illness.This work has been published today in the journal Plos One.

Parkinson's disease has long been identified as a neurodegenerative disorder of the central nervous system which causes the motor indications of the disease (muscular rigidity and difficulties in carrying out rapid alternating gestures). However, it is now clearly established that the lesions of Parkinson's disease are not limited to the central nervous system but also afflict the peripheral nervous systems.

This recent advance has allowed a major practical problem in the study of Parkinson's disease to be solved: how to study lesions in living patients. Effectively, whereas access to the central nervous system is only possible after the death of the patients, the peripheral nervous systems, and particularly the enteric system (see box), have the advantage of being able to be studied "in vivo".

The researchers analysed simple colon biopsies routinely obtained from 39 patients (29 afflicted with Parkinson's disease and 10 controls). With their extensive experience in understanding the enteric nervous system, they were able to successfully quantify and qualify digestive neurons taken from the biopsies.

In 21 of the 29 Parkinson's patients, the Inserm researchers uncovered anomalies in the digestive neurons identical to the anomalies present in the central nervous system (the Lewry neurites) (see figure). They were also able to establish a link between the lesions and the clinical symptoms: the size of the lesions was correlated to the severity of Parkinson's disease.

Figure: Immunomarking of the submucous plexus taken from colonic biopsies. A. Markers allowing the number of neurons to be counted and identification of the extensions B. Identification of the pathological inclusions (Lewy neurites) in certain extensions identified by the marking of the neurofilaments. Scale 30 μm.

Figure: Immunomarking of the submucous plexus taken from colonic biopsies. A. Markers allowing the number of neurons to be counted and identification of the extensions B. Identification of the pathological inclusions (Lewy neurites) in certain extensions identified by the marking of the neurofilaments. Scale 30 μm.

The results of this study show, for the first time, that analysis of the enteric nervous system provides a genuine "open window" on the central nervous system. Furthermore, the observed link between the lesions and the clinical symptoms represents a useful severity indicator for Parkinson's disease. "The progress of the disease could hence be determined from analysis of simple colic biopsies carried out in the hospital using colonoscopy studies or recto-sigmoidoscopy", explains Pascal Derkinderen. If our results are confirmed on the larger scale, it will be possible to make a diagnosis of the severity of Parkinson's disease in living patients and to adjust their treatment and control", conclude the researchers.

 

(1) Lewy bodies and neurites are abnormal deposits of a protein which forms inside the nerve cells of the brain. They were described and identified in 1913 in the central nervous system of individuals afflicted by Parkinson's disease. Since then, they have been used as an indicator for this disease.


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Source
Colonic biopsies to assess the neuropathology of Parkinson's disease and its relationship with symptoms
Plos One, 14 September 2010

Research contact
Pascal Derkinderen
Inserm Unit 913
CIC-04, neurology department
E-mail: derkinderenp@yahoo.fr; pascal.derkinderen@chu-nantes.fr
Tel: 02 40 16 52 05 ; 02 40 08 75 14 ; 06 47 94 13 70

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