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Clinical research

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Main article: Research in Parkinson's disease
Astronaut Alexander Gerst conducts Parkinson's research aboard the International Space Station in 2018

As of 2024, no disease-modifying therapies exist that reverse or slow the progression of Parkinson's.[1][2] Active research directions include the search for new animal models of the disease and studies of the potential usefulness of gene therapy, stem cell transplants, and neuroprotective agents.[3] Improved treatments will likely use a combination of therapeutic strategies to improve PD symptoms and maximize outcomes.[4] Reliable biomarkers for Parkinson's are also needed for early diagnosis.[5] Research criteria for their identification have been established.[6]

Neuroprotective treatments

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See also: Anti-α-synuclein drug

Anti-alpha-synuclein drugs that prevent alpha-synuclein oligomerization and aggregation or promote their clearance are heavily investigated, and potential therapeutic strategies include small molecules and immunotherapies like vaccines and monoclonal antibodies.[7][8][9] Although immunotherapies have shown promise, their effiacy is often inconsistent.[8] Anti-inflammatory drugs that target NLRP3 and the JAK-STAT signaling pathway are another possible therapeutic strategy.[10]

As the gut microbiome in PD is often disrupted and may produce toxic compounds, fecal microbiota transplants may restore a healthy microbiome and improve various motor and non-motor symptoms.[7] Although neurotrophic factors—peptides that enhance the growth, maturation, and survival of neurons—have shown modest results and require invasive surgical administration, less invasive routes such as viral vectors are being explored.[11] Calcium channel blockers may restore the calcium imbalance present in Parkinson's, and are being investigated as a neuroprotective treatment.[12] Other therapies, like deferiprone, may reduce the abnormal accumulation of iron in PD.[12]

Cell-based therapies

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Main article: Cell-based therapies for Parkinson's disease
Researchers at Argonne National Laboratory examining induced pluripotent stem cells
Researchers at Argonne National Laboratory examine induced pluripotent stem cells (iPSCs) for use in Parkinson's and other diseases: the action potentials of one such iSPC differentiated into a dopaminergic neuron are visible at right.

In contrast to other neurodegenerative disorders, many Parkinson's symptoms can be attributed to the loss of a single cell type. Consequently, dopaminergic neuron regeneration is a promising therapeutic approach.[13] Although most initial research sought to generate dopaminergic neuron precursor cells from fetal brain tissue,[14] pluripotent stem cells—particularly induced pluripotent stem cells (iPSCs)—have become an increasingly popular tissue source.[15][16]

Both fetal and iPSC-derived DA neurons have been transplanted into patients in clinical trials.[17][18] Although some patients see improvements, the results are highly variable. Adverse effects, such as dyskinesia arising from excess dopamine release by the transplanted tissues, have also been observed.[19][20]

Gene therapy

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Main article: Gene therapy in Parkinson's disease

Gene therapy for Parkinson's seeks to restore the healthy function of dopaminergic neurons in the substantia nigra by delivering genetic material—typically through a viral vector—to these diseased cells.[21][22] This material may deilver a functional, wildtype version of a gene, or knockdown a pathological variants.[23] Experimental gene therapies for PD have aimed to increase the expression of growth factors or enzymes involved in dopamine sythesis, like tyrosine hydroxylase.[24] The one-time delivery of genes circumvents the recurrent invasive administration required to administer some peptides and proteins to the brain.[25] MicroRNAs are an emerging PD gene therapy platform that serves as an alternative to viral vectors.[26]

References

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  • Gouda NA, Elkamhawy A, Cho J (February 2022). "Emerging Therapeutic Strategies for Parkinson's Disease and Future Prospects: A 2021 Update". Biomedicines. 10 (2): 1–40. PMID 35203580.
  • Jasutkar HG, Oh SE, Mouradian MM (January 2022). "Therapeutics in the Pipeline Targeting α-Synuclein for Parkinson's Disease". Pharmacological Reviews. 74 (1): 207–237. PMID 35017177.
  • Pardo-Moreno T, García-Morales V, Suleiman-Martos S, Rivas-Domínguez A, Mohamed-Mohamed H, Ramos-Rodríguez JJ, Melguizo-Rodríguez L, González-Acedo A (February 2023). "Current Treatments and New, Tentative Therapies for Parkinson's Disease". Pharmaceutics. 15 (3): 1–24. PMID 36986631.
  • Shaheen N, Shaheen A, Osama M, Nashwan AJ, Bharmauria V, Flouty O (October 2024). "MicroRNAs regulation in Parkinson's disease, and their potential role as diagnostic and therapeutic targets". npj Parkinson's Disease volume. 10 (3): 1–11. PMID 39369002.
  • Van Laar AD, Van Laar VS, San Sebastian W, Merola A, Elder JB, Lonser RR, Bankiewicz KS (2021). "An Update on Gene Therapy Approaches for Parkinson's Disease: Restoration of Dopaminergic Function". Journal of Parkinson’s Disease. 11 (S2): S173–S182. PMID 34366374.
  • Schweitzer JS, Song B, Herrington TM, Park TY, Lee N, Ko S, Jeon J, Cha Y, Kim K, Li Q, Henchcliffe C, Kaplitt M, Neff C, Rapalino O, Seo H, Lee IH, Kim J, Kim T, Petsko GA, Ritz J, Cohen BM, Kong SW, Leblanc P, Carter BS, Kim KS (May 2020). "Personalized iPSC-Derived Dopamine Progenitor Cells for Parkinson's Disease". The New England Journal of Medicine. 382 (20): 1926–1932. doi:10.1056/NEJMoa1915872. PMC 7288982. PMID 32402162.
  • Alfaidi M, Barker RA, Kuan W (December 2024). "An update on immune-based alpha-synuclein trials in Parkinson's disease". Journal of Neurology. 272 (1): 1–9. PMID 39666171.
  • Poewe W, Seppi K, Tanner CM, Halliday GM, Brundin P, Volkmann J, Schrag AE, Lang AE (March 2017). "Parkinson disease". Nature Reviews. Disease Primers. 3 (1): 17013. doi:10.1038/nrdp.2017.13. PMID 28332488. S2CID 11605091.
  • Li T, Le W (February 2020). "Biomarkers for Parkinson's Disease: How Good Are They?". Neuroscience Bulletin. 36 (2): 183–194. PMID 31646434.
  • Heinzel S, Berg D, Gasser T, Chen H, Yao C, Postuma RB (October 2019). "Update of the MDS research criteria for prodromal Parkinson's disease". Movement Disorders. 34 (10): 1464–1470. doi:10.1002/mds.27802. PMID 31412427. S2CID 199663713.
  • Hitti FL, Yang AI, Gonzalez-Alegre P, Baltuch GH (September 2019). "Human gene therapy approaches for the treatment of Parkinson's disease: An overview of current and completed clinical trials". Parkinsonism & Related Disorders. 66: 16–24. doi:10.1016/j.parkreldis.2019.07.018. PMID 31324556. S2CID 198132349.


Other junk

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  1. ^ Crotty & Schwarzschild 2020, p. 1.
  2. ^ Fabbri et al. 2024, p. 2.
  3. ^ Poewe et al. 2017.
  4. ^ Pardo-Moreno et al. 2023, p. 1.
  5. ^ Li & Le 2020, p. 183.
  6. ^ Heinzel et al. 2019.
  7. ^ a b Pardo-Moreno et al. 2023, pp. 12–13.
  8. ^ a b Alfaidi, Barker & Kuan 2024, p. 1.
  9. ^ Jasutkar, Oh & Mouradian 2022, p. 208.
  10. ^ Pardo-Moreno et al. 2023, pp. 10–11.
  11. ^ Pardo-Moreno et al. 2023, p. 13.
  12. ^ a b Pardo-Moreno et al. 2023, p. 10.
  13. ^ Parmar, Grealish & Henchcliffe 2020, pp. 103.
  14. ^ Parmar, Grealish & Henchcliffe 2020, pp. 103–104.
  15. ^ Parmar, Grealish & Henchcliffe 2020, pp. 106.
  16. ^ Henchcliffe & Parmar 2018, pp. 134.
  17. ^ Parmar, Grealish & Henchcliffe 2020, pp. 106, 108.
  18. ^ Schweitzer et al. 2020, p. 1926.
  19. ^ Parmar, Grealish & Henchcliffe 2020, pp. 105, 109.
  20. ^ Henchcliffe & Parmar 2018, pp. 132.
  21. ^ Van Laar et al. 2021, p. S174.
  22. ^ Hitti et al. 2019, p. 16.
  23. ^ Hitti et al. 2019, pp. 16–17.
  24. ^ Van Laar et al. 2021, p. S174, S176.
  25. ^ Hitti et al. 2019, p. 21.
  26. ^ Shaheen et al. 2024, pp. 5–6.
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