Biomarkers

12/14/2011

I am often asked what’s new in research? Do we have a cure yet? Although there is not yet a cure for Parkinson’s disease, 2011 has brought many exciting advances. Advances not just in how the brain functions, or the impact of disease. But how it responds to disease, and how function can improve even in the face of disease- a process called neuroplasticity. The role of genetics and the impact of the environment on disease continue to be hot research topics and will continue to shed light on potential causes of cell damage in Parkinson’s. Research exploring new treatments, improved diagnosis, and advances in gene and cell therapy continue to show promise.

All in all we can look back on last year’s research and discovery with a sense of hope and anticipation for better things to come. Explore the 2011 year in review

Making the Diagnosis

Making the right diagnosis is important for any disease but especially so with Parkinson’s given the lack of laboratory tests that are available. Prior to 2011, there was no specific test to aid in the diagnosis of Parkinson’s. Diagnosis relied on a person’s history of problems and changes in movement and clinical examination findings. Many people were given the wrong diagnosis, told they had essential tremor or even that they were just getting old. As researchers are exploring new ways to keep dopamine nerve cells (vulnerable to cell death in Parkinson’s) healthy, it is not only important to diagnose the disease early and accurately but also identify people that may be at future risk of getting the disease.

Fortunately this is changing. The following research illustrates major advances in our understanding of this problem.

[See related article making the diagnosis for more information.]

Biomarkers

What is a biomarker? A bio marker is a ‘substance, process or characteristic of the body that correlates with a person’s risk of developing a disease, the diagnosis of the disease or changes along with the disease. For example, a measure of blood pressure is a simple maker of heart and blood vessel function.

Why are biomarkers important?

A biomarker allows researchers to accurately diagnose disease. It also serves as a way to measure true changes in disease over time or in response to treatment. With biomarkers, researchers will have tools to measure whether a therapy is neuroprotective or modifies the course of Parkinson’s over time helping to bring neuroprotective therapies to market.

What are some of the potential biomarkers in Parkinson’s?

Pre-motor Symptoms Turns out that movement problems are not the first changes to occur in Parkinson’s. Non-movement problems can predate motor symptoms and collectively may identify people at risk for displaying future Parkinson’s motor symptoms. Pre-motor symptoms include:Loss of Smell

Depression
Constipation
REM Behavior Disorder

Imaging

DAT Scan In 2011 the FDA has approved the use of a nuclear medicine brain imaging technique called SPECT imaging. The DAT Scan that can indirectly measure the levels of dopamine nerve cells in the brain. It is important to note that this test can be used to differentiate essential tremor from Parkinson’s tremor but cannot accurately state whether someone has Parkinson’s disease or other type of atypical parkinsonism.
Transcranial ultrasound Parkinson’s is associated with an increase in substantia nigral (area of the brain with dopamine nerve cell loss) echogenicity or ultrasound signal. This finding is also seen in elderly people. It is not yet known whether this will become a clinically useful tool for diagnosis or early detection, however, the relatively low risk and cost of this procedure adds to its promise.
Cardiac metaiodabenzylguanidine (MIBG) Clinicians have long known that Parkinson’s affects our autonomic nervous system. A research test nuclear medicine test shows reduced heart uptake of this compound (similar to the autonomic nervous system neurotransmitter, norepinephrine) in the heart. Unfortunately these findings are not specific to Parkinson’s since many other disease can also show this finding.

Genetics

Multiple candidate genes thought to play a role in Parkinson’s. 23 and Me, a genetic and ancestry analysis company, is launching a major research initiative with the Parkinson’s Institute to measure gene abnormalities associated with Parkinson’s. We will discuss the role of genetics and Parkinson’s disease in our March-April Issue.

Log on to 23 and Me for more information on this project.

Other Tissue Biomarkers

The following lab tests measuring changes in certain blood and/or cerebrospinal fluid compounds show promise but are not yet proven for clinical use

Blood platelet mitochondrial function
Phosphorylated Alpha synuclein- found to be higher in blood samples of a small group with Parkinson’s

The Michael J Fox Foundation is funding a major initiative called the Parkinson’s Progression Markers Initiative (PPM). This 45 million dollar project is dedicated to finding biomarkers that will diagnose and measure disease.

Author: Monique Giroux, MD

www.nwpf.org/wellness

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