CONy 2024 | The use of precision medicine in Parkinson’s disease

Precision medicine is a very interesting terminology that sprung out of the mother term of personalized medicine. And a lot of people often confuse precision medicine only with genomic medicine. But actually, precision medicine is a way to deliver personalized medicine. And indeed, we are ready for that for Parkinson’s, because on the genomic side, there are development of new clinical trials. We’ll hear about the role of ambroxol in people with a pathogenic GBA mutation, there are trials with LRRK2 kinase inhibitors, there are trials with alpha synuclein antibodies. Although you could argue that some of the trials have been thus far negative, the fact that we are getting these trials suggests that there’s been a translation of the concept to clinical practice.

But also, we apply personalized medicine in other way; we determine a patient’s therapy based on their age. Older people will not have certain types of treatment, in younger people, we are cautious about certain other types of treatment. That’s also a form of precision medicine, if you will, or personalized medicine. Similarly, we’ve also brought in what we call the dashboard for Parkinson’s. That also describes certain phenotypes within Parkinson’s, which allows you to deliver targeted therapy. So, for instance, if somebody has significant osteoporosis, you would avoid certain strategies, personalized medicine. If somebody has the memory dysfunction-oriented Parkinson’s, you’ll avoid anticholinergic drugs, again an example of personalized medicine. So you can see it’s a wide construct and I think the time has really come. We can build on the translation that we already see around us.

I think the questions in relation to better implement precision medicine would be to ensure that we run properly designed inclusive trials in all populations, not just a western White population, but across globally, because the fact will apply to Parkinson’s patients, for instance, across the world. And secondly, to have a very clear idea of what is being achieved, given that we know Parkinson’s is a very heterogeneous condition. It has many different neurotransmitters involved, many different clinical manifestations. So, precision medicine might apply the more we become very clear about the different subtypes of Parkinson’s. So this one particular pattern of precision medicine might apply to a specific subtype. So we need to get better at the subtyping concept, a bit like what we do in cancer medicine. You know, you classify your breast cancers and you go with specific therapy and I think that’s what we are aiming for. And we’ll get better with time.