EAN 2023 | Exploration of Parkinson’s disease and the future of personalized treatments
Prof. K. Ray Chaudhuri, MD, DSc, FRCP, FEAN, King’s College London, London, UK, discusses a novel approach to Parkinson’s disease (PD) subtyping, aiming to move away from the traditional one-size-fits-all treatment approach. Their review, ‘The Noradrenergic Subtype of Parkinson’s Disease,’ published in Nature Review Neurology, delves into the various Parkinson’s subtypes, where patients may present with cognitive, sleep, or autonomic issues. Through an analysis of data from animal models, global cluster studies, and clinical observations, Prof. Chaudhuri’s team highlights how noradrenergic system dysfunction in PD leads to the noradrenergic subtype. The team also explored how biomarkers can be used in clinical subtype identification, paving the way to a future of personalized PD therapy. This interview took place at the European Academy of Neurology (EAN) 2023 Congress in Budapest, Hungary.
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Transcript (edited for clarity)
We’ve been very interested in the subtyping of Parkinson’s, because probably one of the biggest problems we’ve had is putting Parkinson’s as a single disease and putting a one size fits all strategy, which doesn’t work for Parkinson’s. In the process of that, we found different subtypes of Parkinson’s, where patients might present more with sleep related problems, might present with cognitive problems, might present with autonomic problems...
We’ve been very interested in the subtyping of Parkinson’s, because probably one of the biggest problems we’ve had is putting Parkinson’s as a single disease and putting a one size fits all strategy, which doesn’t work for Parkinson’s. In the process of that, we found different subtypes of Parkinson’s, where patients might present more with sleep related problems, might present with cognitive problems, might present with autonomic problems. And initially we termed them as Park sleep, Park autonomic, Park cognitive etc.
Later on, we’ve now looked at more of the pathophysiological basis of these symptoms and putting together data from animal model studies, cluster analysis studies from big cohorts around the world, as well as clinical observational studies, we see that the dysfunction of the noradrenergic system, both in the brain and the periphery, may play a big part in the phenotypic expression of Parkinson’s, and we call this the noradrenergic subtype of Parkinson. These patients usually would present with autonomic problems, they might have sleep problems in the form of REM behavior disorder, they might have pain which has a noradrenergic basis, and some of the other non-motor aspects of Parkinson’s.
So, in this review which we published in Nature Review Neurology, we discuss the animal model basis of this subtype, the translational studies, translating this animal model data to humans, the data from cluster analysis, independent studies. And thereafter we look at biomarkers, or what might in future allow us to identify the subtype in the clinic. This is very relevant because the noradrenergic subtype might need specific therapies, so otherwise subtype specific personalized therapy for the future.
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