{"title":"Is Parkinson Disease Better Defined Solely by Biology or as a Clinical–Biological Entity? Lessons to be Learned from Alzheimer's Disease on Biological Definition and Staging","authors":"Tiago A. Mestre MD, PhD, Cristina Sampaio MD, PhD","doi":"10.1002/mds.30173","DOIUrl":"10.1002/mds.30173","url":null,"abstract":"","PeriodicalId":213,"journal":{"name":"Movement Disorders","volume":"40 4","pages":"625-626"},"PeriodicalIF":7.4,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Heart of the Matter: Cardiac Denervation Casts Doubt on the Brain-First Versus Body-First Hypothesis of Parkinson's Disease","authors":"Tomoko Totsune MD, PhD, Toru Baba MD, PhD, Takafumi Hasegawa MD, PhD, Atsushi Takeda MD, PhD","doi":"10.1002/mds.30174","DOIUrl":"10.1002/mds.30174","url":null,"abstract":"<p>Parkinson's disease (PD) is an increasingly common neurodegenerative disease that is pathologically characterized by preferential dopaminergic cell loss in the substantia nigra (SN) and the appearance of Lewy bodies (LBs) in other neurons. Braak and colleagues<span><sup>1</sup></span> have shown that the dorsal motor nucleus of the vagal nerve (DMV) in the medulla oblongata and the olfactory bulb (OB) are the two major sites of early LB formation. Further, the DMV has a higher burden of LB pathology than the upper brainstem, including the locus coeruleus and the SN in PD. Due to the caudorostral gradient of brainstem LBs, it has been hypothesized that the pathological process in PD begins in the lower brainstem and subsequently progresses in an ascending fashion. This is referred to as the Braak hypothesis.<span><sup>1, 2</sup></span> Thereafter, Hawkes et al<span><sup>3</sup></span> refined this concept by incorporating the peripheral autonomic nervous system (PNS) and the OB, and they have proposed an in-depth hypothesis that neurotoxic pathogens (eg, viruses, pesticides, and air pollutants) enter the brain via two routes in the enteric nervous system (ENS) and the OB. This is referred to as the dual-hit hypothesis. Then, some experimental findings (eg, α-synuclein [aS] aggregates propagating from one cell to another) were integrated,<span><sup>4</sup></span> leading to a compelling hypothesis, in particular, that the pathophysiology of PD is governed unitarily by prion-like transmission of misfolded aS either from the brain or the gut (the brain-first vs. body-first PD hypothesis).<span><sup>5, 6</sup></span> This conceptual framework has attracted significant attention with the expectation that transmissible aS species could be novel targets of neuroprotective therapies such as immunotherapy.<span><sup>7</sup></span> However, the notion that PD pathology can be explained solely by the spread of noxious aS remains a matter of debate<span><sup>8-10</sup></span> and has been mainly criticized for its oversimplification as an explanation for the complexity of actual PD pathology.<span><sup>11</sup></span> Recently, we reported that cardiac sympathetic denervation was associated with widespread cortical atrophy, but not with nigrostriatal neurodegeneration in PD.<span><sup>12</sup></span> The finding that neurodegeneration in PD occurs in both the PNS and central nervous system (CNS) independent of a midbrain lesion may support the idea of multifocal or diffuse pathological initiation rather than one-way propagation from a single origin. To address these issues, we discuss limitations of the brain-first versus body-first hypothesis in PD by focusing on the unique feature of cardiac sympathetic involvement.</p><p>The aS origin site and connectome (SOC) model, which was proposed by Borghammer and colleagues,<span><sup>5, 13</sup></span> is a recent topical hypothesis about prion-like spreading of aS pathologies in PD. In this model, interneuronal","PeriodicalId":213,"journal":{"name":"Movement Disorders","volume":"40 5","pages":"807-812"},"PeriodicalIF":7.4,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/mds.30174","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jennifer K Behnke, Robert L Peach, Jeroen G V Habets, Johannes L Busch, Jonathan Kaplan, Jan Roediger, Varvara Mathiopoulou, Lucia K Feldmann, Moritz Gerster, Juliette Vivien, Gerd-Helge Schneider, Katharina Faust, Patricia Krause, Andrea A Kühn
Per Svenningsson, Per Odin, Filip Bergquist, Karin Wirdefeldt, Dag Nyholm, Mattias Andréasson, Ioanna Markaki, Anders C. Johansson, Måns Jergil, Christopher Jankosky, Mark A. Varney, Fabienne Herbrecht, Steven A. Johnson, Adrian Newman‐Tancredi