The Journal of Parkinson’s Disease has published a freely accessible special issue in which key opinion leaders write about the future of potential disease modifying treatments and symptomatic therapies.

By asking clinicians and scientists from around the world to review progress and share their vision on what the future holds in the next 20 years, this collection may help to guide ongoing research efforts and possibly shape the future of Parkinson’s.

In the last two decades, research into disease modifying and symptomatic therapies for Parkinson’s has accelerated rapidly. Significant factors have been both the development of new technologies and methods, as well as the recognition that this condition can present itself in so many different ways and at different ages. The editors identified 19 areas of research in which very significant progress might be achieved within the next 20 years. Many of these important topics, with their peer reviewed original research articles have been reported previously.

The first important area in which progress is anticipated concerns the definition of Parkinson’s - when it starts and how it is best defined: by motor signs and symptoms, non-motor symptoms or biological markers of neurodegeneration before motor symptoms even appear. Find out more in this webinar.

What is currently viewed as the 'prodromal phase' of the condition or the early premotor stage, will be more widely understood and managed as Parkinson’s proper. Unlike most diseases, the burden of Parkinson’s actually increases with socioeconomic level, and important environmental factors such as exposure to agricultural chemicals including paraquat and air pollutants have been shown to increase the risk of Parkinson's. The lifetime risk now stands at 1 in 37 in the UK, indicating that activism, focused planning and novel approaches are necessary.

Understanding the origins of Parkinson’s in the body, and the roles of environmental factors that interact with the brain, gut and olfactory system for example, as the dual hit theory of Parkinson’s holds, depend critically on our ability to identify it at its earliest stages.The authors highlight these as areas we will be focusing on in the years to come. Interpreting early associations is important: how can we capitalise on the patterns observed in individuals who experience REM behaviour sleep disturbance at the very earliest stage who tend to show greater amounts of abnormal alpha synuclein in the gut and skin, compared to patients without this sleep disturbance? And what role does the gut microbiome play?

Given the range and remarkable differences in the presentation of Parkinson’s, and the different routes to neurodegeneration dependent on genetic predisposition, ageing effects and environmental exposure, it is proposed that a molecular definition rather than one based solely on signs and symptoms would be advantageous - this webinar explains more. Such patient-derived molecular signatures, like those which transformed treatments for cancer, could help develop and deliver the right drugs to those who are likely to benefit the most. Read more...

A number of articles also focus on big data, electronic patient records and digital technologies, and international collaborations aimed at cracking important open questions such as the genetic causes of Parkinson’s. For example, the International Parkinson’s Disease and Movement Disorder Society (MDS) Gene Database (MDSGene) initiative is an online resource linking reported genetic mutations with movement disorders, demographic and clinical information. Its aim is now to include unpublished cases in a bid to capture more of these valuable clinical-genetic data faster, as diagnoses are continually being made around the world. Moreover, remote monitoring devices are increasingly being used around the world, for example through sensors in wrist watches, glasses and other wearable devices. Thus, data from continuous symptom monitoring could be linked back to individual electronic patient records for the development of personalised assessment and treatment algorithms through the use of artificial intelligence (AI) approaches. One review focuses on digital health pathways, and elaborates on the potential for delivery of high quality, personalised care which is tailored to the individual, and interprets and shares their continuous data with a coordinated care team. Such approaches could also help standardise patient data and contribute to the development of more refined algorithms that can predict an individual’s disease progression. Read more about how AI could help repurpose drugs for Parkinson's...

Drug repurposing to find cures that slow, stop or reverse Parkinson’s is an increasingly active area, with trials currently underway with a variety of drugs such as the anti-diabetic drug exenatide, the mucolytic ambroxol targeting GBA and others, all supported by The Cure Parkinson's Trust. A variety of approaches to disease modification are actively being pursued, targeting alpha synuclein misfolding and reducing cell to cell transmission, genetic factors, inflammation, and promoting cell survival. Read more...

Given global advances in gene therapies, these are also predicted to come to bear on disease modification in Parkinson's. Cell replacement approaches are increasingly focusing on induced pleuripotent stem cells (iPSCs), with trials currently underway. The future in this field is promising, given the potential for iPSCs to deliver a sustainable and standardised source of transplantable cells, which may help avoid graft induced dyskinesias associated with cells of embryonic origin. Read more here...

Read the full article - iospress.com/journal-of-parkinsons-disease