npj Parkinson's Disease

Parkinsons disease (PD) is a progressive age-related neurodegenerative disorder characterized by both motor and non-motor symptoms. The poorly understood prodromal period, decades-long progression, and disease-phenotype heterogeneity continue to impede the development of preventive and curative therapies. A growing appreciation of immune system changes during the progression of PD suggests that evaluating peripheral immune cells may help identify signatures relevant to disease etiology. We employed single-cell RNA sequencing to profile the transcriptomes of peripheral blood mononuclear cells (PBMCs) from a cohort of 12 patients with PD and 12 healthy controls, equally distributed by sex. Analysis identified gene expression signatures specific to immune cell lineages in PD when compared with healthy controls. Analysis of the dataset indicated that aspects of the PD-related changes were associated with sex, including metabolic and inflammatory changes. Further analysis of myeloid and T cell subsets identified additional pathways and gene expression profiles associated with PD. Trajectory analysis of the myeloid and T cell datasets indicated significant changes in the distribution of cells across states of gene expression in PD compared with controls. This work provides new evidence of peripheral immune cell changes in PD utilizing high-resolution transcriptomics in a cohort powered to analyze sex as a variable. HighlightsTranscriptomic dataset in a cohort powered to analyze immune phenotype in Parkinsons disease Parkinsons disease-specific gene expression signatures in peripheral immune cell lineages Identification of sex differences in the immune cell transcriptome in Parkinsons disease Trajectory analysis identifies changes in immune cell phenotypic distribution in Parkinsons monocytes

Extracellular vesicles (EVs) hold promise as minimally invasive biomarkers for neurodegenerative proteinopathies, but disease- and stage-specific profiles remain unclear. For this study, we enrolled 378 participants across five centers and the MJFF-BioFIND cohort: 100 healthy controls [HC], 64 isolated REM sleep behavior disorder [iRBD], 41 DeNovo Parkinsons Disease [PD], 89 Late PD, 32 other Synucleinopathies, and 52 Tauopathies. All participants underwent clinical evaluation and blood collection. The 77 subjects from the BioFIND cohort also provided CSF samples. EV concentration and size were assessed by nanoparticle tracking analysis; flow cytometry quantified tetraspanins (CD9/CD63/CD81) and 37 surface markers. Multivariable logistic regression, receiver operating characteristic analyses (ROC), and repeated random forest (rRF) classifiers evaluated diagnostic utility. Late PD showed the highest EV concentrations compared to HC and other disease groups. Participants exhibited distinct EV surface immunophenotypes, with the iRBD group displaying the most extensive immune activation signature vs HC, followed by PD patients. Multivariate logistic regression analysis identified diagnostic marker panels: CD3/CD9/CD25/CD56 for iRBD, SSEA4 for Late PD, CD146/CD209 for Synucleinopathies, and CD8/CD45/CD62P for Tauopathies. ROC confirmed good discriminatory performance, with CD56 emerging as the strongest single predictor for iRBD vs HC, SSEA4 showing high sensitivity for Late PD, and marker combinations providing optimal balance for Synucleinopathy/Tauopathy classification vs HC. In the CSF BioFIND subset, Late PD EVs exhibited increased myeloid (CD1c), adhesion (CD29), activation (CD69), and epithelial (CD326) markers compared to HC. Among these, CD326 was independently associated with Late PD diagnosis. Machine learning classifiers using all 37 surface antigens achieved excellent training performance (91.7-94.3% accuracy for iRBD/Synucleinopathies vs HC) and maintained robust validation accuracy, particularly for iRBD (77.8%) and DeNovo PD (76.6%) vs HC. EV immuno-phenotyping reveals distinct signatures across the neurodegenerative proteinopathies spectrum, with the highest diagnostic utility for prodromal iRBD detection. Longitudinal validation and cell-of-origin refinement represent key next steps toward clinical translation.

Heterogeneity in sporadic Parkinsons Disease (PD) is a critical problem that drives variable rates of progression and treatment response and complicates clinical trials. Access to large PD datasets that may help in clustering this heterogeneity is restricted by privacy and regulatory constraints. Simulated patients or digital twins may offer a solution. We developed a large language model (LLM)-framework to generate high-fidelity synthetic PD patients from the Parkinsons Progression Markers Initiative (PPMI) dataset based on the open-source Qwen3-8B-Base model. Using a relational, tree-structured representation and domain-specific fine-tuning, the model produces patient-level records with longitudinal clinical, imaging, and biomarker data. Fidelity was assessed through distributional similarity, correlation structure, and neurologist review. Utility was tested by training diagnostic classifiers, reproducing a published pharmacometric disease progression model applied to in silico trials, and by extracting a stringent dopamine-motor impairment relationship at early PD stages. Privacy was evaluated via identical match share, distance-to-closest-record, and membership inference attacks. These findings support the use of a dedicated LLM framework for patient simulation, contributing to the foundations of digital twins for PD in silico trials.

Adeno-associated viral (AAV)-mediated overexpression of human wildtype -synuclein (-syn) in the substantia nigra (SN) is a widely used approach to model Parkinsons disease (PD) in rodents. However, variability in the ability of AAV-based systems to induce nigrostriatal pathology and motor deficits has limited reproducibility across studies, especially in mice. Here, we systematically optimized key vector features - AAV serotype, promoter, viral titer - to establish a highly efficient and reliable mouse model of PD. We compared the tropism and expression efficiency of mixed AAV2/1 and AAV2/rh10 serotypes combined with three promoters - CMV enhancer/chicken {beta}-actin (CBA), human Synapsin (hSYN), and rat Tyrosine Hydroxylase (TH) - to drive human -syn gene (SNCA) expression in nigral dopaminergic neurons. The AAV.TH.SNCA vector, delivered at an optimized titer, achieved selective and sustained -syn overexpression in nigral neurons, resulting in nigro-striatal neurochemical changes and progressive motor deficits preceding overt neuronal loss. Fine tuning -syn expression proved critical for detecting early disease processes: lower AAV.TH.SNCA titer induced early pathological signatures, including -syn hyperphosphorylation and neuroinflammation, whereas higher titers produced robust nigrostriatal degeneration not achieved with other promoter constructs. Notably, we demonstrate that motor and neurochemical impairments can occur prior to dopaminergic cell death, implicating microglial activation and -syn pathology as primary drivers of dysfunction. This observation is consistent with human genetic evidence showing that triplication of the wild-type SNCA gene alone can cause Parkinsonian pathology, highlighting that our model enables the use of a single experimental reagent to investigate the molecular, cellular, and behavioral consequences of controlled increases in -syn expression. This novel AAV.TH.SNCA model provides a powerful and versatile platform for investigating mechanisms of a -syn-mediated neurotoxicity and for evaluating disease modifying interventions targeting early, pre-degenerative stages of PD. HighlightsO_LITitrated -syn expression uncouples early dysfunction from dopaminergic neuron loss C_LIO_LIAAV2/rh10-TH-SNCA model captures prodromal and degenerative PD stages C_LIO_LIMotor deficits arise from -syn pathology and nigral molecular changes before neurodegeneration. C_LI

BackgroundParkinsons disease (PD) is a neurodegenerative disorder for which there is currently no cure or reliable biomarker for early detection or for evaluating the effectiveness of potential treatments. PD pathology is driven by misfolding and subsequent accumulation of alpha-synuclein (Syn) protein into pathological aggregates within neurons and glial cells. Seed amplification assay (SAA) is a highly sensitive and specific diagnostic tool developed to detect pathological Syn species in the cerebrospinal fluid (CSF) of PD patients. However, Syn aggregates are present in multiple tissues and biosamples, including stools. In this study, we aimed to investigate the potential diagnostic value of SAA using stool samples from PD patients and healthy controls (HC). MethodsStool samples from PD patients (n=45) and healthy controls (n=35) were analysed for the presence of Syn species using slot blot assays with a panel of six Syn antibodies, and ELISA assays. Samples were subjected to SAA, and the end-point products (SAA EP) were characterised using transmission electron microscopy (TEM). Extracellular vesicles (EVs) were isolated from the subset of samples (n=5 per group) using size exclusion chromatography and characterized by TEM. The seeding activity of isolated EVs was evaluated using SAA, followed by TEM analysis of SAA EP. ResultsProtein extracts from both PD and HC stool samples revealed pathological Syn species in the slot blot assay using the phosphorylated Syn antibody, pS129 and conformation-specific antibodies, MJFR-14 and 5G4. ELISA showed significantly elevated total Syn levels in PD samples compared to HC, although no differences in aggregated Syn levels were detected. In stool protein extracts, SAA demonstrated 55.6% sensitivity and 60% specificity. When applied to stool-derived EVs from PD patients and controls, sensitivity increased to 100%, while specificity remained at 60%. Notably, SAA applied to stool-derived EVs pre-incubated with recombinant monomeric Syn achieved 100% sensitivity and 100% specificity. ConclusionThese findings suggest that SAA applied to EVs isolated from stool samples, particularly after pre-incubation with recombinant monomeric Syn, may serve as a valuable, non-invasive screening tool for the diagnosis of PD.

Background-Synuclein (-Syn) plays a central role in Parkinsons disease (PD). Under pathological conditions, -Syn aggregates into toxic oligomers and fibrils that act as damage-associated molecular patterns (DAMPs), stimulating microglial reactivity. This -Syn-microglia axis creates a self-perpetuating cycle of neuroinflammation and neurodegeneration, accelerating dopaminergic neuron loss in the substantia nigra pars compacta (SNpc) and contributing to motor deficits. Moreover, -Syn pathology spreads through the brain, disrupting synaptic plasticity in cognitive regions like the cortex and hippocampus, leading to early cognitive decline. Thus, targeting -Syn aggregation and its inflammatory consequences presents a promising dual-hit therapeutic strategy for PD. MethodsThis study investigates the therapeutic potential of 3-monothiopomalidomide (3MP), a novel thalidomide derivative designed to reduce neuroinflammation with a potentially better safety profile than Pomalidomide (POM). The neuroprotective and anti-inflammatory effects of 3MP were evaluated in rat primary mesencephalic mixed neuron-microglia cultures exposed to human -Syn oligomers (H-SynOs). Anti-aggregation activity was assessed via Thioflavin T (ThT) assays and Thioflavin S (ThS) staining in SH-SY5Y cells. Finally, the anti-aggregation, anti-inflammatory, and neuroprotective effects of 3MP were evaluated in vivo in a rat model of PD induced by intracerebral infusion of H-SynOs. ResultsIn primary cell cultures, 3MP dose-dependently reduced -Syn-induced neuronal death and microglial inflammatory responses. It also significantly inhibited -Syn aggregation in vitro in the ThT assay and in SH-SY5Y cells exposed to -Syn protofibrils, outperforming POM. When chronically administered in vivo, 3MP preserved dopaminergic neurons within the SNpc and yielded functional benefits on motor and cognitive readouts. Notably, 3MP markedly attenuated -Syn aggregates induced by the H-SynOs infusion in the SNpc more efficiently than POM, as shown by reduced intraneuronal staining for pSer129--Syn+ and reduced pSer129-Syn in both cytoplasmic and phagolysosomal compartments of microglia. In addition, mesencephalic and cortical inflammatory microgliosis that followed to intranigral H-SynOs-infusion, were significantly dampened by 3MP. ConclusionsOverall, 3MP emerges as a dual-action drug candidate capable of modulating neuroinflammation and -Syn aggregation and thereby disrupting the -Syn-driven inflammatory cycle. Its neuroprotective effects and favourable safety profile support its potential as a disease-modifying therapy for PD, with promising implications for clinical translation.

Parkinsons disease (PD) is a neurodegenerative disorder characterized by a prolonged prodromal stage that culminates in motor deficits. Current PD therapies primarily alleviate symptoms, underscoring the need for disease-modifying strategies. Glucagon-like peptide-1 (GLP-1) analogs showed early promise as candidate disease modifiers, but recent clinical results have been inconsistent, and their mechanism of action remains poorly defined. Here, we employed our SncaG51D/G51D knock-in mouse model to investigate the effects of subcutaneously administered GLP-1 analogs, semaglutide and lixisenatide. Both analogs reversed motor and non-motor deficits and reduced gliosis and detergent-insoluble -synuclein. Bulk and single-nuclei transcriptomics together with CellChat-based intercellular communication analysis revealed that GLP-1 analogs normalize early striatal mitochondrial and inflammatory dysregulation and restore neuregulin (NRG) and neurexin (NRXN) signaling networks to wild-type levels. Treatment was effective when initiated either before or shortly after symptom onset, defining an early therapeutic window for GLP-1 analog therapy in PD.

In Parkinsons disease (PD), failure to regulate blood pressure is a common comorbidity that is hard to treat, worsens quality-of-life and often precedes diagnosis. It is caused by -synuclein-mediated damage to the autonomic nervous system (ANS) that precedes overt symptoms, and while central dysfunction is a key component it remains uncharacterised in-vivo due to various imaging challenges. Here, we characterised the function of a brainstem-cortical ANS network in relation to cardiovascular autonomic failure. 81 individuals with early-PD and 65 aged-matched healthy controls (HC) performed resting-state 3T fMRI, neurological assessments and a 3-minute standing test: lied down for 5-minutes, had blood-pressure measured, then stood-up and had blood-pressure measured every minute for 3-minutes. We used Dynamic Causal Modelling to investigate how drops in blood pressure linked to effective connectivity in medullary and relay nuclei, hypothalamus, and cortical autonomic regions. Steep drops in blood-pressure in PD were associated with an overall inhibitory pattern departing from the rostro-ventrolateral medulla, a region responsible for sympathetic-mediated increase in blood pressure, as well as increased self-inhibition of this region. Additionally, the patient model was dominated by bottom-up connectivity from medullary regions to relay and cortical ones, potentially pertaining to state-signalling to higher-order regions, given the decreased ability of medullary regions to regulate blood pressure. Conversely, in HC, we observed widespread and unspecific weakening of connectivity. Our findings elucidate for the first time how a baseline dysfunction originating from the medulla, may cause poor central ANS reactivity to orthostatic stimuli and predispose those with PD to drops in blood pressure upon standing. These findings are compatible with known pathophysiology literature, pave the way to more in-depth characterisations of central autonomic dysfunction in-vivo, and may result in functional signatures useful to track disease progression or outcomes in clinical trials.

Background: Parkinson's disease (PD) has a prolonged prodromal phase during which non-motor symptoms (NMS) may emerge years before the appearance of classical motor signs. This makes NMS a promising and clinically accessible source of information for early risk stratification. Objective: In this study, we investigated whether NMS alone can serve as reliable predictors of PD risk using clinical data from the Parkinson's Progression Markers Initiative (PPMI) cohort. Methods: We developed a stacked ensemble machine learning framework that integrates feature-level modelling, a global multivariate model, and a patient-similarity component to capture complementary patterns within NMS profiles. The model was trained using leakage-controlled patient-level validation and evaluated on an independent held-out test set. Results: The final ensemble achieved strong predictive performance, with an area under the ROC curve of 0.955, sensitivity of 0.929, and specificity of 0.900. Explainability analysis further showed that olfactory dysfunction, gastrointestinal symptoms, urinary and other autonomic features, and selected cognitive measures were among the most influential predictors. These findings support the hypothesis that NMS are not merely associated features of PD, but can function as meaningful predictors of disease risk even without imaging or biomarker inputs. Additionally, the final validated model is implemented as a web-based research prototype to demonstrate real-time translational feasibility. Conclusion: Overall, this study highlights the predictive value of NMS for PD risk assessment and supports their use in research-oriented early screening frameworks.

Studies reporting alpha-synuclein seed amplification assay (aSyn-SAA) results are often cross-sectional. Here we investigated the intra-individual consistency of aSyn-SAA results over time from participants in the Parkinson's Progression Marker Initiative (PPMI). A total of 1238 participants had >1 CSF aSyn-SAA result for analysis (Parkinson's disease [PD]=633, prodromal =563, healthy control [HC]=42) which were collected over a median (min, max) of 2.0 (0.4, 11.4) years. Emphasis was placed on evaluating consistency in less common results such as aSyn-SAA- PD participants, aSyn-SAA+ HC and conversion rates from aSyn-SAA negative to positive results prodromal participants. Of aSyn-SAA+ PD participants, 96% (474/493, 95%CI 94-98%) remained positive in subsequent samples, and 92% (116/126, 95%CI 86-96%) of aSyn-SAA- PD participants remained negative. 99% (303/307, 95%CI 97-99%) of aSyn-SAA+ prodromal participants remained positive, and 95% (234/247, 95%CI 91-97%) of aSyn-SAA- prodromal participants remained negative. 89% (16/18, 95%CI 67-97%) of aSyn-SAA+ HC participants remained positive, and 87% (20/23, 95%CI 68-95%) of aSyn-SAA- HC participants remained negative. These results confirm a high consistency of aSyn-SAA results over time, even in less expected results.

Parkinsons disease is characterized by progressive dopaminergic degeneration, yet motor symptoms emerge only after substantial neuronal loss - a dissociation that challenges the sensitivity of conventional behavioral endpoints in preclinical models. Here, we present a proof-of-principle study establishing a graded hemiparkinsonism model in adult male capuchin monkeys (Sapajus apella) through unilateral, MRI-guided stereotaxic injection of 6-hydroxydopamine into the substantia nigra pars compacta. Three toxin concentrations (4, 10, and 40 mg/mL; n = 3) were tested alongside a vehicle-injected sham control (n = 1). Motor function was assessed longitudinally before and after surgery using a three-task battery comprising the Staircase test, Tube test, and Brinkman board, capturing complementary dimensions of motor functions, including gross lateralization, forelimb use asymmetry, and fine digit coordination. Critically, we introduce a novel sequence-deviation metric applied to Brinkman board performance data to quantify disruption in the spatial organization of pellet retrieval independently of task success. Post-surgical tyrosine hydroxylase immunohistochemistry combined with optical fractionator stereology revealed ipsilateral dopaminergic cell losses of 47%, 59%, and 44% relative to the contralateral hemisphere across the three treated animals, with the sham showing no meaningful hemispheric difference. Behavioral impairments were heterogeneous and strategy-dependent: task completion rates were largely preserved, whereas fine motor strategy analysis revealed post-lesion increases in retrieval sequence disorganization in two of three animals. Exploratory regression analyses suggested that strategy-level metrics were more sensitive to nigrostriatal degeneration than global performance measures. These findings demonstrate that capuchin monkeys subjected to unilateral 6-hydroxydopamine lesions reproduce clinically relevant features of hemiparkinsonism and that motor sequence analysis constitutes a sensitive readout of subclinical dopaminergic dysfunction, and can outperform conventional performance-based metrics detecting early motor alterations, therefore a potential biomarker of subclinical dopaminergic dysfunction, with implications for early detection paradigms in Parkinsons disease research.

Background: Parkinson's disease (PD) is the second most common progressive neurological disorder that is pathologically characterized by the loss of dopaminergic neurons within the substantia nigra (SN). However, disease progression probably involves coordinated changes across both neuronal and glial cell populations. Although single-nucleus RNA-seq resolved cell-type-specific transcriptional profiling, differential expression and regulatory interpretation are commonly reported separately; however, they may limit the mechanistic prioritization to uncover novel therapeutic targets. Methods: Here, we performed sample-aware pseudobulk framework analysis on single-nucleus transcriptomes obtained SN of PD and control donors. Cell-type-specific differential expression for PD vs. control was identified using edgeR quasi-likelihood modeling (FDR < 0.05; |log2FC| > 0.5). Further, to quantify disease-specific remodelling, we computed one-vs-rest cell-type specificity scores in each condition and defined delta-specificity as the PD-control shift. We further prioritized the gene-set for dopaminergic neurons and microglia based on edge R significance and delta-specificity shifts, followed by upstream regulatory assessment using transcription factor enrichment and subnetwork visualization using ChEA-KG. Moreover, we used Cellchat to identify altered cell-cell communication networks to infer differences between both conditions. Results: Dopaminergic neurons demonstrated upregulation of neuronal-state remodeling transcriptional programs related gene sets in PD group, including receptor signaling and contact/guidance pathways (e.g., CHRM3, ROBO1, PLXNA4, UNC5D, EFNA5), neuronal excitability homeostatsis, RNA components, cellular traffickings and proteostasis, suggesting coordinated remodeling in surviving neuronal population. Microglia exhibited a compact PD-associated signature enriched for regulatory and activation state-related genes. TF networks analysis revealed distinct regulatory subnetwork in each population,including BNC2-centered network in microglia and an NPAS3-centered network in dopaminergic neurons with embedded ZNF804A and chromatin-associated components. Conclusions: In summary, integrating pseudobulk, delta-specificity scoring and TF-network enrichment analysis provides coherent dopaminergic and microglial programs in PD substantia nigra. This framework prioritizes cell-type-specific potential candidate mechanisms for downstream validation. The inferred regulatory networks and interactions are hypothesis generating and need orthogonal validation, such as spatial or proteomics approaches and independent cohorts.

Background. Parkinson's disease (PD) diagnosis remains delayed and suboptimally accurate, largely due to clinical overlap with atypical parkinsonian syndromes and the lack of reliable biomarkers. Here, we evaluated the performance of a previously patented 6-metabolites blood biomarker (6M-BB) for the differential diagnosis of PD and its translation to clinical IVDr NMR platform. Methods. Patient serum samples from de novo PD (n=30), multiple system atrophy (MSA, n=30), progressive supranuclear palsy (PSP, n=30), Alzheimer's disease (AD, n=33), and healthy individuals (n=29), were profiled by 1H NMR and classified using the 6M-BB. For clinical use, we rebuilt the model on absolute concentrations acquired on a Bruker Avance IVDr 600 MHz system. Results. The 6M-BB validation yielded 0.902 AUC and 87.9% accuracy for PD vs. HC (sensitivity 86.7%, specificity 89.3%), with an overall accuracy of 82.6% across all groups. The IVDr-based refit achieved 0.878 AUC (overall accuracy 77%). Adding VLDL-5 free cholesterol (V5FC) and citrate markedly improved performance to 0.959 AUC, with 94.9% accuracy for PD vs. HC (sensitivity 96.7%, specificity 93.1%) and 84.9% when MSA/PSP were included. Conclusion. The externally validated 6M-BB has demonstrated its robustness for the differential diagnosis of PD compared to other parkinsonian syndromes at de novo stage. Its successful transfer to a fully automated, standardized IVDr machine, with gains from V5FC and citrate, supports the feasibility and promising potential for clinical implementation, justifying future prospective multicenter studies.

BackgroundFilamentation induced by cAMP domain-containing protein (FICD) is an endoplasmic reticulum (ER)-resident adenylyltransferase that catalyzes protein AMPylation, a post-translational modification. Although FICD-mediated AMPylation has been linked to the fine-tuning of proteostasis and neuronal integrity, its role in neurodegenerative diseases characterized by protein dyshomeostasis remains unclear. Parkinsons disease (PD) is defined by dopaminergic neurodegeneration and aggregation of -synuclein (aSyn) as a consequence of impaired protein homeostasis. We therefore investigated whether dysregulated FICD-mediated AMPylation contributes to PD pathogenesis. MethodsWe combined analyses of human post-mortem PD brain tissue with complementary models, including midbrain dopaminergic neurons derived from human induced pluripotent stem cells (hiPSCs) of a PD patient carrying an SNCA gene duplication and its isogenic gene dosage-corrected control line, transgenic mouse models of synucleinopathy, and an aSyn-overexpressing H4 neuroglioma cell model. Genetic and pharmacological modulation of FICD activity was integrated with multi-proteomic approaches, including chemical proteomics-based AMPylation profiling, stable isotope labelling with amino acids in cell culture-based global protein turnover analysis, and whole-proteome profiling to identify AMPylation-associated molecular pathways. ResultsFICD was preferentially expressed in dopaminergic neurons and was upregulated in SNCA duplication PD patient-derived neurons, as well as in the basal ganglia of PD post-mortem brains and synucleinopathy mice. Despite this overall increase, the proportion of FICD-expressing dopaminergic neurons was reduced under PD conditions, suggesting selective vulnerability of dopaminergic neurons to FICD. Mechanistically, FICD selectively AMPylated lysosomal proteins, thereby linking AMPylation to the regulation of degradative pathways. Moreover, hyperactivation of FICD-induced AMPylation triggered ER stress, impaired lysosomal function, reduced protein turnover, and ultimately promoted aSyn aggregation and apoptotic cell death. Importantly, pharmacological inhibition of AMPylation reversed aSyn pathology and neurite degeneration in PD patient-derived neurons. ConclusionsWe identify the pathological relevance of FICD-mediated AMPylation in PD-related neurodegeneration and its contribution to aSyn aggregation through a bidirectional interplay with aSyn pathology. Our findings support FICD-mediated AMPylation as a defining molecular switch regulating intracellular protein homeostasis in PD and highlight the FICD-AMPylation pathway as a potential therapeutic target for restoring aSyn pathology and mitigating disease progression.

BackgroundEffective screening for Parkinson disease (PD) is important for both symptomatic treatment and recruitment into intervention trials. We recently developed a toolkit to quantify PD risk. Here, we examined the PREDIGT models diagnostic performance when deployed at home. MethodsWe contacted 613 subjects following outpatient clinic encounters. Between 2022-2024, 305 participants (range, 40-85 years) were recruited: 93 with typical PD; 66 had other neurological diseases (OND); 146 were neurologically healthy. Two versions of the toolkit were completed: First, an original, 69-item-long questionnaire paired with a 40-scent smell test; thereafter, a simplified, 11-item-long questionnaire and a newly developed, 8-scent smell test. PREDIGT summary scores were calculated for each subject to examine diagnostic classifications. Area-under-the-ROC-curve, sensitivity, specificity, and likelihood ratios were used to evaluate performances and to determine clinically relevant thresholds. ResultsIn both versions, PD patients had higher questionnaire scores and lower smell test scores than neurologically healthy controls (p<0.001); scores for OND subjects ranked at intermediate levels. The simplified questionnaire outperformed the original version in diagnostic accuracy. The abbreviated smell test performed as well as the 40-item version in identifying hyposmia. At a value of 22.94 (range 0-100) for the threshold that separates PD subjects from other participants, the simplified PREDIGT summary score showed a sensitivity of 0.98, a specificity of 0.83, and revealed positive and negative likelihood ratios of 5.88 and 0.02, respectively. InterpretationOur study reveals that unsupervised screening for typical PD can be effectively carried out at home using an 11-item questionnaire and 8-scent smell test.

BackgroundParkinsons disease (PD) is a prevalent neurodegenerative disorder characterized by progressive motor dysfunction and broad cellular impairment, including significant disruptions in lysosomal function, lipid metabolism, and intracellular trafficking. Glycosphingolipids (GSLs), critical for various cellular processes, depend on effective lysosomal degradation. Aberrant GSL metabolism has been linked to PD pathology, and glycoprotein non-metastatic melanoma protein B (GPNMB) has emerged as a biomarker associated with lysosomal dysfunction and lipid imbalance in PD. ObjectivesTo assess the relationship between GPNMB and GSL levels in cerebrospinal fluid (CSF) and plasma from PD patients and controls within the BioFIND cohort. We also investigated potential sex differences and associations with PD-related biomarkers such as -synuclein. MethodsGSL species and GPNMB protein levels were quantified using high-performance liquid chromatography (HPLC) and ELISA assays, respectively, in matched CSF and plasma samples from PD patients and controls. ResultsLevels of the paraglobosides GSL species, alpha-2,3SpG and pGb were significantly elevated in the plasma of PD patients compared to healthy controls, while levels of the ganglioside GD1a and the lacto-series GSL, Leb combined (GD1a + Leb), were significantly reduced in PD. GPNMB levels positively correlated with several GSL species in both plasma and CSF. Plasma GSLs and GPNMB concentrations were significantly higher in females compared to males, independent of PD diagnosis. CSF GPNMB correlated positively with age and -synuclein concentrations. InterpretationOur findings confirm that GSL metabolism is altered in PD. They also highlight significant sex-based biochemical variations in GSL and GPNMB levels, emphasizing the need for sex-specific analyses in PD biomarker research. The relationship between GSLs and GPNMB supports their potential as interconnected biomarkers of lipid pathology in PD.

BackgroundVascular cells are emerging as active players in Parkinsons disease (PD), yet their molecular contribution to -Synuclein (-Syn) pathology remains undefined. Here, we show that human brain pericytes respond in a distinct manner to unique -Syn strains, with systematic validation identifying BCL-XL as a potential regulator of the neurovascular unit in PD. MethodsPrimary human brain-derived pericytes were exposed to five recombinant -Syn strains (Fibrils, Fibrils-65, Fibrils-91, Fibrils-110, and Ribbons). Transcriptomic profiling identified differentially expressed genes (DEGs), which were validated at the protein level using multiplex immunocytochemistry and in situ labelling of post-mortem middle temporal gyrus (MTG) tissue microarrays from PD (n = 24) and neurologically normal (n = 24) cases. Results-Syn strain exposure produced 300 DEGs with limited overlap between strains. BCL-XL and CSNK1D were upregulated in -Syn-treated pericytes. In post-mortem PD tissue BCL-XL showed marked pericyte-specific elevation in the MTG and increased pericytic and microglial expression in the substantia nigra. ConclusionBCL-XL emerges as a potential regulator of pericyte and microglial resilience in PD, linking acute -Syn strain-specific responses in pericytes to broader neurovascular alterations. Its upregulation likely represents a generalised compensatory response to chronic -Syn-associated stress beyond individual strain effects, identifying BCL-XL as a possible therapeutic target within the neurovascular unit.

Braak and others have proposed that Lewy body pathology LBP in Parkinson disease PD may arise not only in the brain but alternatively from an initial site in the gastrointestinal GI tract with subsequent passage to the central nervous system CNS through the vagus nerve or other routes. We tested this hypothesis by using both immunohistochemistry IHC and RT QuIC a form of alpha synuclein seed amplification assay SAA to detect alpha synuclein LBP in samples from selected brain regions and 10 GI tract sites taken from autopsies of 50 PD subjects and 128 elderly subjects without parkinsonism or dementia including 34 with IHC identified CNS incidental Lewy body disease ILBD and 94 with no Lewy body IHC pathology detected NLB. A positive SAA or IHC result was restricted to the GI tract in only 2 subjects while LBP by either SAA or IHC was restricted to the brain in 11 subjects. To fairly compare GI only with brain only synucleinopathy however we would have to do SAA on brain samples from all ILBD and NLB cases in at least 4 critical brain regions olfactory bulb medulla pons and amygdala. Further SAA of brain regions is estimated based on the proportional results to date to potentially identify 21 additional brain only LBP subjects total of 32 if it were done on all of the NLB subjects. From this brain only LBP is estimated to be 16 times more common than GI only LBP. To assess the clinical impact of SAA positive GI sites we found that the number of positive sites per subject is significantly correlated with UPDRS motor score and SCOPA AUT GI related scores including those for salivation straining constipation and bowel movement.

Aggregates of misfolded -synuclein (Syn) and neuroinflammation are pathological features of Parkinsons disease (PD). These, misfolded conformations of Syn promote cytokine and chemokine signaling in the surrounding microenvironment by triggering activation of glial cells through pattern recognition receptors. Microglia and astrocytes act as innate mediators of the neuroimmune response in the brain by regulating inflammatory signaling via paracrine and autocrine forms of cell communication. Extracellular vesicles (EVs) represent a form of glial cell to cell communication that can regulate the glial neuroimmune responses depending on the phenotype of the donor cell. Research has shown that the contents of EVs can be altered via pharmacologically altering the donor cell which offers a potential avenue for the regulation of inflammation. As such, we analyzed enriched mouse cortical primary astrocytes and characterized their response to Syn exposure in the absence and presence of microglia-derived EVs. Using trans-resveratrol, a naturally occurring polyphenol implicated for its anti-inflammatory properties, as our pharmacological agent to generate an anti-inflammatory microglial-derived EV phenotype we found that EVs derived from resveratrol-treated microglia decreased the production of proinflammatory molecules in enriched astrocytes exposed to Syn. Sequencing of EV miRNAs revealed two miRNAs (miR-5099 and miR-115) with significant up-regulation in resveratrol EVs compared to control EVs. Astrocytes transfected with corresponding miRNA mimics prior to Syn exposure showed a dramatic decrease in inflammatory biomarker production. These findings show that microglia-derived EVs and their specific miRNA cargo can attenuate Syn-directed inflammation in astrocytes and may serve as a novel therapeutic for proteinopathies like PD.

Parkinsons disease (PD) is a progressive neurodegenerative disorder characterized by -Synuclein (-Syn) aggregation, dopaminergic neuronal loss, and chronic neuroinflammation. Chlorogenic acid (CA), a dietary polyphenol abundant in coffee, exhibits antioxidant and anti-inflammatory properties and has shown neuroprotective effects in acute toxin-based PD models. However, its efficacy in chronic, -Syn-driven PD models remains unclear. Here, we evaluated the therapeutic potential of CA using an -Syn-based in vitro system and a chronic -Syn overexpression mouse model that recapitulates key pathological features of human PD. In vitro, CA significantly improved cell viability, reduced -Syn aggregation, and attenuated H2O2-induced apoptosis in U118 and N2a cells. In contrast, chronic oral administration of CA (100 mg/kg for 16 weeks) in C57BL/6J mice (male and female) failed to improve motor behavior, attenuate -Syn pathology, preserve nigrostriatal dopaminergic neurons, or reduce oxidative stress-associated DNA double-strand breaks in vivo. Notably, CA elicited a modest reduction in microglial and astrocytic activation in female mice, highlighting a sex-dependent immunomodulatory response. Collectively, these findings reveal a clear dissociation between robust in vitro neuroprotection and limited in vivo efficacy in a chronic -Syn-driven PD mouse model, emphasizing the importance of incorporating progressive disease paradigms and sex as a biological variable in preclinical therapeutic evaluation.