Potential Novel Treatments for Parkinson’s Disease

Abstract

This review aims to evaluate novel developments in treatments for Parkinson’s disease that focus on slowing, stopping, and/or reversing the neurodegeneration associated with the disease. Parkinson’s disease (PD) is a neurodegenerative disease that affects dopaminergic neurons in the substantia nigra, located in the basal ganglia of the brain. This region also contains high levels of alpha synuclein, a protein found abundantly in the brain due to its important role in neurotransmitter release. α-synuclein has been found to be misfolded and overexpressed in people with PD, which leads to fibril formation and aggregation, which directly interfere with basic cellular processes and results in neurodegeneration. In PD patients, dopaminergic neurons are most affected; therefore, an artificial supply of dopamine must be provided to them via dopamine precursors that can cross the blood-brain barrier. However, these medications fail to slow, stop, or reverse the progression of PD and merely pose as treatments for physical symptoms, such as tremors. Researchers are now focusing on 2 major avenues for new PD treatments: treatments that target α-synuclein aggregates/Lewy body assemblies and treatments that focus on replacement of lost dopaminergic neurons in the brain. The use of antibodies (immunotherapy) to target and clear αsynuclein aggregates or the upregulation of genes that encode autophagic mechanisms to destroy dysfunctional proteins were shown to reduce α-synuclein aggregation and behavioral deficits in mice. Results from clinical trials have shown a 96.5% reduction in the concentration of extracellular α-synuclein aggregates, and doses were well tolerated with no serious side effects. In order to rebuild the neurons that were lost to PD neurodegeneration, a renewable source of dopamine-producing cells that can integrate into the host brain and survive for years is required. More specifically, the reprogramming of astrocytes can be used to develop functional dopaminergic neurons. To reprogram the astrocytes and fibroblasts, the RNA binding protein PTB was suppressed; PTB suppresses numerous neuronal genes required for neuronal maturation, thus, downregulation of PTB generates functional, mature neurons. When in vivo astrocyte reprogramming was performed in a mouse model of PD, researchers found new, successful dopaminergic neurons in the substantia nigra and increased dopamine levels. Although both avenues for treatment require further clinical trials and testing in human subjects, they both hold significant promise in the future.