Cardiac sympathetic denervation precedes neuronal loss in the sympathetic ganglia in Lewy body disease
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Decreased cardiac uptake of meta-iodobenzylguanidine (MIBG) on [123I]MIBG myocardial scintigraphy has been reported in Parkinson’s disease (PD) and dementia with Lewy bodies (DLB). We hypothesized that cardiac sympathetic denervation might account for the pathomechanism. To elucidate the extent, frequency and pattern of cardiac sympathetic nerve involvement in Lewy body disease and related neurodegenerative disorders, we immunohistochemically examined heart tissues from patients with PD (n=11), DLB (n=7), DLB with Alzheimer’s disease (DLB/AD; n=4), multiple system atrophy (MSA; n=8), progressive supranuclear palsy (PSP; n=5), pure AD (n=10) and control subjects (n=5) together with sympathetic ganglia from patients with PD (n=5) and control subjects (n=4), using an antibody against tyrosine hydroxylase (TH). TH-immunoreactive nerve fibers in the hearts had almost entirely disappeared in nearly all the patients with PD, DLB and DLB/AD, whereas they were well preserved in all the patients with PSP and pure AD as well as in all except for one patient with MSA. In PD, neurons in the sympathetic ganglia were preserved in all except for one patient. Decreased cardiac uptake of MIBG in Lewy body disease reflects actual cardiac sympathetic denervation, which precedes the neuronal loss in the sympathetic ganglia.
Keywordsmeta-iodobenzylguanidine Cardiac sympathetic denervation Sympathetic ganglia Parkinson’s disease Dementia with Lewy bodies
We thank Dr. Iwatsubo for providing the phosphorylated α-synuclein antibody, and Ms. Yamada and Ms. Nakamura for their technical assistance. This work was supported in part by a grant from the Japan Foundation for Neuroscience and Mental Health (Tama Nakagawa Foundation).
- 15.Matthews MR (1992) Autonomic ganglia in multiple system atrophy and pure autonomic failure. In: Bannister R, Mathias CJ (eds) Autonomic failure: a textbook of clinical disorders of the autonomic nervous system. Oxford University Press, New York, pp 593–621Google Scholar
- 16.Mirra SS, Heyman A, McKeel D, Sumi SM, Crain BJ, Brownlee LM, Vogel FS, Hughes JP, van Belle G, Berg L (1991) The Consortium to Establish a Registry for Alzheimer’s disease (CERAD). Part ll. Standardization of the neuropathologic assessment of Alzheimer’s disease. Neurology 41:479–486PubMedGoogle Scholar
- 22.Polinsky RJ, Kopin IJ, Ebert MH, Weise V (1981) Pharmacologic distinction of different orthostatic hypotension syndromes. Neurology 31:1–7Google Scholar
- 26.Taki J, Nakajima K, Hwang E-H, Matsunari I, Komai K, Yoshita M, Sakajiri K, Tonami N (2000) Peripheral sympathetic dysfunction in patients with Parkinson’s disease without autonomic failure is heart selective and disease specific. Eur J Nucl Med 27:566–573Google Scholar
- 27.Wakabayashi K, Takahashi H, Ohama E, Takeda S, Ikuta F (1993) Lewy bodies in the visceral autonomic nervous system in Parkinson’s disease. In: Narabayashi H, Nagatsu N, Yanagisawa N, Mizuno Y (eds) Advances in Neurology. Lippincott-Raven, New York, pp 609–612Google Scholar