Acta Neuropathologica

, Volume 119, Issue 6, pp 703–713 | Cite as

Lewy pathology in the submandibular gland of individuals with incidental Lewy body disease and sporadic Parkinson’s disease

  • Kelly Del TrediciEmail author
  • Christopher H. Hawkes
  • Estifanos Ghebremedhin
  • Heiko Braak
Original Paper


A retrospective autopsy-based study of the human submandibular gland, one of the three major salivary glands, together with anatomically related peripheral structures (cervical superior ganglion, cervical sympathetic trunk, vagal nerve at the level of the carotid bifurcation), was conducted on a cohort consisting of 33 individuals, including 9 patients with neuropathologically confirmed Parkinson’s disease (PD), three individuals with incidental Lewy body disease (iLBD), 2 individuals with neuropathologically confirmed multiple system atrophy (MSA), and 19 controls, using α-synuclein immunohistochemistry in 100 μm polyethylene glycol-embedded tissue sections. Lewy pathology (LP) was present in the submandibular glands and cervical superior ganglia in PD (9/9 cases) and iLBD (2/3 cases) but not in MSA or controls. The cervical sympathetic trunk (7/9 PD cases, 2/3 iLBD cases) and peripheral vagal nerves (9/9 PD cases, 2/3 iLBD cases) also displayed LP. The results are discussed within the context of hyposmia as well as autonomic dysfunction in PD (sialorrhea, sialopenia, dysphagia). Potential disease-related changes in salivary volume, contents, and viscosity might make it possible, in combination with other tests, to employ human saliva as a biomarker.


Alpha-synuclein Autonomic nervous system/ganglia Dysphagia Esophagus Lewy body disease Lewy neurites Parkinson’s disease Peripheral nervous system Sialopenia Sialorrhea Submandibular gland Superior cervical ganglion Synucleinopathy 



This study was made possible by funding from the German Research Council (Deutsche Forschungsgemeinschaft, DFG), the Hilde Ulrichs Foundation (Florstadt-Staden), and the Michael J. Fox Foundation for Parkinson’s Research. A summary of the findings reported in this paper was presented at the Alpha-synuclein Summit held in New York City on 14 January 2009 under the auspices of the Michael J. Fox Foundation. The authors also wish to thank Prof. Albert C. Ludolph (Director, Department of Neurology, University of Ulm) and Dr. med. dent. Clemens Stadler (Blaustein) for ongoing discussions. They acknowledge Ms. Siegrid Baumann, Ms. Gabrielle Ehmke, Ms. Verena Hofmann (immunohistochemistry, Center for Clinical Research, University of Ulm), Mr. Stephan Mayer (graphics, Department of Neurology, University of Ulm) for their technical expertise, and the Braak Collection (Goethe University Frankfurt).


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Kelly Del Tredici
    • 1
    Email author
  • Christopher H. Hawkes
    • 2
  • Estifanos Ghebremedhin
    • 3
    • 4
  • Heiko Braak
    • 1
  1. 1.Clinical Neuroanatomy, Center for Clinical Research, Department of NeurologyUniversity of UlmUlmGermany
  2. 2.Neuroscience Centre, Institute of Cell and Molecular ScienceBarts and the London School of Medicine and DentistryLondonUK
  3. 3.Department of Anatomy and Developmental Biology, School of Biomedical SciencesUniversity of QueenslandBrisbaneAustralia
  4. 4.Laboratory for Neuropathology, Institute of Pathology, Center for Clinical ResearchUniversity of UlmUlmGermany

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