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Parkinson’s disease and the gastrointestinal microbiome

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Abstract

Recently, there has been a surge in awareness of the gastrointestinal microbiome (GM) and its role in health and disease. Of particular note is an association between the GM and Parkinson’s disease (PD) and the realisation that the GM can act via a complex bidirectional communication between the gut and the brain. Compelling evidence suggests that a shift in GM composition may play an important role in the pathogenesis of PD by facilitating the characteristic ascending neurodegenerative spread of α-synuclein aggregates from the enteric nervous system to the brain. Here, we review evidence linking GM changes with PD, highlighting mechanisms supportive of pathological α-synuclein spread and intestinal inflammation in PD. We summarise existing patterns and correlations seen in clinical studies of the GM in PD, together with the impacts of non-motor symptoms, medications, lifestyle, diet and ageing on the GM. Roles of GM modulating therapies including probiotics and faecal microbiota transplantation are discussed. Encouragingly, alterations in the GM have repeatedly been observed in PD, supporting a biological link and highlighting it as a potential therapeutic target.

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Author notes

  1. Ryan L. Davis and Carolyn M. Sue are co-last authors.

Authors and Affiliations

  1. Department of Neurology, Royal North Shore Hospital, St Leonards, NSW, Australia

    Michal Lubomski & Carolyn M. Sue

  2. Department of Neurogenetics, Kolling Institute, University of Sydney, Northern Clinical School, St Leonards, NSW, Australia

    Michal Lubomski, Ryan L. Davis & Carolyn M. Sue

  3. School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia

    Michal Lubomski

  4. Division of Neurology and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson’s and Related Disorders, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

    Ai Huey Tan & Shen-Yang Lim

  5. The Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, Australia

    Andrew J. Holmes

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ML: performed literature review, drafted and reviewed the manuscript. AHT: drafted and reviewed the manuscript. S-YL: reviewed the manuscript. AJH: reviewed the manuscript. RLD: drafted and reviewed the manuscript. CMS: drafted and reviewed the manuscript

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Correspondence to Michal Lubomski.

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This study was not industry sponsored and had no sources of support. No statistical analysis was performed. All authors report no relevant disclosures.

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Lubomski, M., Tan, A.H., Lim, SY. et al. Parkinson’s disease and the gastrointestinal microbiome. J Neurol 267, 2507–2523 (2020). https://doi.org/10.1007/s00415-019-09320-1

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