A postmortem study suggests a revision of the dual-hit hypothesis of Parkinson’s disease

Abstract

The dual-hit hypothesis of Parkinson’s disease (PD) originally postulated that a neurotropic pathogen leads to formation of α-synuclein pathology in the olfactory bulb (OB) and dorsal motor nucleus of the vagus (DMV) and then invades the brain from these two entry points. Little work has been conducted to validate an important underlying premise for the dual-hit hypothesis, namely that the initial Lewy pathology does arise simultaneously in the OB and the enteric nervous system (ENS) plexuses and DMV at the earliest disease stage. We conducted a focused re-analysis of two postmortem datasets, which included large numbers of mild Lewy body disease (LBD) cases. We found that cases with α-synuclein pathology restricted to the peripheral autonomic nervous system and/or lower brainstem (early body-first LBD cases) very rarely had any OB pathology, suggesting that Lewy pathology commonly arises in the ENS without concomitant involvement of the OB. In contrast, cases with mild amygdala-predominant Lewy pathology (early brain-first LBD cases) nearly always showed OB pathology. This is compatible with the first pathology being triggered in the OB or amygdala followed by secondary spreading to connected structures, but without early involvement of the ENS or lower brainstem. These observations support that the pathologic process starts in either the olfactory bulb or the ENS, but rarely in the olfactory bulb and gut simultaneously. More studies on neuropathological datasets are warranted to reproduce these findings. The agreement between the revised single-hit hypothesis and the recently proposed brain-first vs. body-first model of LBD is discussed.

Distribution of phosphorylated alpha-synuclein in non-diseased brain implicates olfactory bulb mitral cells in synucleinopathy pathogenesis

“…Recent reports looking at LP distribution in PD described cases where OB LP was not present 52 – 54 . Two PD subtypes might exist where pathology begins either in the peripheral nervous system “body-first” or in the central nervous system “brain-first”, with LP being brainstem prominent or OB prominent, respectively 52 – 54 . We observed apparent LP (PK-resistant PSER129 reactivity) in all human PD OBs tested here; however, the sample size was small.…”

Searching for Biomarkers in the Blood of Patients at Risk of Developing Parkinson’s Disease at the Prodromal Stage

“…In the brain-first (top-down) subtype, PD begins with impaired sense of smell and then spreads to peripheral autonomic functions [39]. With the body-first (bottom-up) subtype, PD pathology initially arises in the enteric autonomic nervous system, and then spreads along the vagus and sympathetic fibers to the basal ganglia and olfactory system [40]. Premotor RBD is thought to be a marker of the body-first subtype of PD.…”

Viruses and amyloids - a vicious liaison

“…In PD αSyn fibrils accumulate in and around dopaminergic neuronal cells causing depletion of the substantia nigra and loss of motor function. PD is however a systemic disease with significant CNS-gastric transfer of αsyn aggregates via the autonomous nervous system [ 47 ]. PD is multifactorial with many risk genes involved in endosomal trafficking, autophagy and mitochondrial function [ 48 ].…”