Journal article
Disease modification and biomarker development in Parkinson disease: Revision or reconstruction?
Neurology, Vol.94(11), pp.481-494
03/17/2020
DOI: 10.1212/WNL.0000000000009107
PMID: 32102975
Abstract
A fundamental question in advancing Parkinson disease (PD) research is whether it represents one disorder or many. Does each genetic PD inform a common pathobiology or represent a unique entity? Do the similarities between genetic and idiopathic forms of PD outweigh the differences? If aggregates of α-synuclein in Lewy bodies and Lewy neurites are present in most (α-synucleinopathies), are they also etiopathogenically significant in each (α-synuclein pathogenesis)? Does it matter that postmortem studies in PD have demonstrated that mixed protein-aggregate pathology is the rule and pure α-synucleinopathy the exception? Should we continue to pursue convergent biomarkers that are representative of the diverse whole of PD or subtype-specific, divergent biomarkers, present in some but absent in most? Have clinical trials that failed to demonstrate efficacy of putative disease-modifying interventions been true failures (shortcomings of the hypotheses, which should be rejected) or false failures (shortcomings of the trials; hypotheses should be preserved)? Each of these questions reflects a nosologic struggle between the lumper's clinicopathologic model that embraces heterogeneity of one disease and the splitter's focus on a pathobiology-specific set of diseases. Most important, even if PD is not a single disorder, can advances in biomarkers and disease modification be revised to concentrate on pathologic commonalities in large, clinically defined populations? Or should our efforts be reconstructed to focus on smaller subgroups of patients, distinguished by well-defined molecular characteristics, regardless of their phenotypic classification? Will our clinical trial constructs be revised to target larger and earlier, possibly even prodromal, cohorts? Or should our trials efforts be reconstructed to target smaller but molecularly defined presymptomatic or postsymptomatic cohorts? At the Krembil Knowledge Gaps in Parkinson's Disease Symposium, the tentative answers to these questions were discussed, informed by the failures and successes of the fields of breast cancer and cystic fibrosis.
Details
- Title: Subtitle
- Disease modification and biomarker development in Parkinson disease: Revision or reconstruction?
- Creators
- Alberto J EspayLorraine V KaliaZiv Gan-OrCaroline H Williams-GrayPhilippe L BedardSteven M RoweFrancesca MorganteAlfonso FasanoBenjamin StecherMarcelo A KauffmanMatthew J FarrerChris S CoffeyMichael A SchwarzschildTodd ShererRonald B PostumaAntonio P StrafellaAndrew B SingletonRoger A BarkerKarl KieburtzC Warren OlanowAndres LozanoJeffrey H KordowerJesse M CedarbaumPatrik BrundinDavid G StandaertAnthony E Lang
- Resource Type
- Journal article
- Publication Details
- Neurology, Vol.94(11), pp.481-494
- DOI
- 10.1212/WNL.0000000000009107
- PMID
- 32102975
- ISSN
- 0028-3878
- eISSN
- 1526-632X
- Grant note
- MC_PC_17230 / Medical Research Council P50 NS108675 / NINDS NIH HHS P30 DK072482 / NIDDK NIH HHS MC_PC_12009 / Medical Research Council MR/R007446/1 / Medical Research Council 203151/Z/16/Z / Wellcome Trust
- Language
- English
- Date published
- 03/17/2020
- Academic Unit
- Biostatistics
- Record Identifier
- 9984214959702771
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