The Etiopathogenesis of Parkinson Disease and Suggestions for Future Research. Part II

We are at a critical juncture in our knowledge of the etiology and pathogenesis of Parkinson disease (PD). It is clear that PD is not a single entity simply resulting from a dopaminergic deficit; rather it is most likely caused by a combination of genetic and environmental factors. Although there is extensive new information on the etiology and pathogenesis of PD, which may advance its treatment, new syntheses of this information are needed. The second part of this two-part, state-of-the-art review by leaders in PD research critically examines the research field to identify areas for which new knowledge and ideas might be helpful for treatment purposes. Topics reviewed in Part II are genetics, animal models, and oxidative stress. There have been 2 important approaches to genetic research studies in Parkinson disease (PD). The first focuses on rare families with parkinsonism apparently following Mendelian inheritance and using the classic methodology of linkage analysis and positional cloning. In the other, an attempt is made to evaluate the PD population as a whole, using association studies and nonparametric linkage methodology and trying to define risk alleles that contribute to the sporadic form of the disease. Over the past years, genetic research following the first approach has been highly effective in identifying the genes underlying monogenic PD, in particular α-synuclein (1) (Park-1) and LRRK2 (Park-8) (2, 3) in dominant families, as well as the recessive PD genes parkin(Park-2) (4), PINK1(Park-6) (5), and DJ-1(Park-7) (6). These mutations probably cause the disease in only a very small subset of families, with the exception of LRRK2, which is responsible for a significant proportion of familial PD (5.1%-18.7%) and a smaller portion of sporadic PD (1.5%-6.1%), although Ashkenazi Jews and Arabs have a higher frequency in the majority of populations studied. Nevertheless, these discoveries have been extremely fruitful, leading the way to some molecular pathways involved in nigral degeneration, which includes protein aggregation, defective proteasomal degradation, mitochondrial dysfunction, and oxidative stress (7). The findings that LRRK2 encodes a protein from the family of mitogen-activated protein kinases and that mutations may lead to an increase of kinase activity (8) may translate relatively quickly into a novel treatment option involving kinase inhibition. However, the contribution of the mechanisms of these and other genes to idiopathic PD as a whole is still poorly defined.

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