Spring / Summer 2024 | Research 5
A diverse group , above , of people with Parkinson ’ s , clinicians , researchers , regulators and industry representatives gathered at the PD Staging Roundtable in April 2023 , hosted by MJFF with leading Parkinson ’ s organizations . Co-authors from this group contributed to the proposed staging system for PD , NSD-ISS , published in The Lancet Neurology , left .
Initiative ( PPMI ), the aSyn-SAA enables objective detection of PD even prior to the onset of any visible symptoms .
The framework then proposes a staging system , called the neuronal alpha-synuclein disease integrated staging system ( NSD-ISS ), based on two biological hallmarks for PD : dysfunctional alpha-synuclein as detected in spinal fluid with the aSyn-SAA , and dopaminergic transport dysfunction , which can be visualized in the brain later in the disease process using DaTscan imaging .
Stages one and two are based on these objective biomarkers , and stages three to six are based on these biomarkers along with progressive motor and other nonmotor symptoms , such as REM sleep-behavior disorder , tremor , severe loss of smell , cognitive impairments and gait and balance problems .
What You Should Know about the Framework
The framework ’ s authors — an international team of patient , research and industry leaders — have underscored that for now the NSD-ISS is a researcher accelerator and not intended for clinical application . ( See the potential implications for care of the new biomarker and staging as explained by MJFF ’ s Dr . Rachel Dolhun , our Ask the MD , at michaeljfox . org / biomarker .) But that does not mean people with the disease will not benefit from it . In addition to having an immediate impact on therapeutic development , the framework will help drive research that advances understanding of PD biology , including :
+ The molecular aspects of PD , such as genetic mutations , inflammation and mitochondrial dysfunction , starting before clinical symptoms are apparent .
+ The distinct biology in the 10 percent of individuals who have clinical PD symptoms but test negative for aSyn .
+ The diseases other than PD that have similar aSyn pathology , like dementia with Lewy bodies .
Every advance in understanding the biology driving Parkinson ’ s disease holds critical importance because ultimately a treatment that targets the biology of the disease , rather than just its symptoms , is the key to a cure .