Can Parkinson’s Patients Give Blood?

Specifically, we will review the issue of blood donation from PD patients. We will present the evidence, sample the prevailing attitudes and policies, and then make our recommendations.

Part I of this series discussed the similarities between the possible cell to cell progression of Parkinson’s pathogenesis and contagious proteinaceous pathogens called prions. Despite these similarities, there is no evidence of person to person transmission of Parkinson’s disease. Parkinson’s disease is not contagious.

However, the next form of transmission we need to consider is transmission through blood and tissue. We have seen the evidence that human α-synuclein is the prion-like culprit of PD pathogenesis, capable of transmission. Here is a brief review:

•   α-synuclein aggregates are toxic in living cells

•   Pathological human α-synuclein can be inoculated or seeded into the brains of animals, initiating a PD-like disease in those animals

•   Animals can even be “infected” by injecting the protein into their muscle tissue. This “infection” then appears to travel up the sciatic nerve on its way to the brain.

•   Transplantation of fetal cells in PD subjects became “infected” 14 years after grafting.

Animals don’t get PD and it is difficult to make conclusions from these animal experiments about the possibility for inoculation of PD in humans. However, since α-synuclein seeding appears to occur in animals, it would be wise to be cautious about human PD inoculation.

The best evidence against PD transmission comes from two epidemiological studies.

1. A group of 6018 people with hemophilia in the UK were tracked for between 2 and 23 years. This disease is traditionally controlled with regular infusions of blood clotting factor extracted from human blood serum. The study did not find increases in mortality other than from HIV and from those causes that would be expected from this population of patients. There was also no evidence of deaths from Creutzfeldt-Jakob disease (CJD), a human prion disease.

2. Patients treated with human growth hormone (hGH) have traditionally used a product extracted from cadaveric pituitary glands. These patients were followed and their cause of death determined. The mean age of death was a young 27.2 years. This study did indeed find instances of CJD transmitted through this procedure. However, they did not find evidence of PD transmission.

These observations cast doubt on the possibility of PD transmission, however there are alternate explanations for these observations:

•   Infectious α-synuclein material does not survive the extraction process.

•   A long incubation time for PD obscures the analysis and tracking for reduced lifespan illnesses or short tracking times. Assuming a 20 year incubation time and a 15 year post diagnosis lifespan, tracking would likely miss this population.

A recent review of this issue recommended that “a thorough decontamination of surgical instruments and other medical devices from aggregated Aβ-, tau- and α-synuclein by effective and routinely applicable reprocessing procedures may possibly add to patient safety.”

Yet despite the conflicting evidence, PD patients are typically not discouraged from donating blood or organs.

•   The American Red Cross, does not list Parkinson’s disease on their list of those not eligible to give blood.

•   The New Zealand Blood Service does not allow PD patients to give blood only because it considers donating a health risk to PD patients.

•   The Central California Blood Center explicitly allows PD patients to give blood.

•   The Australian Red Cross explicitly encourages PD patients to donate blood. In fact, PD patient, Alan Harvey, is celebrated in marketing material for having made 400 blood donations as of Winter, 2013.

The only blood service in our limited sampling that forbids blood donation from PD patients in order to protect its blood supply is the United Kingdom’s NHS Blood and Transplant. The official statement on Parkinson’s patients is: “We are very sorry but sadly you are not able to donate blood. This is either for the safety of yourself in giving blood or for the safety of patients that receive your blood.” A BBC article suggests the reason is the “uncertain origin” of the disease.

PD professionals and pundits almost universally approve of blood donation from PD patients:

•   Monique L. Giroux, MD. Medical Director of the Northwest Parkinson’s Foundation states very confidently “Parkinson’s disease is not a condition transmitted by blood so having PD does not exclude a person from giving blood.”

•   Michael S. Okun, M.D. National Medical Director of NPF, UF Center for Movement Disorders & Neurorestoration feels PD patients can give blood as long as they don’t have low blood pressure.

•   The Answers.com entry on the issue states: “Depending on medications and general health it would be fine.”

•   Chacha.com answers that donating blood would be fine “Since Parkinson’s is not a transmittable disease“.

In our opinion, of all the blood donation services and PD professionals, the UK’s NHS has provided the only accurate statement on this serious issue. As of the date of this post, evidence suggesting at least the possibility of blood to blood transmission of PD is not insignificant. To proclaim otherwise is irresponsible at best. We propose, therefore, the following recommendations until definitive conclusions about blood-borne transmission of PD are possible.

1. That worldwide blood donation policy groups PD with prion diseases like CJD.

2. Until such policy is enacted we urge all PD patients to voluntarily refrain from giving blood and from consenting to donate organs.

3. We urge the tracking of blood donors who either had PD at the time of blood donation or who gave blood at any time prior to being diagnosed with PD.

4. Recipients who have received such blood should be informed and tracked by PD status, including testing for early pre-motor symptoms (a smell test, for example) and PD markers (when they are developed).

5. Recipients should initiate a neuroprotective prevention protocol based on all applicable research. Our team has a good idea what such a protocol would look like and we plan to publish a prevention protocol in the near future.

6. All references to blood donation also include organ donation.

It is our hope that concern about blood supplies will provide an additional incentive to better fund research on Parkinson’s disease and indeed all those diseases of uncertain origin.

Dr. Steve

Researcher at Stop Parkinson's

Dr. Steve is a biochemist, specializing in medical bioinformatics and nutrition. Dr. Steve directs a biomedical consulting laboratory, focusing primarily on biomedical investing and health policy.

Manganese and Parkinson's Disease

Manganese is an essential nutrient humans require on a daily basis. However, according to the Agency for Toxic Substances & Disease Registry, exposure to too much manganese can cause brain damage. Manganese is present in food, water, multivitamin supplements and the air you breathe, especially in locations where manganese is used in manufacturing.

Functions:

Manganese performs several functions in the body and is found in your pancreas, bones, liver and kidneys. According to the University of Maryland Medical Center, manganese helps your body form sex hormones, bones, connective tissues and blood-clotting factors, is necessary for normal nerve and brain function, is an antioxidant that helps fights free radicals and plays a role in calcium absorption, blood sugar regulation and metabolism.

Food Source:

Manganese is abundant in foods such as nuts, seeds, legumes, leafy green vegetables and whole grains. According to Oregon State University, manganese is also present in tea, sweet potatoes, brown rice, oatmeal, raisin bran cereal, pineapples and pineapple juice.

Minimum Requirements:

The Institute of Medicine has established adequate intakes, which are minimum daily requirements for manganese consumption. Manganese adequate intakes for adults are: 2.6 milligrams per day for breastfeeding women, 2.0 milligrams per day for pregnant women, 1.8 milligrams per day for other adult women and 2.3 milligrams per day for adult men.

Tolerable Upper Intakes:

Since overconsumption of manganese is toxic, the Institute of Medicine has also established maximum safe amounts for manganese called "tolerable upper intakes," or ULs. The manganese UL for adults is 11 milligrams per day.

Manganese Deficiency:

According to the University of Maryland Medical Center, up to 37 percent of people in the United States may not consume enough manganese in their diets. The same source reports that manganese deficiency can cause weakness, bone malformation, infertility and seizures.

Manganese Toxicity:

Manganese toxicity can result from consuming too much manganese from food, water, supplements or exposure to manganese dust in the air. According to Oregon State University, manganese toxicity can cause neurological problems, symptoms similar to Parkinson’s disease, tremors, muscle spasms, difficulty walking, irritability, hallucinations and aggressiveness.

Concerns in Children:

Manganese is a essential for proper growth and development in children. However, exposure to too much manganese can delay a child’s motor and cognitive development. According to the U.S. Environmental Agency, children exposed to arsenic and manganese in their environment usually score lower on memory and general intelligence tests.

Requirements for Children:

The Institute of Medicine’s adequate intake levels for manganese in children are 0.003 milligrams per day for infants up to 6 months old, 0.6 milligrams per day for infants ages 6 to 12 months old, 1.2 milligrams per day for children ages 1 to 3 years old, 1.5 milligrams per day for children ages 4 to 8 years old, 1.6 milligrams per day for girls ages 9 to 18 years old, 1.9 milligrams per day for boys ages 9 to 13 years old and 2.2 milligrams per day for boys ages 14 to 18 years old.

ULs for Children:

To help prevent neurological problems and developments delays in children, avoid overexposure to manganese. The Institute of Medicine ULs for manganese in children are 2 milligrams per day for children ages 1 to 3 years old, 3 milligrams per day for children ages 4 to 8 years old, 6 milligrams per day for children ages 9 to 13 years old and 9 milligrams per day for children ages 14 to 18 years old.

Nutrient Interactions:

Manganese absorption is likely affected by taking certain types of supplements. According to Oregon State University, consuming iron, calcium or magnesium supplements may decrease manganese absorption in your body.

A team of researchers has uncovered a key way that cells respond to stress.

By Mary Elizabeth Dallas, HealthDay Reporter

THURSDAY, Sept. 11, 2014 (HealthDay News) -- A team of researchers has uncovered a key way that cells respond to stress.

As they explain it, cells produce more than 25,000 different proteins with specific 3-D shapes, but when stressed, they can make mistakes and produce misshapen proteins that are unfolded or misfolded.

Duke University researchers found, however, that cells are able to recognize this build-up of misshapen proteins and respond by temporarily slowing down production or shutting it off entirely.

The researchers suggested that their findings, published Sept. 11 in the journal Cell, could help scientists gain a better understanding of diseases like Alzheimer's, Lou Gehrig's disease (ALS), Huntington's, Parkinson's and type 2 diabetes, which involve the accumulation of misfolded proteins.

"We have identified an entirely new mechanism for how the cell responds to stress," study author Christopher V. Nicchitta, a professor of cell biology at Duke University School of Medicine, said in a university news release. "Essentially, the cell remodels the organization of its protein production machinery in order to compartmentalize the tasks at hand."

Cells work like a factory, making protein on a production line: each cell has a DNA blueprint, which is first transcribed into messenger RNA or mRNA, which then travels to the outer part of the cell and is translated into proteins.

When a cell gets stressed from overheating or starvation, however, its proteins do not fold properly. These unfolded proteins trigger an alarm that causes the cell to slow down its production line and clean up the misshapen proteins. This reaction is known as the unfolded protein response, the researchers explained.

"You can slow down protein production, but sometimes slowing down the workflow is not enough," explained Nicchitta. "You can activate genes to help chew up the misfolded proteins, but sometimes they are accumulating too quickly. Here we have discovered a mechanism that does one better -- it effectively puts everything on hold. Once things get back to normal, the mRNAs are released from the holding pattern."

Nicchitta said he was now looking for the factors that determine which mechanism cells employ during a stress response.

More information

The U.S. National Institute of Mental Health has more on the health effects of stress.

Copyright © 2014 HealthDay. All rights reserved.

World Parkinson Coalition to Hold Online Conference

• September 6, 2014 

The World Parkinson Coalition (WPC) is hosting its first ever WPC Scientific Update online for free September 30 to October 1.

WPC Scientific Update: Parkinson Pipeline Umbrella will take place over three days in six one-hour sessions at 12 p.m. ET/9 a.m. PT and at 2 p.m. ET/ 11 p.m. PT. In addition to the live webcast, the sessions will archived for later viewing.

Sessions will be about the latest scientific updates from the Parkinson’s research world. The full program is available online. Participants are also encouraged to tweet before and during the sessions using the hashtag #WPCwebcast.

http://www.worldpdcoalition.org/?page=2014Webcast#general

Parkinson’s therapy aims to help retrain brains

 September 6, 2014

 BRIDGEWATER, Pa. (AP) — Parkinson’s robs people of the ability to control their movements, but some patients in Beaver County are seeing big results from a physical therapy program designed to counteract the symptoms of the degenerative disease.

While there is no cure for Parkinson’s disease and little is known about the cause, experts know that people with the nervous system disorder have trouble with slowness of movement, and their movements are also small, said Dale Reckless, facility director of M-R-S Physical Therapy in Bridgewater.

But the Lee Silverman Voice Treatment Big (LSVT Big) therapy program, which Reckless brought to M-R-S and Beaver County earlier this year, is aimed at keeping people’s movements big and quick in order to counteract those symptoms.

People with Parkinson’s experience an internal queuing problem, so even if they are taking shuffling steps, their brains believe they are walking at a regular pace, Reckless explained.

The idea behind LSVT Big, he said, is to overcompensate with big, bold exercises and essentially retrain the brain to get a person’s movements back to normal.

“We’re helping the patients to think big but in the real sense they’re actually coming out to making normal movements,” Reckless said.

People with Parkinson’s also often experience tremors, stiffness and rigidity, and posture and balance issues, Reckless said, in addition to speech problems, which a related program, LSVT Loud, was designed for.

There are other treatments for Parkinson’s including medications, but research has shown that exercise as well as physical and occupational therapies, including LSVT Big, can help improve mobility in some patients.

Reckless worked at HealthSouth Harmarville Rehabilitation Hospital for more than two decades before joining M-R-S in April, and he said he is now the only physical therapist certified to offer LSVT Big in the county.

“I was pretty excited to come out here because I knew that it was an under-served population,” Reckless said.

According to the National Parkinson Foundation, about 8,000 to 10,000 people in western Pennsylvania are living with a Parkinson’s diagnosis. Major celebrities who have been diagnosed with Parkinson’s, such asMichael J. Fox and the late Robin Williams, have helped bring attention to the impact of the disease.

“It’s not a small issue, it’s a pretty big issue,” Reckless said.

Since he became certified two years ago, Reckless said he has yet to see a patient who doesn’t benefit in some way from the LSVT Big program.

George Rowse, 88, of Monaca was diagnosed with Parkinson’s in February and was referred by his neurologist to see Reckless for LSVT Big therapy. Since starting the 16-week program, Rowse said the biggest changes he’s noticed have been in his balance and control.

Before LSVT, Rowse was falling at least a couple times a week. “You lose that balance and you’re done,” he said. But as of early August, he had not fallen in at least three weeks.

Rowse said he was discouraged and almost quit LSVT early on, but he’s thankful he listened to his doctor and stuck with it. After completing the program at M-R-S, he’ll continue the exercises on his own at home.

During a session, Rowse mirrors the exercises that Reckless demonstrates. Reach all the way to the floor from a seated position. Reach one hand out to the side, sweep it down the floor and across the body, and hold. “Finish big,” Reckless instructed.

“I’m starting to learn what to do,” Rowse said. “I’m starting to learn to control things.”

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Online:

http://bit.ly/1CpHDI4

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Information from: Beaver County Times, http://www.timesonline.com/