Published on April 5, 2016, By Lucy Piper
Submandibular gland biopsy can be used to identify α-synuclein (αSyn)
aggregates, potentially offering not only a simple means of histologically
confirming Parkinson's disease (PD) but also a marker for the disease in
patients with premotor manifestations, researchers report.
Aggregates of αSyn were found by this method in 54% of the 45
patients studied, of whom 21 had idiopathic rapid-eye-movement sleep behaviour
disorder (IRBD) and 24 PD. This compared with none of 26 control individuals
(seven healthy, 11 undergoing neck surgery and eight autopsies).
"Core needle biopsy of the submandibular gland might be an
option for the detection of αSyn because the gland is located subcutaneously,
and is easy to localise by manual palpation or ultrasonography guidance",
comments researcher Eduardo Tolosa (Hospital Clinic de Barcelona, Spain) and
colleagues.
"Biopsy of the submandibular gland does not need general
anaesthesia, is routinely done for diagnostic purposes [...], is less invasive
than other procedures such as colonoscopy, and poses little risk to the
patient", they add.
Material containing glandular parenchyma was obtained by
transcutaneous core needle biopsy in nine of the 21 patients with IRBD, 12 of
the 24 patients with PD and all 26 of the controls. And immunohistochemistry
analysis showed the presence of αSyn aggregates in the nerve fibres of eight
(89%) of the IRBD patients and eight (67%) of the PD patients, but in none of
the controls.
Among the participants whose biopsy samples did not contain
glandular parenchyma, but only muscular or connective tissue, αSyn aggregates
were detected in these extraglandular tissues of an additional three (25%) of
12 patients with IRBD and five (42%) of 12 patients with PD. Again, none of the
controls showed signs of αSyn in these tissues.
"Our observation that Lewy body type pathology is
frequently found in the submandibular gland of patients with IRBD, but not in
controls, provides in-vivo evidence that this sleep disorder is a manifestation
of prodromal Parkinson's disease", the researchers write in The Lancet
Neurology.
And it suggests that pathological changes in IRBD patients
extend to a wider area beyond the brainstem nuclei that regulate rapid eye
movement.
It is therefore possible that as well as being useful for
histological confirmation of PD, αSyn detection in submandibular glands could
serve as a marker for the disease in patients with IRBD and "might be
useful for the design of disease-modifying strategies", say the
researchers.
They caution, however, that "technical refinement is needed
to implement the procedure in clinical and research settings. If this cannot be
achieved, more accessible peripheral tissues (eg, skin or minor salivary
glands) should be assessed with the aim of obtaining adequate histological
samples."
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