Parkinson's disease may start in appendix, study finds

Lewy Body

Lewy Body

A peek at surgically removed appendix tissue shows this tiny organ, often considered useless, seems to be a storage depot for an abnormal protein - one that, if it somehow makes its way into the brain, becomes a hallmark of Parkinson's.

FLORIDA, Nov 1 ― Parkinson's disease has always been considered a disease of the brain, but research out yesterday found it may start in the gut ― specifically in the appendix, a tiny organ near the large intestine.

Scientists led by the Van Andel Research Institute in MI scoured two large patient registries, encompassing data from 1.7 million people, and made an astounding discovery: People who have their appendixes removed early in life reduce their risk of developing Parkinson's disease by 19% to 25%.

But the researchers argue the guts are a breeding ground for the protein, which then travels up the vagus nerve and into the brain.

Indeed, a smaller study using Danish health registries, published in 2016, found that appendectomies were associated with a small increase in Parkinson's disease risk 10 or more years after surgery.

But don't look for a surgeon just yet.

Viviane Labrie, an assistant professor at Van Andel Research Institute in MI and senior author of the study, said: "Despite having a reputation as largely unnecessary, the appendix actually plays a major part in our immune systems, in regulating the makeup of our gut bacteria and now, as shown by our work, in Parkinson's disease".

Doctors and patients have long known there's some connection between the gastrointestinal tract and Parkinson's. Constipation and other GI troubles are very common years before patients experience tremors and movement difficulty that lead to a Parkinson's diagnosis.

The find gives Parkinson's researchers a new focus for their work, and it also hints at a new path for treatments.

"This is a great piece of the puzzle".

An analysis of around 1.7 million people has revealed a curious link between the appendix and Parkinson's disease.

The idea that the gut is involved in Parkinson's is rapidly gaining attention.

He noted that despite its reputation, the appendix appears to play a role in immunity that may influence gut inflammation.

"There has to be some other mechanism or confluence of events that allows the appendix to affect Parkinson's risk", said Labrie.

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In Parkinson's, toxic proteins build up in the brain to kill nerves, particularly those linked with movement.

The study couldn't prove cause and effect, but it found that appendectomy lowered Parkinson's risk by roughly 20 percent. And while the researchers stopped short of suggesting appendectomies as preventative measures, they did point out that the finding could lead to new therapies for Parkinson's that target the GI tract.

First, the researchers analyzed Sweden's huge national health database, examining medical records of almost 1.7 million people tracked since 1964.

Researchers say it is possible that someday, drug therapies could be developed to cut down on the protein's accumulation in the appendix, thereby lowering the risk of Parkinson's.

One puzzling caveat: People living in rural areas appeared to get the benefit.

Parkinson's disease could originate in the appendix, according to one of the largest studies of the neurodegenerative illness.

Conway, who was not involved in the research, added that "several previous studies have looked for relationships between appendix removal and various other diseases, including heart disease as well as various diseases of the gut".

So next, Labrie's team examined appendix tissue from 48 Parkinson's-free people. In 46 of them, the appendix harbored the abnormal Parkinson's-linked protein.

Photomicrograph of a region of the substantia nigra in a Parkinson's patient showing Lewy bodies. Whether the appendix was inflamed or not also didn't matter.

"It's present in everyone", Labrie said. There has to be another step that makes it risky only for certain people.

"If it were to enter the brain, it can seed and spread from there and have neurotoxic effects that could eventually lead to Parkinson's disease".

According to Kevin McConway, emeritus professor of applied statistics at The Open University, the study goes "part of the way to establishing a reason why the relationship between appendix removal and Parkinson's disease might be one of cause and effect".

The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education. The AP is exclusively responsible for all content.

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