Microbiocenosis-correcting approaches to personalized complex therapy of Parkinson’s disease patients
Abstract. Parkinson’s disease (PD) is a socially significant neurodegenerative disorder characterized by dysbiotic imbalances in intestinal microbiome. The aim: to evaluate the effect of personalized combination therapy for PD based on an assessment of gastrointestinal microbiome and its correlation with iron, hemoglobin, cyanocobalamin, and folate metabolism, as well as cognitive status. Material and methods. 112 patients with PD (aged 50–85 years) and 52 healthy volunteers were examined. A cohort of 60 patients (n = 60) was randomized into two groups: Group 1 received metronidazole and a probiotic (Bifiform) along with standard PD therapy; Group 2 (n = 30) received standard therapy alone. Participants were assessed for fecal microbiome, iron metabolism parameters, vitamin B9 and B12 levels, and neuropsychological scale scores (HADS, MoCA, 3-KT, MDS-UPDRS, MOSCOW). Results. Desulfovibrio spp. bacteria were detected in 73.3% of PD patients and only in 1.9% of healthy control participants (p <0.001). With intestinal cleansing, patients showed improvements in HADS (decreased anxiety/depression) and MoCA (increased mean score; decreased proportion of patients with moderate cognitive impairment) scales’ indexes. According to the 3-CT scale, patients with PD showed significant improvements in semantic and phonetic associations, clock drawing, and recall tests. More than 90% of PD patients had baseline iron deficiency (median 8.4 vs. 13.1 μmol/L in healthy individuals; p <0.001), and they were also more likely to have low blood levels of vitamins B9 and B12. After the treatment, patients in Group 1, who received metronidazole and a probiotic in addition to standard PD therapy, showed statistically significant increases in hemoglobin, iron, and B9 levels. Furthermore, the proportion of patients with vitamin B6, B12, and iron deficiencies in this study group was statistically significantly reduced. Conclusion. High Desulfovibrio spp. levels in case of PD and their reduction with targeted therapy are accompanied by clinical and metabolic improvements in patients having such kind of disease.Antonova V.S., Bityumina L.A., Kulikova N.G., Levin O.S., Ploskireva A.A.
Keywords
Parkinson’s disease
intestinal microbiocenosis
Desulfovibrio spp
References
1. Barrenschee M, Zorenkov D, Bottner M, Lange C, Cossais F, Scharf AB et al. Distinct pattern of enteric phospho-alpha-synuclein aggregates and gene expression profiles in patients with Parkinson’s disease. Acta Neuropathol Commun. 2017;5(1):1.
PMID: 28057070. PMCID: PMC5217296. https://doi.org/10.1186/s40478-016-0408-2
2. Braak H, Rub U, Gai WP, Del Tredici K. Idiopathic Parkinson’s disease: Possible routes by which vulnerable neuronal types may be subject to neuroinvasion by an unknown pathogen. J Neural Transm (Vienna). 2003;110(5):517–36.
PMID: 12721813. https://doi.org/10.1007/s00702-002-0808-2
3. Wallen ZD, Appah M, Dean MN, Sesler CL, Factor SA, Molho E et al. Characterizing dysbiosis of gut microbiome in PD: Evidence for overabundance of opportunistic pathogens. NPJ Parkinsons Dis. 2020;6:11.
PMID: 32566740. PMCID: PMC7293233. https://doi.org/10.1038/s41531-020-0112-6
4. Lin A, Zheng W, He Y, Tang W, Wei X, He R et al. Gut microbiota in patients with Parkinson’s disease in southern China. Parkinsonism Relat Disord. 2018;53:82–88.
PMID: 29776865. https://doi.org/10.1016/j.parkreldis.2018.05.007
5. Huynh VA, Takala TM, Murros KE, Diwedi B, Saris PEJ. Desulfovibrio bacteria enhance alpha-synuclein aggregation in a Caenorhabditis elegans model of Parkinson’s disease. Front Cell Infect Microbiol. 2023;13:1181315.
PMID: 37197200. PMCID: PMC10183572. https://doi.org/10.3389/fcimb.2023.1181315
About the Authors
Victoria S. Antonova, MD, neurologist of Admissions Department, L.A. Vorokhobov City Clinical Hospital No. 67 of the Department of Healthcare of Moscow. Address: 123423, Moscow, 2/44 Salyama Adilya St.E-mail: victoriaas0296@gmail.com
ORCID: https://orcid.org/0009-0004-0633-3807
Lutsiya A. Bityumina, MD, researcher and bacteriologistat the Research group for antimicrobial resistance of food-borne pathogens, Central Research Institute of Epidemiology of Rospotrebnadzor. Address: 111123, Moscow, 3A Novogireevskaya St.
E-mail: bitumina@cmd.su
ORCID: https://orcid.org/0000-0002-5378-0827
Nina G. Kulikova, MD, PhD (Biology), head of the Research group for antimicrobial resistance of food-borne pathogens, Central Research Institute of Epidemiology of Rospotrebnadzor. Address: 111123, Moscow, 3A Novogireevskaya St.
E-mail: kulikova_ng@cmd.su
ORCID: https://orcid.org/0000-0002-1716-6969
Oleg S. Levin, MD, Dr. Sci. (Medicine), professor of the Department of neurology with a course in reflexology and manual therapy, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia, senior researcher at S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center of the Department of Healthcare of Moscow. Address: 125284, Moscow, 5 2nd Botkinsky Lane.
E-mail: neurolev@mail.ru
ORCID: https://orcid.org/0000-0003-3872-5923
Antonina A. Ploskireva, MD, Dr. Sci. (Medicine), professor, professor of RAS, deputy director for clinical work at the Central Research Institute of Epidemiology of Rospotrebnadzor. Address: 111123, Moscow, 3A Novogireevskaya St.
Email: antoninna@mail.ru
ORCID: https://orcid.org/0000-0002-3612-1889
Similar Articles
