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Submandibular gland biopsy for the diagnosis of Parkinson's disease

Submandibular gland biopsy for the diagnosis of Parkinson's disease Beach TG, Adler CH, Dugger BN, et al. Submandibular gland biopsy for the diagnosis of Parkinson disease. J Neuropathol Exp Neurol . 2013;72:130–136. The diagnosis of Parkinson's disease (PD) is made clinically based on typical motor abnormalities. However, the clinical diagnosis may be wrong in 10% to 15% of cases. Thus, reliable diagnostic biomarkers are warranted. Markers that are sensitive to the earliest premotor stages would be ideal. To identify a potential biomarker that would allow the pathologic diagnosis of PD in vivo, Beach et al. recently investigated submandibular gland tissue retrieved by biopsy. 128 individuals were included in the postmortem study, including 28 individuals with PD, 5 with idiopathic Lewy body disease, 5 with progressive supranuclear palsy, 3 with corticobasal degeneration, 2 with multiple system atrophy, 22 with Alzheimer's disease with Lewy bodies, 16 with Alzheimer's disease with no Lewy bodies, and 50 cognitively normal elderly controls. The diagnosis was confirmed neuropathologically in all individuals. Large blocks (approximately 1.5‐cm 2 segments) of the submandibular gland were taken from all 128 individuals. Additional needle cores of the submandibular glands were sampled in a subgroup of 19 PD patients. Clinical information, including mean Unified Parkinson's Disease Rating Scale score, mean Mini‐Mental State Examination score, and mean Braak stage, was correlated. The authors demonstrated the presence of phosphorylated α‐synuclein in submandibular gland tissue in 100% of patients with PD (and, to a small extent, in patients with Alzheimer's disease) in large tissue blocks but in 0% of normal controls. The needle‐core samples revealed positive results in 89% of PD patients. The study by Beach et al. is noteworthy for several reasons. To our knowledge, theirs is the first study using needle‐core biopsies to assess submandibular gland tissue in PD demonstrating the presence of Lewy body pathology in a remarkably high number of patients. Immunohistochemistry was combined with histologic methods to minimize the number of false‐positive findings. The authors confirmed findings of prominent phosphorylated α‐synuclein in the submandibular gland and in other salivary glands in PD reported in 3 previous postmortem studies and in 1 in vivo study. In this context, it is remarkable that Lewy body pathology in the gut may be present even in the premotor phase of PD, which may help us understand the pathophysiology and spread of distribution in PD. The current report emphasizes the recent endeavors to detect Lewy body in peripheral tissue from patients with PD. This is an interesting development; however, more studies critically evaluating the techniques are needed. Athanasia Alexoudi, MD Susanne A. Schneider, MD, PhD Günther Deuschl, MD Department of Neurology, Christian‐Albrechts University of Kiel, Kiel, Germany http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Movement Disorders Wiley

Submandibular gland biopsy for the diagnosis of Parkinson's disease

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References (8)

Publisher
Wiley
Copyright
Copyright © 2013 Movement Disorder Society
ISSN
0885-3185
eISSN
1531-8257
DOI
10.1002/mds.25467
pmid
23720221
Publisher site
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Abstract

Beach TG, Adler CH, Dugger BN, et al. Submandibular gland biopsy for the diagnosis of Parkinson disease. J Neuropathol Exp Neurol . 2013;72:130–136. The diagnosis of Parkinson's disease (PD) is made clinically based on typical motor abnormalities. However, the clinical diagnosis may be wrong in 10% to 15% of cases. Thus, reliable diagnostic biomarkers are warranted. Markers that are sensitive to the earliest premotor stages would be ideal. To identify a potential biomarker that would allow the pathologic diagnosis of PD in vivo, Beach et al. recently investigated submandibular gland tissue retrieved by biopsy. 128 individuals were included in the postmortem study, including 28 individuals with PD, 5 with idiopathic Lewy body disease, 5 with progressive supranuclear palsy, 3 with corticobasal degeneration, 2 with multiple system atrophy, 22 with Alzheimer's disease with Lewy bodies, 16 with Alzheimer's disease with no Lewy bodies, and 50 cognitively normal elderly controls. The diagnosis was confirmed neuropathologically in all individuals. Large blocks (approximately 1.5‐cm 2 segments) of the submandibular gland were taken from all 128 individuals. Additional needle cores of the submandibular glands were sampled in a subgroup of 19 PD patients. Clinical information, including mean Unified Parkinson's Disease Rating Scale score, mean Mini‐Mental State Examination score, and mean Braak stage, was correlated. The authors demonstrated the presence of phosphorylated α‐synuclein in submandibular gland tissue in 100% of patients with PD (and, to a small extent, in patients with Alzheimer's disease) in large tissue blocks but in 0% of normal controls. The needle‐core samples revealed positive results in 89% of PD patients. The study by Beach et al. is noteworthy for several reasons. To our knowledge, theirs is the first study using needle‐core biopsies to assess submandibular gland tissue in PD demonstrating the presence of Lewy body pathology in a remarkably high number of patients. Immunohistochemistry was combined with histologic methods to minimize the number of false‐positive findings. The authors confirmed findings of prominent phosphorylated α‐synuclein in the submandibular gland and in other salivary glands in PD reported in 3 previous postmortem studies and in 1 in vivo study. In this context, it is remarkable that Lewy body pathology in the gut may be present even in the premotor phase of PD, which may help us understand the pathophysiology and spread of distribution in PD. The current report emphasizes the recent endeavors to detect Lewy body in peripheral tissue from patients with PD. This is an interesting development; however, more studies critically evaluating the techniques are needed. Athanasia Alexoudi, MD Susanne A. Schneider, MD, PhD Günther Deuschl, MD Department of Neurology, Christian‐Albrechts University of Kiel, Kiel, Germany

Journal

Movement Disorders – Wiley

Published: Jun 1, 2013

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