Scientists at Van Andel Institute discover link between Parkinson’s disease and appendix

Alicia Farmer
November 3, 2018

The research found that the risk for the disease, which has famously affected high-profile figures like actor Michael J. Fox and boxer Muhammad Ali, was found to be greatly reduced in people who have had their appendix removed.

Scientists from the Van Andel Research Institute in MI examined data on 1.7 million people in Sweden and found that having an appendectomy is linked to a 19.3 percent reduced risk of developing Parkinson's in a general population.

The study couldn't prove cause and effect, but it found that appendectomy lowered Parkinson's risk by roughly 20 percent.

Researchers consider the appendix a "hub" containing the potentially risky protein, known as the alpha-synuclein.

"However, these approaches are unlikely to eliminate the condition, as Parkinson's may also start in other areas of the body or brain".

One of the key findings, Labrie said, is that a clump protein considered the "hallmark pathology" of Parkinson's was found in the appendixes of all individuals studied - no matter their age or health.

"The question that remains is why Parkinson's develops in only some people with abnormal alpha synuclein aggregation in the gut, and why others are seemingly resistant", Tom Foltynie of the Institute of Neurology at University College London tells The Guardian's Devlin.

Perhaps, and according to experimental evidence, "it can travel up the nerve that connects the G.I. tract to the brain", says Labrie.

Researchers also found those with Parkinson's who had an appendectomy had a later onset of the disorder by an average of 3.6 years.

Symptoms of the disease can show up in the gut earlier than in the brain, so to understand why, Labrie and her colleagues looked at the appendix-once considered useless but now thought to play a role in the immune system by scanning for infectious pathogens.

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The research by scientists at Michigan's Van Andel Research Institute comes on the back of increasing evidence that there is a link between our gut and the neurodegenerative disease. That's because, in the first stages of the disease, the problems manifest in a very different place: the gut. 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.

Dr Viviane Labrie, an assistant professor at Van Andel Research Institute in MI and senior author of the study, said that this study does not recommend all people to undergo an appendectomy (surgical removal of appendix) to protect themselves from Parkinson's disease.

This often includes constipation and the need to urinate frequently, and the issues can predate a Parkinson's diagnosis by many years. "If we can couple this understanding with tests that detect the earliest changes and treatments that can stop it progressing, we will have a real pathway to preventing Parkinson's".

Claire Bale, head of research at Parkinson's United Kingdom, said the findings "build on previous research indicating that, for some, Parkinson's starts in the gut".

Parkinson's disease is a chronic disease of the nervous system, characteristic for the elderly.

Overall, finding a link between the appendix and Parkinson's is significant, he said. "Parkinson's is relatively rare - less than 1 percent of the population - so there has to be some other mechanism or confluence of events that allows the appendix to affect Parkinson's risk".

Data for the study were gleaned from an in-depth characterization and visualization of alpha-synuclein forms in the appendix, which bore a remarkable resemblance to those found in the Parkinson's disease brain, as well as analyses of two large health-record databases.

The findings were published in the October 31 issue of Science Translational Medicine. One priority will be to try to figure out what distinguishes healthy people with alpha-synuclein clumps in their appendixes from those who go on to develop Parkinson's. "Any of these differences might be the cause of the decreased risk of Parkinson's disease in those who had their appendix out, rather than the removal of their appendix".

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

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