Parkinson’s disease is a complex, progressive neurological disorder affecting up to 10 million people. And it is fast growing in prevalence worldwide.
The birthday on April 11 of James Parkinson — who first described this syndrome in 1817 — kicks off World Parkinson’s Awareness Week.
The disease is most often diagnosed in people over 60, more often males. Classic symptoms include tremor in about 60 percent of cases, rigidity, poor posture and slow movement.
But several decades before diagnosis, subtler symptoms like sleep disturbances and loss of smell often appear together with constipation and erectile dysfunction.
This happens because clumps of alpha-synuclein protein are aggregating in the brain and autonomic nervous system, damaging dopaminergic (dopamine-producing) cells governing motor control, among other functions. Loss of dopaminergic cells eventually causes the classic Parkinson’s symptoms.
Alpha-synuclein clumping can be triggered by aging, genetic mutations, conditions such as diabetes and hypertension, environmental toxins like pesticides and lifestyle factors like smoking, exercise, diet and mood.
Worldwide, about 10 percent of cases have a genetic basis. While Israel’s rate of Parkinson’s is no different than in other countries, the percentage caused by genetic mutations is much higher.
“In Israel among Jews of Ashkenazi heritage, 37 percent of Parkinson’s cases are genetic,” says international expert Professor Nir Giladi, chairman of Tel Aviv Medical Center’s Neurological Institute and co-director of the Aufzien Family Center for the Prevention and Treatment of Parkinson’s Disease, which opened in June 2019 at Tel Aviv University.
“About 10 percent of Israelis carry genetic mutations that increase Parkinson’s risk. Having a parent with Parkinson’s increases the risk three times,” says Giladi, who’s treated about 20,000 Parkinson’s patients over 30 years.
“Israel’s high rate of genetic Parkinson’s provides an opportunity to make Israel a global hub for research and development,” he said.
Some earlier breakthroughs in Parkinson’s research and treatment came out of Israeli labs. Technion Professor Moussa Youdim, for example, helped develop Azilect and Selegiline for treating Parkinson’s symptoms.
Today, every Israeli university has Parkinson’s researchers, and the focus is more on prevention than symptom management.
“The aim is to prevent the disease by detecting markers for these genes years before symptoms appear. I think it’s doable,” sai Gdiladi.
The Aufzien Family Center for the Prevention and Treatment of Parkinson’s Disease
More than 40 scientists study molecular, genetic, physiological and genetic elements of Parkinson’s disease at Aufzien.
“We provide an organizational and funding umbrella so researchers and clinicians can work together and find solutions faster,” said co-director Professor Karen B. Avraham, a specialist in genetic deafness research and vice dean of Tel Aviv University’s schools of medicine and neuroscience.
Giladi said Aufzien “is quite a unique center combining the most advanced basic research at the university with clinical research at Tel Aviv Medical Center and community outreach through the Israel Parkinson Association to provide knowledge, awareness and country-based research.”
The center’s new website invites first-degree relatives of genetic Parkinson’s patients to register, helping researchers develop a scoring system for risk and expected onset of symptoms.
“In the next 10 years, we hope to have tens of thousands registered and follow them prospectively,” Giladi says.
“For now, we are suggesting how to modify their lifestyle to lower risk. Exercise cuts risk 30 percent. A good night’s sleep, improved mood and a Mediterranean diet all have an impact,” he said.
“In the future, we hope to offer a vaccine or other intervention to protect them from further progression. Some genes decrease the risk of Parkinson’s disease, and if we can identify them, we can develop drugs using the same protein.”
Giladi said some 150 Israeli startups are developing technologies to help prevent, stop or even cure Parkinson’s. The Aufzien Center also has close ties to the Michael J. Fox Foundation for Parkinson’s Research in the United States.
The Aufzien Center on April 29 is partnering in the first Israel Parkinson’s (virtual) Conference bringing together startups, researchers, physicians, allied health therapists, and patients and families for therapeutic activities and scientific updates.
The dope on dopamine
“Parkinson’s disease is defined by degeneration of dopamine-producing neurons. That’s the pathological hallmark,” said Dr. Claude Brodski, a renowned Parkinson’s researcher at Ben-Gurion University of the Negev.
“For many years I’ve been interested in embryonic dopamine-producing nerve cells in the brain, hoping to understand why they are associated with so many dysfunctions and many important functions like movement. Why do they degenerate in Parkinson’s?”
Last November, his lab published a paper in the journal Brain on the role of bone morphogenetic proteins, known as BMPs, in the development, survival and degeneration of dopamine-producing neurons in animal models. The BMP pathway could be a novel Parkinson’s drug candidate.
“In Parkinson’s disease, there are many drugs that treat symptoms but no disease-modifying drug,” Brodski said.
“We can show now in these animal models that BMPs could stop the progression of neurodegeneration. We’re working hard to bring it closer to the clinic.”
Predicting Parkinson’s
Last June, a team of neuroscientists from Bar-Ilan University was one of four winners of the Michael J. Fox Foundation and Sage Bionetworks BEAT-PD data competition seeking new methods to predict Parkinson’s disease severity.
Professor Izhar Bar Gad and his Neural Interfaces Lab approached the problem by applying signal-processing methods to smartwatch and smartphone sensor data. The results were then used in machine-learning models to allow for patient-specific characteristics.
The lab’s long-term goal is to use the interaction between computerized systems and the central nervous system to better understand neural disorders and to create electrophysiological treatments for symptoms.
In the University of Haifa electrophysiology lab, led by Shani Stern, induced pluripotent stem cell (iPSC) technology is used to create neuron cell lines derived from genetic and non-genetic Parkinson’s patients.
Observing these nerve cells as they develop and age, the team looks for common traits of different types of Parkinson’s disease as well as the roles of various genes in the process.
Stern has seen pathological changes, such as a reduction in synaptic connectivity between neurons, occurring before a patient would show symptoms.
“Parkinson’s disease patients have a severe neuronal cell death that is more specific to areas in the brain that are compacted with dopaminergic neurons,” she says.
Stern is growing 3D structures that resemble one of these brain areas as a novel platform for testing possible treatments such as dopamine receptor modulators.
She aims to build an algorithm that could predict disease onset and severity at the pre-symptomatic stage.
Mental imagery
Amit Abraham of the physiotherapy department at Ariel University, has a new Mental Imagery and Human EmbodiedPotential lab studying how different types of mental imagery help rehabilitate patients with a variety of physical conditions, and enhance performance of dancers and athletes.
“For Parkinson’s disease rehabilitation, mental imagery is an innovative and promising tool,” he said.
“Parkinson’s is a multifaceted condition mostly known for causing slowness of movement, rigidity, balance dysfunctions and resting tremor. But about 60 percent also have sensory and cognitive deficits that are less talked about. We thought mental imagery would address these deficits in addition to the motor ones,” he said.
During his postdoc at Emory University School of Medicine, Abraham developed a pilot intervention for people with Parkinsonʼs disease based on the Franklin method of dynamic neurocognitive imagery. His goal was to correct distorted mental representations of the body that can worsen motor and cognitive deficits.
“I focused on the pelvis, spine and lower extremities. For two weeks, five sessions per week for two hours a day, people with Parkinson’s disease did a dynamic neurocognitive imagery protocol that included movement and imagery. We showed a wide range of beneficial effects for both motor and non-motor symptoms.”
Results were published in Neural Plasticity in 2018 and in Complementary Therapies in Medicine in 2019. Abraham is now working on developing a set of protocols.
Meanwhile, Bar-Ilan researcher Adam Zaidel is studying how sensory augmentation devices or sensory retraining can help Parkinson’s patients overcome their deteriorating visual perception of self-motion.
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