The First Biological Staging System for Parkinson’s: A Research Accelerator for the Field

Taking another major step into the new biological era of Parkinson’s disease (PD), an international team of patient, research and industry leaders has proposed the first iteration of a research framework for staging and defining PD based on its underlying biology. Published in the January issue of The Lancet Neurology, the new research tool uses biomarkers that can detect Parkinson’s objectively in a living body — a significant paradigm shift after nearly two centuries of relying on outward, primarily movement-based symptoms for its detection. This new biological framework for PD is expected to have an immediate impact on research, speeding clinical trials and increasing the success of scientific discovery. And ultimately, a treatment targeting the biology of the disease — rather than just its symptoms — is the path to a cure. The framework defines PD by the presence of alpha-synuclein (aSyn), the protein that misfolds, clumps and damages the brain over the course of the disease. The ability to define PD based on this underlying biology was made possible by a new biomarker — called the aSyn-seeding amplification assay (SAA) — that can detect aSyn in the spinal fluid of living people even prior to the onset of visible symptoms. The biomarker was validated in April 2023 by The Michael J. Fox Foundation’s Parkinson’s Progression Markers Initiative (PPMI) and has set about a sea change in how we think about the disease. The framework then describes a system for staging the disease that accounts for Parkinson’s risk, diagnosis, and functional impairment ranging from slight to severe. An individual’s stage is premised on their personal biological profile, including their genetic risk factors and the presence or absence of aSyn in cerebral spinal fluid as well as dopamine degeneration in the brain. Read the full article on Michael J. Fox Fundation in the attached link.