title: Colonic biopsies to assess the neuropathology of Parkinson's disease and its relationship with symptoms.
abstract: BACKGROUND
  The presence of Lewy bodies and Lewy neurites (LN) has been demonstrated in the enteric nervous system (ENS) of Parkinson's disease (PD) patients. The aims of the present research were to use routine colonoscopy biopsies (1) to analyze, in depth, enteric pathology throughout the colonic submucosal plexus (SMP), and (2) to correlate the pathological burden with neurological and gastrointestinal (GI) symptoms.
  
  
  RESULTS
  A total of 10 control and 29 PD patients divided into 3 groups according to disease duration were included. PD and GI symptoms were assessed using the Unified Parkinson's Disease Rating Scale part III and the Rome III questionnaire, respectively. Four biopsies were taken from the ascending and descending colon during the course of a total colonoscopy. Immunohistochemical analysis was performed using antibodies against phosphorylated alpha-synuclein, neurofilaments NF 220 kDa (NF) and tyrosine hydroxylase (TH). The density of LN, labeled by anti-phosphorylated alpha-synuclein antibodies, was evaluated using a quantitative rating score. Lewy pathology was apparent in the colonic biopsies from 21 patients and in none of the controls. A decreased number of NF-immunoreactive neurons per ganglion was observed in the SMP of PD patients compared to controls. The amount of LN in the ENS was inversely correlated with neuronal count and positively correlated with levodopa-unresponsive features and constipation.
  
  
  CONCLUSIONS
  Analysis of the ENS by routine colonoscopy biopsies is a useful tool for pre-mortem neuropathological diagnosis of PD, and also provides insight into the progression of motor and non-motor symptoms.
authors.affiliation: UMR 913, Inserm, Nantes, France. thibaud.lebouvier@univ-nantes.fr
authors.forename: Thibaud
authors.initials: T
authors.lastname: Lebouvier
authors.forename: Michel
authors.initials: M
authors.lastname: Neunlist
authors.forename: Stanislas
authors.initials: S
authors.lastname: Bruley des Varannes
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Coron
authors.forename: Anne
authors.initials: A
authors.lastname: Drouard
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: N'Guyen
authors.forename: Tanguy
authors.initials: T
authors.lastname: Chaumette
authors.forename: Maddalena
authors.initials: M
authors.lastname: Tasselli
authors.forename: Sébastien
authors.initials: S
authors.lastname: Paillusson
authors.forename: Mathurin
authors.initials: M
authors.lastname: Flamand
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Galmiche
authors.forename: Philippe
authors.initials: P
authors.lastname: Damier
authors.forename: Pascal
authors.initials: P
authors.lastname: Derkinderen
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003106:Colon / Q000294:innervation* / Q000378:metabolism / Q000473:pathology*; D003113:Colonoscopy; D017615:Enteric Nervous System / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D016631:Lewy Bodies / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*