title: Alpha-synuclein aggregates in epicardial fat tissue in living subjects without parkinsonism.
abstract: BACKGROUND
  In Parkinson's disease (PD), alpha-synuclein (AS) aggregates occur frequently in peripheral autonomic nervous system (pANS). Their presence in asymptomatic subjects suggests incidental Lewy-body disease (iLBD) that is thought to reflect pre-clinical PD. Cardiac involvement has been detected in post-mortem studies in both, PD and also in iLBD. In vivo documentation of cardiac AS pathology is lacking.
  
  
  OBJECTIVE
  To prospectively assess the presence of AS aggregates in epicardial fat tissue from living subjects without parkinsonism undergoing elective cardiac surgery.
  
  
  METHODS
  Epicardial fat tissue obtained during cardiac surgery from 91 subjects was studied by histology and immunohistochemistry. Areas more likely to contain pANS elements were selected. PD-related motor and non-motor symptoms (NMS) were assessed immediately before or after surgery.
  
  
  RESULTS
  Small autonomic nerves, ganglia and/or tyrosine-hydroxylase positive fibres were identified in epicardial fat in each of the 91 subjects (62 male/29 female, mean age 67 years). AS aggregates were detected in 7 subjects (7.7%), and were more frequent in those aged above 70 years. In AS-positive subjects constipation and acting dreams were significantly more frequent than in the AS-negative ones.
  
  
  CONCLUSIONS
  AS aggregates occur in epicardial pANS in subjects without parkinsonism, suggesting the diagnosis of iLBD. The presence in some of these subjects of non-motor symptoms such as acting dreams and constipation known to occur in premotor PD supports this interpretation. Adequate follow-up of the subjects in this study will indicate the time, if any, to progression to motor PD.
authors.affiliation: Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Judith
authors.initials: J
authors.lastname: Navarro-Otano
authors.forename: Ellen
authors.initials: E
authors.lastname: Gelpi
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Mestres
authors.forename: Eduard
authors.initials: E
authors.lastname: Quintana
authors.forename: Sebastian
authors.initials: S
authors.lastname: Rauek
authors.forename: Teresa
authors.initials: T
authors.lastname: Ribalta
authors.forename: Verónica
authors.initials: V
authors.lastname: Santiago
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tolosa
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D001341:Autonomic Nervous System / Q000473:pathology*; D005260:Female; D006321:Heart / Q000294:innervation; D006801:Humans; D020961:Lewy Body Disease / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D020734:Parkinsonian Disorders / Q000378:metabolism / Q000473:pathology; D011446:Prospective Studies; D014446:Tyrosine 3-Monooxygenase / Q000378:metabolism*; D051844:alpha-Synuclein / Q000378:metabolism*
chemical_list: D051844:alpha-Synuclein; D014446:Tyrosine 3-Monooxygenase