title: Increased urinary indoxyl sulfate (indican): new insights into gut dysbiosis in Parkinson's disease.
abstract: BACKGROUND
  Changes in the composition of gut microflora have been associated with an increase in chronic diseases. Indican urinary concentration is one of the most common and easily assessable markers of intestinal dysbiosis. Little information is available on intestinal dysbiosis in Parkinson's disease (PD). We decided to investigate indican urinary concentrations in a cohort of PD patients.
  
  
  METHODS
  A case-control study including PD patients (N = 68) on treatment with levodopa (PD) or on no pharmacological treatment (De Novo, DPD; N=34) and an age and gender-matched healthy control group (CTR; N=50). Main confounders, such as nutritional habits and constipation diagnosed according to Rome III criteria, were also investigated.
  
  
  RESULTS
  Indican urinary concentrations were significantly higher in PD and DPD than in CTR (P < 0.001 and P < 0.01, respectively). In PD patients the concentrations were unrelated to the presence of constipation, whereas this symptom was associated with higher concentrations in controls (P=0.043). The frequency of dairy product consumption was also positively associated with increased concentrations (P=0.008). Predictors of indican concentrations were sought by multivariate linear regression analysis. The higher indican urinary concentrations found in both DPD (P=0.045) and PD (P=0.023) patients persisted after adjustment for age, gender, BMI, constipation and consumption of dairy products.
  
  
  CONCLUSIONS
  Gut dysbiosis seems to be an important issue in PD, independently of the presence of constipation and starting from the early stages of the disease. The role of gut dysbiosis in the pathogenesis of PD deserves further investigation.
authors.affiliation: Parkinson Institute-Istituti Clinici di Perfezionamento, Milano, Italy. Electronic address: erica.cassani@live.it.
authors.forename: Erica
authors.initials: E
authors.lastname: Cassani
authors.affiliation: Parkinson Institute-Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Barichella
authors.affiliation: Istituto Auxologico Italiano, IRCCS, Milano, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Cancello
authors.affiliation: Parkinson Institute-Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Ferruccio
authors.initials: F
authors.lastname: Cavanna
authors.affiliation: Parkinson Institute-Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Iorio
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cereda
authors.affiliation: Parkinson Institute-Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Bolliri
authors.affiliation: Parkinson Institute-Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Zampella Maria
authors.affiliation: Parkinson Institute-Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Bianchi
authors.affiliation: Department of Biomedical and Clinical Sciences L. Sacco, School of Clinical Nutrition, Faculty of Medicine and Surgery-University of Milan, Milano, Italy.
authors.forename: Benvenuto
authors.initials: B
authors.lastname: Cestaro
authors.affiliation: Parkinson Institute-Istituti Clinici di Perfezionamento, Milano, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Pezzoli
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D003248:Constipation / Q000453:epidemiology; D064806:Dysbiosis / Q000453:epidemiology / Q000382:microbiology / Q000652:urine; D005260:Female; D000069196:Gastrointestinal Microbiome / Q000502:physiology*; D006801:Humans; D007200:Indican / Q000652:urine*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000453:epidemiology / Q000382:microbiology / Q000652:urine
chemical_list: D007200:Indican
keywords: Constipation; Gut dysbiosis; Parkinson disease; Small intestinal bacterial overgrowth (SIBO); Urinary indoxyl sulfate