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Phosphorylated α-synuclein as a potential biomarker for Parkinson’s disease and related disorders

A unifying pathological feature of most neurodegenerative brain diseases is the accumulation of misfolded proteins in the CNS, in the form of extracellular amyloid fibrils and/or intracellular inclusion bodies containing protein fibrils (e.g., neurofibrillary tangles and Lewy bodies [LBs]) [1]. The formation and accumulation of these misfolded proteins is likely to underlie the neuro degenerative process, although emphasis has now shifted away from the fibrils themselves as possible toxins, towards their progenitors, the early ‘soluble oligomers’, as being a common neurotoxic entity [2]. Molecular genetics has provided a strong rationale for the importance of these protein aggregation events in disease pathogenesis, because mutations in the gene for each misfolded protein can always give rise to an inherited form of a relevant neurodegenerative condition [1]. Differences in the type and anatomical distribution of these protein aggregates are likely to result in different brain topographical patterns of neurodegeneration, which then dictate clinical symptoms. The ultimate goal of research in this field is to understand the mechanisms behind these events, and to modify or prevent the course of such changes therapeutically. However, in order to be able to devise and implement appropriate and effective treatments, it will be necessary to make a precise diagnosis of each disease as early as possible during its course, before too much irreversible damage has been done to nerve cells and their synaptic connections. Clinical assessment and neuropsychological tests can detect early symptomatic changes, but a clear differential diagnosis of each neurodegenerative disease can often be problematic at this early stage. Neuroimaging techniques can detect early changes in cerebral function/atrophy, but are often imprecise (e.g., MRI) or too expensive to administer in routine clinical practice (e.g., PET). Therefore, there has been a recent surge in interest in the development of molecular biomarkers for these various neurodegenerative diseases, based on the analysis of components of easily obtainable body fluids, including cerebrospinal fluid (CSF) and blood.