Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Department of Nuclear Medicine & PET, Aarhus University Hospital, Aarhus, Denmark.
J Parkinsons Dis. 2024;14(s2):S297-S306. doi: 10.3233/JPD-230419.
Parkinson's disease (PD) unfolds with pathological processes and neurodegeneration well before the emergence of noticeable motor symptoms, providing a window for early identification. The extended prodromal phase allows the use of risk stratification measures and prodromal markers to pinpoint individuals likely to develop PD. Importantly, a growing body of evidence emphasizes the heterogeneity within prodromal and clinically diagnosed PD. The disease likely comprises distinct subtypes exhibiting diverse clinical manifestations, pathophysiological mechanisms, and patterns of α-synuclein progression in the central and peripheral nervous systems. There is a pressing need to refine the definition and early identification of these prodromal subtypes. This requires a comprehensive strategy that integrates genetic, pathological, imaging, and multi-omics markers, alongside careful observation of subtle motor and non-motor symptoms. Such multi-dimensional classification of early PD subtypes will improve our understanding of underlying disease pathophysiology, improve predictions of clinical endpoints, progression trajectory and medication response, contribute to drug discovery and personalized medicine by identifying subtype-specific disease mechanisms, and facilitate drug trials by reducing confounding effects of heterogeneity. Here we explore different subtyping methodologies in prodromal and clinical PD, focusing on clinical, imaging, genetic and molecular subtyping approaches. We also emphasize the need for refined, theoretical a priori disease models. These will be prerequisite to understanding the biological underpinnings of biological subtypes, which have been defined by large scale data-driven approaches and multi-omics fingerprints.
帕金森病(PD)在明显运动症状出现之前就已经有病理过程和神经退行性变,这为早期识别提供了机会。扩展的前驱期允许使用风险分层措施和前驱标志物来确定可能发展为 PD 的个体。重要的是,越来越多的证据强调了前驱期和临床诊断的 PD 中的异质性。该疾病可能包含不同的亚型,表现出不同的临床表现、病理生理机制以及中枢和外周神经系统中α-突触核蛋白进展的模式。因此,需要对这些前驱亚型进行更精细的定义和早期识别。这需要一个综合的策略,包括遗传、病理、影像学和多组学标志物,以及对细微运动和非运动症状的仔细观察。这种早期 PD 亚型的多维分类将改善我们对潜在疾病病理生理学的理解,提高对临床终点、进展轨迹和药物反应的预测,通过识别亚型特异性疾病机制为药物发现和个性化医学做出贡献,并通过减少异质性的混杂效应来促进药物试验。在这里,我们探讨了前驱期和临床 PD 中的不同亚型划分方法,重点关注临床、影像学、遗传和分子亚型划分方法。我们还强调需要细化、理论上的先验疾病模型。这些将是理解通过大规模数据驱动方法和多组学指纹定义的生物学亚型的生物学基础的前提。
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