Sympathetic and parasympathetic subtypes of body-first Lewy body disease observed in postmortem tissue from prediagnostic individuals
Recent studies suggest the existence of brain-first and body-first subtypes within the Lewy body disorder (LBD) spectrum, including Parkinson's disease. These studies primarily focused on α-synuclein propagation through the parasympathetic vagal and olfactory bulb routes, leaving the possibility of a sympathetic nervous system spreading route unexplored. In the present study, we analyzed two postmortem datasets, which included 173 and 129 cases positive for Lewy pathology. We observed a clear distinction between brain-first and body-first subtypes in early prediagnostic cases with mild Lewy pathology. Brain-first cases displayed minimal peripheral organ pathology in prediagnostic phases, contrasting with marked autonomic involvement in prediagnostic body-first cases. Utilizing the SuStaIn machine learning algorithm, we identified two distinct body-first subtypes, one with vagal predominance and another with sympathetic predominance, in equal proportions. Our study supports the existence of three prediagnostic LBD subtypes and highlights the sympathetic nervous system alongside the parasympathetic system in LBD onset and progression.
Authors
- Katrine B. Andersen (ORCID: https://orcid.org/0000-0003-0015-2170)
- Per Borghammer (ORCID: https://orcid.org/0000-0001-6391-8052)
- Jacob Horsager (ORCID: https://orcid.org/0000-0001-6098-0045)
- Shigeo Murayama (ORCID: https://orcid.org/0000-0001-9709-5242)
- Tuomo Polvikoski
- Nathalie Van Den Berge (ORCID: https://orcid.org/0000-0001-9384-1279)
- Karoline Knudsen (ORCID: https://orcid.org/0000-0002-0805-8659)
- Jon B. Toledo (ORCID: https://orcid.org/0000-0003-4366-9268)
- Mie Kristine Just
- Johannes Attems (ORCID: https://orcid.org/0000-0003-1636-1700)
- Casper Skjærbæk (ORCID: https://orcid.org/0000-0003-2823-8785)
- Jacob W. Vogel (ORCID: https://orcid.org/0000-0001-6394-9940)
- Yuko Saito (ORCID: https://orcid.org/0000-0002-9974-8638)
- A. Krishnamurthy (ORCID: https://orcid.org/0000-0002-4512-5996)
Institutions
- Houston Methodist (US)
- Lund University (SE)
- Aarhus University (DK)
- Cornell University (US)
- Royal Victoria Infirmary (GB)
- Aarhus University Hospital (DK)
- Methodist Hospital (US)
- Newcastle Hospitals - Campus for Ageing and Vitality (GB)
- Tokyo Metropolitan Geriatric Hospital (JP)
- The University of Osaka (JP)
Publication Details
- Journal
- Nature Neuroscience
- Published
- 2025-03-13
- DOI
- https://doi.org/10.1038/s41593-025-01910-9
- Citations
- 34
- Primary Topic
- Parkinson's Disease Mechanisms and Treatments
- Type
- article
- Field-Weighted Citation Impact
- 47.24
Funders
- Sundhed og Sygdom, Det Frie Forskningsråd
- Parkinsonforeningen
- Japan Agency for Medical Research and Development
- Jascha Fonden
- Alzheimer's Society
- Newcastle University
- Lundbeckfonden
- Newcastle upon Tyne Hospitals NHS Foundation Trust
- Danmarks Frie Forskningsfond
- Science for Life Laboratory
- Tokyo Metropolitan University
- H. Lundbeck A/S
- Japan Society for the Promotion of Science
- NIHR Newcastle Biomedical Research Centre