• C Warren Olanow and Patrik Brundin.
• Department of Neurology, Mount Sinai School of Medicine, New York, New York 10029, USA. warren.olanow@mssm.edu
• Mov. Disord. 2013 Jan 1;28(1):31-40.

AbstractAltered protein handling is thought to play a key role in the etiopathogenesis of Parkinson's disease (PD), as the disorder is characterized neuropathologically by the accumulation of intraneuronal protein aggregates (Lewy bodies and Lewy neurites). Attention has particularly focused on the α-synuclein protein, as it is the principal component of Lewy pathology. Moreover, point mutations in the α-synuclein gene cause rare familial forms of PD. Importantly, duplication/triplication of the wild type α-synuclein gene also cause a form of PD, indicating that increased levels of the normal α-synuclein protein is sufficient to cause the disease. Further, single nucleotide polymorphisms in the α-synuclein gene are associated with an increased risk of developing sporadic PD. Recent evidence now suggests the possibility that α-synuclein is a prion-like protein and that PD is a prion-like disease. Within cells, α-synuclein normally adopts an α-helical conformation. However, under certain circumstances, the protein can undergo a profound conformational transition to a β-sheet-rich structure that polymerizes to form toxic oligomers and amyloid plaques. Recent autopsy studies of patients with advanced PD who received transplantation of fetal nigral mesencephalic cells more than a decade earlier demonstrated that typical Lewy pathology had developed within grafted neurons. This suggests that α-synuclein in an aberrantly folded, β-sheet-rich form had migrated from affected to unaffected neurons. Laboratory studies confirm that α-synuclein can transfer from affected to unaffected nerve cells, where it appears that the misfolded protein can act as a template to promote misfolding of host α-synuclein. This leads to the formation of larger aggregates, neuronal dysfunction, and neurodegeneration. Indeed, recent reports demonstrate that a single intracerebral inoculation of misfolded α-synuclein can induce Lewy-like pathology in cells that can spread from affected to unaffected regions and can induce neurodegeneration with motor disturbances in both transgenic and normal mice. Further, inoculates derived from the brains of elderly α-synuclein-overexpressing transgenic mice have now been shown to accelerate the disease process when injected into the brains of young transgenic animals. Collectively, these findings support the hypothesis that α-synuclein is a prion-like protein that can adopt a self-propagating conformation that causes neurodegeneration. We propose that this mechanism plays an important role in the development of PD and provides novel targets for candidate neuroprotective therapies.Copyright © 2013 Movement Disorder Society.

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