Morbus Parkinson und Neuroprotektion: Traum oder Realität?

Zusammenfassung

Neuroprotektive Therapiestrategien des Morbus Parkinson werden seit vielen Jahren in den verschiedenen In-vitro- und In-vivo-Modellen mit Erfolg untersucht. Leider konnten diese Ergebnisse bisher nicht in die Klinik übertragen werden. Dies ist zumindest partiell auf das Fehlen eines Tiermodells mit spezifischer chronischer Degeneration der dopaminergen Neurone zurückzuführen. Dennoch konnten nun Ergebnisse vorgelegt werden, die nahe legen, dass der Verlauf dieser Erkrankung unter der Therapie mit Dopaminagonisten günstiger verläuft als unter der Behandlung mit L-DOPA. Gemessen wurde die Progredienz der Erkrankung mit der Darstellung der FDOPA-Aufnahme oder der Dopamintransporterbindung mittels nuklearmedizinischer Verfahren. Ob es sich hierbei um eine echte Neuroprotektion handelt, kann in Ermangelung der Kenntnis des natürlichen Verlaufs noch nicht beurteilt werden. Diese Studien geben zumindest Anlass zu der Hoffnung, dass in der nahen Zukunft auch der Nachweis der Neuroprotektion gelingen wird.

Abstract

Neuroprotection has been successfully applied using various in vitro and in vivo models for Parkinson's disease. Unfortunately, the translation of such positive results into clinical practice has not been possible. We believe that one of the main issues is the lack of an appropriate animal model with specific chronic progressive degeneration of dopaminergic neurons. However, recent clinical trials comparing the progression of the functional decline of dopaminergic neurons under treatment with a dopamine agonist compared with L-DOPA indicated that the degeneration of dopaminergic neurons is less pronounced when patients are treated with a dopamine agonist. The function of dopaminergic neurons was assessed using quantification of either FDOPA uptake or dopamine transporter binding. Whether dopamine agonists exert a true neuroprotective effect remains unknown as long as comparable data on the natural course are pending. There is considerable hope that neuroprotection will be proven in upcoming clinical trials.

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