The Gut‐Brain Axis in Parkinson disease: Emerging Concepts and Therapeutic Implications

Abstract Background The gut‐brain axis, i.e. the bidirectional communication system between the gut and the brain, has become of central importance in Parkinson disease (PD) research over the past 20 years. Aims We aimed to describe the milestones of the gut‐brain axis research in PD and the development of theories proposing the involvement of the gastrointestinal tract in PD pathogenesis. Methods We searched PubMed using the terms ‘gut‐brain axis’ AND ‘Parkinson disease’, and selected relevant articles to provide the foundation for reconstructing an historical overview of the gut‐brain axis research in PD. Results Mounting evidence from preclinical, clinical and post‐mortem studies suggests that a subgroup of PD patients present with a range of prodromal symptoms (e.g., autonomic dysfunction, rapid eye movement sleep behaviour disorder) which reflect initial accumulation and later spread of pathological α‐synuclein rostrally from the gastrointestinal tract (“body‐first” PD). Through neural connections along the gut‐brain axis, pathological α‐synuclein may spread to the brain, producing clinically manifest disease. Recently, two mechanisms involving the gut‐brain axis have attracted increasing attention for their role in PD pathogenesis and progression, namely the perturbation of the composition of the microorganisms living in the gut (the gut microbiome), and the dysfunction of enteroendocrine cells. Conclusion Treatments targeting the gut‐brain axis, especially the gut microbiome and the enteroendocrine cells pathway, could potentially slow disease progression or even prevent disease onset. Among these, pre/probiotics, faecal microbiota transplantation, and glucagon‐like peptide‐1 receptor agonists, have entered advanced stages of clinical trials in humans and shown potential symptomatic and disease‐modifying effects.