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. 2019 Nov:68:69-72.
doi: 10.1016/j.parkreldis.2019.10.006. Epub 2019 Oct 7.

Feasibility of repeat and bilateral submandibular gland needle biopsies in Parkinson's disease

Charles H Adler  1 , Geidy E Serrano  2 , Nan Zhang  3 , Michael L Hinni  4 , David G Lott  4 , Shyamal H Mehta  5 , Lucia I Sue  2 , Anthony Intorcia  2 , Thomas G Beach  2
Affiliations

Feasibility of repeat and bilateral submandibular gland needle biopsies in Parkinson's disease

Charles H Adler et al. Parkinsonism Relat Disord. 2019 Nov.

Abstract

Introduction: Submandibular gland (SMG) biopsies detect pathological alpha-synuclein (aSyn) in patients with Parkinson's disease (PD). The objectives of this study were to determine 1) the feasibility of performing a second SMG biopsy in previously biopsied patients, 2) the feasibility of doing bilateral SMG biopsies, 3) laterality of aSyn density, 4) whether aSyn density changes over time.

Methods: Seven PD patients (6 males) previously having positive unilateral SMG biopsies underwent bilateral needle biopsies. Staining with a validated antibody to pathologic p-serine 129 aSyn was performed.

Results: Mean age at time of second biopsy was 76 years and mean time between biopsies was 4.1 years. Five subjects had sufficient SMG tissue bilaterally and two only unilaterally for a total of 12/14 glands biopsied having sufficient tissue, all 7 subjects having sufficient tissue on at least one side, and all 12 glands being aSyn positive. There was a 4x increase in aSyn density on average in the repeat biopsy, with 5 subjects having an increase, one no change, and one a decrease in density. Side effects were similar to previous reports; mainly bruising, swelling, slight bleeding.

Conclusions: This is the first published study of bilateral transcutaneous needle biopsies of the SMG in living patients with PD which showed better tissue acquisition and a change in aSyn density over time. While further study is needed, there is potential for SMG biopsies to serve as a tissue biomarker for PD disease progression and potentially as a peripheral outcome measure for anti-aSyn treatment.

Keywords: Biopsy; Parkinson's disease; Submandibular gland; Synuclein.

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Conflict of interest statement

Declaration of competing interest

The authors have no conflicts of interest for this study.

Figures

Fig. 1.
Fig. 1.
Photomicrographs of biopsies from a single subject immunohistochemically stained for aSyn pathology. Portrayed are representative images from the first biopsy (a,d), images from the ipsilateral second biopsy (b, e) and from the contralateral second biopsy (c, f). Nerve fibers positive for aSyn pathology are black while the counterstain is Neutral Red. The calibration bar (f) represents 40 μm and serves for all panels.
Fig. 2.
Fig. 2.
The aSyn density mean between the first biopsy and the second biopsy on the ipsilateral side. aSyn density is on a 0–4 scale.
See this image and copyright information in PMC

References

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