Synbiotic supplementation may globally improve non-motor symptoms in patients with stable Parkinson's disease: results from an open label single-arm study

Abstract

Gut microbiota changes and brain-gut-axis (BGA) dysregulation are common in people with Parkinson's Disease (PD). Probiotics and prebiotics are emerging as a potential therapeutic approach for PD patients. The aim of this paper was to assess the neurological and gastroenterological effects in PD patients with constipation after the administration of a synbiotic product, with a focus on behavioral and cognitive symptoms. We enrolled patients with stable PD who met diagnostic criteria for functional constipation and/or irritable bowel syndrome with constipation according to Rome IV Criteria. Patients received a synbiotic treatment (Enterolactis Duo, containing the probiotic strain Lacticaseibacillus paracasei DG and the prebiotic fiber inulin) for 12 weeks. A neurological and a gastroenterological evaluation were collected before and after the treatment. In addition, 16S rRNA gene profiling and short chain fatty acid quantification were performed to characterize the microbial ecosystem of fecal samples collected before (n = 22) and after (n = 9) the synbiotic administration. 30 patients were consecutively enrolled. After treatment, patients performed better in MDS-UPDRS part 1 (p = 0.000), SCOPA-AUT (p = 0.001), TAS-20 (p = 0.014), HAM-D (p = 0.026), DIFt (p = 0.003), PAS-A (p = 0.048). Gastroenterological evaluations showed improvements in PAC-SYM score (p < 0.001), number of complete bowel movement (p < 0.001) and BSFS (p < 0.001). After the synbiotic administration, we observed a significant increase in the abundance of the order Oscillospirales, as well as the Oscillospiraceae family and the species Faecalibacterium prausnitzii within this order in fecal samples. Synbiotic treatment demonstrates potential efficacy in ameliorating non-motor features in PD patients.

Keywords: Constipation; Movement disorders; Non motor symptoms; Parkinson’s disease.

Figure 1

Fecal bacterial taxa that exhibited significant changes after the synbiotic intake period. ASV refers to Amplicon Sequence Variant. Taxonomic lineage is provided: p, phylum; c, class; o, order; f, family; g, genus; s, species. Taxonomic names highlighted in blue were identified through manual BLASTN searches in GenBank using the corresponding read sequence. Names in square brackets indicate non-validated taxonomy. Corrections to the taxonomic names compared to those in the Greengenes database are highlighted in purple. p values were obtained from Mann–Whitney tests on CLR-transformed bacterial abundances. The numbers in the white-red heatmap indicate the median CLR-transformed abundance of the respective bacterial taxon at T0 and T1. The intensity of the red color in the heatmap corresponds to the increase in abundance.

Figure 2

Organic acids in fecal samples of PD patients. Paired data (i.e., T0 and T1 for the same patient) were available for n = 7 patients except for propionate (n = 6). p values are according to the Wilcoxon test; *, p < 0.05.