Parkinson's
The latest neuro-rehab developments
The Brain Bank helping to change the future for Parkinson’s patients
As the only Brain Bank in the world dedicated to
the study of Parkinson’s, the team at Imperial
College London continue to make advances which
will break crucial new ground in identifying the
neurodegenerative disease at the earliest possible stage.
The internationally-significant Parkinson’s UK Brain Bank has, since its inception in 2002, led many of the significant advances into how the condition progresses, enabling better understanding of Parkinson’s and the development of key interventions and treatments.
The Brain Bank is home to more than 2,500 donated brains, each of which will play a vital role in advancing the team’s research further - and with it, bringing new prospects for Parkinson’s detection, treatment and care for the future.
In the UK, more than 145,000 people live with Parkinson’s and globally it is the fastest-growing neurological condition.
As technology develops and allows more intricate clinical inspection than ever before - with the team making use of cutting-edge new high resolution microscopy - the Brain Bank is adding to the understanding gained from brain tissue by collecting new levels of data from the donor, which can then be linked to pathology. This will give a clearer picture of each individual brain, which will add significantly to the research.
“Ultimately, this is going to help us nail down what the processes are (in the development of Parkinson’s), so we can get it before it appears,” says Professor Steve Gentleman, professor of neuropathology and director of the Parkinson's UK Brain Bank at Imperial.
“Pharma are going to have to come up with a drug that stops progression - but we want to be able to treat people before they are symptomatic.”
The topic of brain donation has come to the fore recently with documentaries charting the personal stories of Jeremy Paxman, who lives with Parkinson’s, and England Rugby World Cup winner Steve Thompson, who has early-onset dementia. Prof Gentleman himself featured in Thompson’s documentary, when the rugby legend visited the brain bank.
“I want to demystify this and show people why we do it,” he says.
“It could be seen as a bit gory and a bit strange, but we are actually doing it for a very good reason. I think public education around why we're here is absolutely vital.”
Dr George Gveric, manager of the tissue bank, adds: “It's very important that people know about it, because many times when we go to talk to branches of Parkinson's UK, a lot of people have never heard of the Brain Bank and never heard of the possibility that they can donate their brain.
“And now we're expanding into the donation of data, this will make a big difference and is really important in terms of Parkinson's research.”
The pioneering research
Through the work of the Parkinson’s UK Brain Bank, hope is being given to people who may be diagnosed with the neurodegenerative condition in future years.
For the past 20 years, research has developed which is helping to shed new light on the condition which affects growing numbers of people in the UK and worldwide.
“Human tissue is the ultimate resource to try and find out what's going on in any given condition. Parkinson's disease originally was diagnosed by looking at the brain post mortem, but post mortems don't happen routinely anymore. Diagnosis is much more of a clinical entity nowadays,” explains Prof Gentleman.
“In the previous century, that was essentially down to having a look at a few slides in one area of the brain, the substantia nigra, seeing the Lewy bodies as a structural stain, and making the diagnosis. Then in the late 90s, alpha synuclein was identified. “In one family, there was a genetic form of Alzheimer's disease and the mutation was found.
And then things exploded, because as soon as you have a gene product protein that has been identified as important, you can make an antibody against it. “Then you go back to the tissue and look to see where this protein is, and that's where we had this huge explosion of understanding. The pathology spreads through the brain in a fairly stereotypical way which corresponds with the emergence of the disease, how the disease progresses, how different things appear at different times.”
The team’s understanding continues to advance, particularly through the introduction of new technology - including microscopy which can identify the health of single cells - and through its focus on the data of the individuals whose brain is subject to pathology.
“We have pushed this beyond just collecting tissue from donors, we are now collecting a lot of data from them regarding their mental capabilities and cognition, which will create a huge amount of data which will be available to researchers,” says Dr Gveric.
“Ultimately, we will link this data to pathology when we receive the tissue, which will make the pathology much more valuable, because you will have different clinical forms of Parkinson's, represented through different pathological features of Parkinson’s."
“One of my main interests is relating the pathology I see in a post mortem to what was happening in life in those individual patients,” says Prof Gentleman.
“A post mortem brain is only as useful for research as the clinical information that goes with it. This allows us to do is look at a large number of individuals, and a large number of different pathologies, and how we can relate it to the clinical evidence.”
The capability and experience of the brain bank team means it is helping to make big advances in diagnostic work around Parkinson’s.
“We can detect Parkinson's much easier than any other clinical or imaging method that's available,” says Dr Gveric.
“We often see cases which are not exactly misdiagnosed, but probably under-diagnosed, because Parkinson's is a condition that mainly affects older people and comes with many other conditions. Therefore, this can muddle the clinical picture, it makes the work of clinicians much harder. We see that when we're going through the medical records.
“That’s one important aspect of doing this sort of work, to provide feedback to clinicians, as well as to improve imaging techniques where we can.”
“It is helping the clinicians, particularly when they have what they might classify as an ‘atypical Parkinson's disease’,” says Prof Gentleman.
“They know it's not quite what they were expecting from what they've seen in their general practice. We can feed back to them and usually point out that you are absolutely right, this was atypical, this may have been one of the differential diagnoses. There are at least three of these, and some even rarer ones.”
The Brain Bank’s role in global research
As the only Brain Bank of its kind in the world, the expertise of the Parkinson’s UK Brain Bank is in demand from many other research teams working in this space, and its work helps to inform the progress they are making.
Research teams around the world are continually in touch with the Brain Bank to gain and share vital new insight into the advances being made at the unique centre, which are helping to drive forward advances globally.
“Our place in this research world is really important,” says Dr Gveric.
“There are very few groups in the world who haven't been in contact already with us. Researchers use our tissue when trying to move into some other avenues, and to validate their results, to work out what's really relevant for someone with Parkinson's.
“We play an important background role in this area. People might come to us either at the beginning of their project, to essentially get some ideas of what might be relevant for someone with Parkinson’s, or at the end of the project, to validate the results in a human system, as opposed to animal models or just cells.”
Prof Gentleman continues: “Some of my PhD students have been working on making brain tissue transparent, and allowing us to look at it in more detail in 3D. That particular paper was published a couple of years ago and has provoked an awful lot of interest from people around the world wanting to know how to do it.”
“So there are things we can develop research wise in the tissue bank, which will help other research groups set up their own research questions, because we've proved it's possible
to do certain things like we do.”
The donation of brains and importance of awareness
Through the generous donation of brains, researchers can help to make the breakthroughs that will shape the future.
To date, more than 1,500 have been collected by the team.
The brains of both people with Parkinson’s and those without the disease - which are used as healthy controls - are vital to the advancement of knowledge, and can be collected from any hospital in the UK and safely transported to London.
"When a donor has passed away, it’s often a family member or a health professional who will get in touch with us very quickly,” says Prof Gentleman.
“We will then arrange the removal of the brain at a hospital somewhere in the country, whichever is the most local and available. The brain will either be couriered to us or collected by a technician and brought back to the facility at Hammersmith Hospital. It’s essential to do this within 48 hours to preserve the structural integrity of the brain.“
"We usually receive a sample of the donor’s cerebrospinal fluid as well – this is enormously helpful in terms of biomarker research.”
"Once the donations have arrived at the Brain Bank, we will preserve and characterise the tissue and work out what exactly went on in the brain of that individual. All of this information goes out with the tissue to research labs around the world.”
Donors consent to giving full access to all their hospital and GP notes, to enable researchers to build a complete picture of their health.
Families have the option to learn more about the brain of their loved one and the condition they lived with, but that is an entirely personal choice.
“Sometimes I talk to the families about what we found, which can help to draw a line under it for them. Some have residual worries and it can help to reassure them there is absolutely nothing else they could have done, and I think it can help to give a little bit of closure,” says Prof Gentleman.
“Others don’t want to hear anything from us, they have their closure, and that’s fine.”
The growth in awareness around the donation of brains to neurological research is having positive effects on the Brain Bank, with more people realising the options available to them and choosing to get involved.
“Back in 2009, we had a really huge PR campaign, and I think we went from something like 40 requests to register on the donor scheme to about 4,000 over the course of four to six weeks,” says Dr Gveric.
“But apart from that, what came out of it was that we were recognised as The Brain Bank and people were coming to us to ask to be part of this effort. We collected a lot of people with Parkinson's and relevant other conditions, but we also sent people to other Brain Banks, so they they got more donors themselves. That is very important.”
The focus on celebrities and sportspeople living with neurodegenerative disease is also highly significant in helping to keep donations at the front of people’s mind.
“Celebrities play a big role in terms of recognition. Brain banking is something that's rather obscure and mostly in the background, and therefore it's very important that people know about it,” says Dr Gveric.
“I think public education is absolutely vital in demystifying this,” says Prof Gentleman.
“Broadening the interest and education is really central to everything we do and in showing people what we do and why we
do it.”
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