Parkinson's disease (PD) patients are known to have higher levels of brain iron than healthy subjects, and there is evidence that excessive brain iron deposition can result in neurodegeneration. However, some evidence suggests that serum iron levels may be lower in PD patients as compared to controls: in support of this, we have previously found that the Hp 2-1 phenotype of the hemoglobin-binding protein haptoglobin (Hp) was associated with increased risk of idiopathic Parkinson's disease (PD) (Costa-Mallen et al., 2008), and the Hp 2-1 phenotype has been previously shown to confer lower serum iron levels to its carriers (Langlois et al., 2000). We also observed from our preliminary results that PD patients have lower serum iron than age- and gender- matched healthy controls. We hypothesize that the low iron levels present in PD patients are not due to anemia of chronic disease but represent a specific pattern of iron homeostasis dysregulation present in PD characterized by lower than normal serum iron and hemoglobin levels, higher than normal soluble transferrin receptor, and higher than normal serum ferritin. We also make the hypothesis that serum and brain iron are inversely correlated, and that lower serum iron will corresponds to higher brain iron accumulation. We will test these hypotheses by measuring total serum iron, hemoglobin, red blood cells count, transferrin, transferrin % saturation, soluble transferrin receptor, haptoglobin phenotype, in 442 study participants, 100 PD patients and 342 healthy normal controls who are matched by age, gender, and ethnicity to the PD patients. We will test how differences in iron-binding protein levels between PD cases and controls are modified by the haptoglobin phenotype. We will also measure directly brain iron levels in a subset of 50 participants, by Magnetic Resonance Imaging (MRI). We will use two methods for brain iron measurements by MRI, the susceptibility weighted imaging method (SWI) as well as the R2 prime method. We expect brain iron in a subject to be inversely correlated with total serum iron, and to be directly correlated to serum ferritin and serum soluble transferrin receptor. Another aspect of the proposed research is related to tobacco smoking. Tobacco smoking has been consistently shown to be protective for PD risk, with mechanisms that still have to be elucidated. In this grant we propose to test the novel hypothesis that smoking protects from PD because it causes an increase in total circulatory iron and a decrease in brain iron, especially for subjects carrying the Hp 2-2 phenotype, which we previously found protects from PD risk (Costa-Mallen et al, 2008). We will test this hypothesis by comparing serum iron and iron-binding proteins between ever-smokers and never-smokers and by measuring brain iron by MRI in the 50 participants, of whom 25 will be ever-smokers and 25 never-smokers.

Public Health Relevance

This study will investigate changes in iron homeostasis in serum and brain of idiopathic Parkinson's disease (PD) patients. The total number of participants who will undergo serum tests will be 442, and 50 of the participants will also undergo MRI scans. By testing blood iron and brain iron by MRI, we will test the hypothesis that low serum iron corresponds to higher levels of brain iron. If this hypothesis is true, it will provde important new insights into mechanisms of PD, since excessive iron deposition in the brain has been shown to be involved in neurodegeneration. Smoking has been known to protect from PD risk, but the mechanism for this epidemiological finding is still unknown: in this study we will alo test the novel hypothesis that smoking protects from PD by changing iron homeostasis: we will investigate if cigarette smoking causes an increase of serum iron levels and a decrease of brain iron. Finally, we will investigate the effect of a common polymorphism for haptoglobin (Hp), a protein that binds hemoglobin and regulates iron homeostasis. The results of this study will provide important information for potential future preventive measures and slowdown of PD progression by mimicking the changes in serum iron-binding proteins caused by tobacco smoking without the health hazards caused by smoking, because serum iron levels can be modified by dietary interventions.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Exploratory/Developmental Grants (R21)
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Clinical Neuroscience and Neurodegeneration Study Section (CNN)
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Sutherland, Margaret L
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Bastyr University
Other Basic Sciences
Schools of Allied Health Profes
United States
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Costa-Mallen, Paola; Gatenby, Christopher; Friend, Sally et al. (2017) Brain iron concentrations in regions of interest and relation with serum iron levels in Parkinson disease. J Neurol Sci 378:38-44
Costa-Mallen, Paola; Zabetian, Cyrus P; Agarwal, Pinky et al. (2016) Response to the letter ""Haptoglobin phenotype and Parkinson disease risk"" by Delanghe et al. Parkinsonism Relat Disord 22:110-1
Costa-Mallen, Paola; Zabetian, Cyrus P; Hu, Shu-Ching et al. (2016) Smoking and haptoglobin phenotype modulate serum ferritin and haptoglobin levels in Parkinson disease. J Neural Transm (Vienna) 123:1319-1330
Costa-Mallen, Paola; Zabetian, Cyrus P; Agarwal, Pinky et al. (2015) Haptoglobin phenotype modifies serum iron levels and the effect of smoking on Parkinson disease risk. Parkinsonism Relat Disord 21:1087-92
Mata, Ignacio F; Leverenz, James B; Weintraub, Daniel et al. (2014) APOE, MAPT, and SNCA genes and cognitive performance in Parkinson disease. JAMA Neurol 71:1405-12