Had your appendix removed?

What about a vagotomy- a treatment for stomach ulcers that severs the vagal nerve.No? That may mean you have a better chance to develop Parkinson’s disease.  (I’m really not sure ‘better’ is the right word choice here.)

“What?”, you say. “Why?”

It turns out that this organ that we considered vestigial is the storage bin for a special protein, alpha synuclein. And, that α-synuclein (αS) is found in misfolded form in the brains of Parkinson’s sufferers. αS also leads to gastrointestinal symptoms (which prevail among those with Parkinson’s). Moreover, it is postulated that this protein can traverse the vagal nerve, reaching the brain, where its adverse effects are manifested.

I‘ve already reported about the Lewy bodies that prevail in brains of Parkinson’s patients. These large proteinaceous deposits surround the brain’s neurons, which hinder the release of dopamine (and other neurotransmitters), critical for our movement. Those Lewy bodies are the clumped alpha synucleins.

I’m sure you recognized  in this exposition that there was no real scientific testing to determine that an appendectomy can protect against manifesting Parkinson’s disease.  Such a study would report that the presence of [A] causes [B]. Or, perhaps, the lack of [A] would let [B] occur.  ([A] in this case would be vagal nerve patency or an extant appendix.  [B] would mean Parkinson’s disease.  Just in case I was being too generalized for you.)

No, Dr. Viviane Labrie’s team examined the medical records of some 1,698,000 Swedes whose medical history has been tracked from 1964 though 2016, a total of 52 years (Statistics Sweden). (Labrie’s  team: Drs. BA Killinger, Z Madaj, N Rey, AJ Haas, Y Vepa, P Brundin, L Brundin of Van Andel Research institute, Grand Rapids [MI]; Drs. JW Sikora and PM Thomas (Northwestern, Evanston, IL); Dr. D. Lindqvist of Lund University (Sweden); and Dr. H Chen (Michigan State University).) They reported these results in the journal,  Science Translational Medicine.

Yet, without the clear connection between [A] and [B], this still is a somewhat creative study. Statistics determines there is a 1% chance that one would develop Parkinson’s after the age of 65. But, it one had an appendectomy (as was manifested by 551647 or about 1/3 of the subjects) , there’s only 0.8% chance. Yes, a full 19% drop in the incidence.

Oh, wait! Maybe not. If one splits the census between rural and urban dwellers, that drop only is manifested for the rural dwellers. Why would that be? Because there probably is an environmental trigger- and the appendectomy alleviates its ability of the trigger to ‘fire’ up changes.

So, Labrie et. al. examined additional data. They found 849 folks with Parkinson’s who were included in the Parkinson’s Progression Markers Initiative (PPMI). And, in this study, for those who had an appendectomy > 20 years (average was 30 y) prior to their disease diagnosis, the onset of Parkinson’s was delayed an average of 3.6 y. (There’s an awful lot of statistics in this linkage, not a lot of scientific medicine.) Moreover, if healthy people were examined (48 folks), 46 of them had the bad form of αS. It was also immaterial if the appendix was inflamed or not. So, that means the protein is prevalent in all of us.

Wait- let’s not give up on the hypothesis. Maybe the appendix is a “fermentor”, a breeding ground for the clumpy αS? How would one test that? If we dump some healthy appendix tissue cells in with normal αS in a petri dish, we find that the proteins cleave into shorter forms, which are those then tend to aggregate, and, therefore, be capable of spreading to the brain.

All of this research is building upon a hypothesis promoted by Dr. Heiko Braak (a neuroscientist) who claimed that Parkinson’s origin is in the gut. And, Parkinson’s spreads from there via the vagal nerve, which renders the brain to convert healthy forms of the protein to the clumpy, misfolded varieties.

If this data is correct, it would mean the appendix is not vestigial, not completely useless- which would overturn decades of thought. Its immune cells must have some functionality, the ability to mediate and coordinate the gut’s response to pathogens. The imbalance of bacteria in our microbiome then creates the potentiality to develop Parkinson’s disease. (As of now, it is not clear if it’s microbiome disturbances or inflammation that is the culprit.)

It is clear that our understanding of Parkinson’s disease has changed- we now consider it a multisystem disorder- one in which both motor and non-motor functionality are adversely affected. Moreover, it seems that many patients develop constipation and additional GI (gastro-intestinal) disorders years before their tremors manifest or before they experience difficulty in their movements.

No one is suggesting that we prophylactically remove folks appendices. Not even these researchers. Which is exactly why I still think the use of albuterol (one of the drugs used to control asthma and COPD) may be a better approach to eradicating the alpha synucleins.

 

I know.  I know. Procrastination is destiny.  So, I am here to remind that today is the LAST day for my special offer.  Sure, my book will still be available.  (You DO need to recognize how the new tax law affects your personal and business taxation.)  But my offer- where I will help you discern what changes you should make to minimize your taxes due- ends at midnight tonight.