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Open AccessArticle

Interventional Influence of the Intestinal Microbiome Through Dietary Intervention and Bowel Cleansing Might Improve Motor Symptoms in Parkinson’s Disease

Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital Bochum, Bochum, 44791, Germany
Clinic of Neurology II, EVK Hattingen, Hattingen 45525, Germany
Clinical Microbiomics A/S, Copenhagen 2200, Denmark
Department of Medical Microbiology, Ruhr-University Bochum, Bochum, 44801, Germany
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Cells 2020, 9(2), 376;
Received: 23 November 2019 / Revised: 12 January 2020 / Accepted: 1 February 2020 / Published: 6 February 2020
(This article belongs to the Special Issue The Molecular and Cellular Basis for Parkinson's Disease 2019)
The impact of the gut microbiome is being increasingly appreciated in health and in various chronic diseases, among them neurodegenerative disorders such as Parkinson’s disease (PD). In the pathogenesis of PD, the role of the gut has been previously established. In conjunction with a better understanding of the intestinal microbiome, a link to the misfolding and spread of alpha-synuclein via inflammatory processes within the gut is discussed. In a case-control study, we assessed the gut microbiome of 54 PD patients and 32 healthy controls (HC). Additionally, we tested in this proof-of-concept study whether dietary intervention alone or additional physical colon cleaning may lead to changes of the gut microbiome in PD. 16 PD patients underwent a well-controlled balanced, ovo-lacto vegetarian diet intervention including short fatty acids for 14 days. 10 of those patients received additional treatment with daily fecal enema over 8 days. Stool samples were collected before and after 14 days of intervention. In comparison to HC, we could confirm previously reported PD associated microbiome changes. The UDPRS III significantly improved and the levodopa-equivalent daily dose decreased after vegetarian diet and fecal enema in a one-year follow-up. Additionally, we observed a significant association between the gut microbiome diversity and the UPDRS III and the abundance of Ruminococcaceae. Additionally, the abundance of Clostridiaceae was significantly reduced after enema. Dietary intervention and bowel cleansing may provide an additional non-pharmacologic therapeutic option for PD patients.
Keywords: vegetarian diet; enema; Parkinson’s disease; microbiome; butyric acid vegetarian diet; enema; Parkinson’s disease; microbiome; butyric acid
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    Doi: 10.5281/zenodo.3551365; 10.5281/zenodo.3605627
    Description: Figure S1: Relative Abundance of Clostridiaceae before and after enema. Figure S2: UPDRS III before and after the interventional interval of 14 days. The dotted line represents the intervention group with enema and vegetarian diet, while the solid line represents the group with vegetarian diet alone. Figure S3. Relative abundance of the level in patients with Parkinson disease before and after intervention. EB: enema before, EA: enema after intervention; NB: nutrition before, NA: nutrition after intervention. Figure S4. Correlation between the rel. abundance of Eggerthela lenta and the cum. levodopa dose [mg] at the top for both groups. Correlation between the rel. abundance of Enterococcus faecalis and the cum. levodopa dose [mg] at the bottom for both groups.
MDPI and ACS Style

Hegelmaier, T.; Lebbing, M.; Duscha, A.; Tomaske, L.; Tönges, L.; Holm, J.B.; Bjørn Nielsen, H.; Gatermann, S.G.; Przuntek, H.; Haghikia, A. Interventional Influence of the Intestinal Microbiome Through Dietary Intervention and Bowel Cleansing Might Improve Motor Symptoms in Parkinson’s Disease. Cells 2020, 9, 376.

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