LETTER TO THE EDITOR Year : 2023  |  Volume : 26  |  Issue : 1  |  Page : 84-85  

Parkinson's disease: The dirty truth about the air

Fulvio A Scorza1, Antonio-Carlos G de Almeida2, Carla A Scorza1, Josef Finsterer3
1 Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP); Centro de Neurociências e Saúde da Mulher “Professor Geraldo Rodrigues de Lima,” Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
2 Centro de Neurociências e Saúde da Mulher “Professor Geraldo Rodrigues de Lima,” Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil; Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São Joã o del-Rei (UFSJ), Vienna, Austria
3 Centro de Neurociências e Saúde da Mulher “Professor Geraldo Rodrigues de Lima,” Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil; Neurology and Neurophysiology Center, Vienna, Austria

Date of Submission14-Oct-2022Date of Decision15-Nov-2022Date of Acceptance05-Dec-2022Date of Web Publication18-Jan-2023

Correspondence Address:
Fulvio A Scorza
Rua Pedro de Toledo, 669 – 10 Andar, CEP: 04039-032, São Paulo – SP
Brazil

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/aian.aian_839_22

  How to cite this article:
Scorza FA, de Almeida ACG, Scorza CA, Finsterer J. Parkinson's disease: The dirty truth about the air. Ann Indian Acad Neurol 2023;26:84-5

People at all levels of society would benefit from industrialization. On the other hand, as industrialized cities are often plagued by air pollution, exposure to fine particulate matter (PM2.5, with an aerodynamic diameter ≤2.5 μm) can have a variety of adverse health outcomes and is an important risk factor for worldwide mortality.[1] In parallel, several epidemiological and experimental studies have shown that PM2.5 could significantly increase the risk of neurological disease such as Parkinson's disease (PD).[1] With these considerations in mind, we are excited to read the recent article by Saitoh and Mizusawa entitled “Current evidence for the association between air pollution and Parkinson's disease”.[2] Despite agreeing with the authors' position to further investigate the multifactorial nature of environmental risk factors for PD, we should not overlook that urban air pollution (AP) is a leading problem and can cause serious cardiovascular dysfunction in patients with PD.

PD is a recognizable, progressive, and systemic clinical syndrome, affecting millions of people worldwide, there is no cure, and its prevalence will double by 2030.[3] Unfortunately, PD patients have a significantly increased mortality compared to the general population.[3] Therefore, determinants such as aspiration pneumonia, cerebrovascular, and cardiovascular diseases typically cause deaths in PD patients.[3] Also, sudden unexpected death in PD (SUDPAR), a rare but fatal event, is increasingly discussed as a contributor to mortality in PD.[3] The cause of SUDPAR is still debated, but a cardiac dysfunction is believed to underlie SUDPAR, even as ~60% of PD patients present with structural and functional heart changes including cardiac autonomic dysfunction, cardiomyopathy, coronary heart disease, and arrhythmias/conduction defects.[3] Against this background, data from recent literature suggest a strong connection between direct and indirect effects of long-term exposure to particulate and gaseous AP on PD.[4] Indeed, it is clear that certain population subgroups defined by demographic factors, geographic location, a country's economic status and comorbidities may experience the adverse cardiovascular effects of AP exposure, including PD patients.[4],[5] Indeed, epidemiological studies have shown that high exposure to AP can promote the onset and aggravation of cardiovascular diseases and increase the risk of myocardial infarction in susceptible individuals.[6],[7] Importantly, we cannot ignore the fact that long-term exposure to particulate and AP has the potential to cause cardiovascular dysfunction which can lead to sudden death.[6],[8] Although the mechanisms underlying such effects are not well understood at present, AP-induced cardiovascular abnormalities may be related to inflammatory processes or oxidative stress triggered by reactive oxygen species in affected cells.[9] Based on these data, it is possible that air pollutants are associated with cardiovascular dysfunctions and even fatal events in PD patients.

What lessons do we learn from this? First, PD is a multicausal and systemic disease. Second, PD can be complicated by sudden death. Third, AP is a serious public health problem. Finally, the excellent article discussed here[10] should stimulate translational research to reduce the burden of cardiovascular disease in PD patients and provide better insight into triggering mechanisms.

Acknowledgements

Our studies are supported by the following grants: FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo); CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico), FAPEMIG (Fundação de Amparo à Pesquisa do Estado de Minas Gerais) and CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

   References 
1.Wang J, Ma T, Ma D, Li H, Hua L, He Q, et al. The Impact of air pollution on neurodegenerative diseases. Ther Drug Monit 2021;43:69-78.  
    2.Saitoh Y, Mizusawa H. Current evidence for the association between air pollution and Parkinson's disease. Ann Indian Acad Neurol 2022;25:S41-6.  
    3.Scorza FA, Fiorini AC, Scorza CA, Finsterer J. Cardiac abnormalities in Parkinson's disease and Parkinsonism. J Clin Neurosci 2018;53:1-5.  
    4.Han C, Lu Y, Cheng H, Wang C, Chan P. The impact of long-term exposure to ambient air pollution and second-hand smoke on the onset of Parkinson disease: A review and meta-analysis. Public Health 2020;179:100-10.  
    5.Tibuakuu M, Michos ED, Navas-Acien A, Jones MR. Air pollution and cardiovascular disease: A focus on vulnerable populations worldwide. Curr Epidemiol Rep 2018;5:370-8.  
    6.Franchini M, Mannucci PM. Thrombogenicity and cardiovascular effects of ambient air pollution. Blood 2011;118:2405-12.  
    7.Zanobetti A, Schwartz J. The effect of particulate air pollution on emergency admissions for myocardial infarction: A multicity case-crossover analysis. Environ Health Perspect 2005;113:978-82.  
    8.Brunekreef B, Holgate ST. Air pollution and health. Lancet 2002;360:1233-42.  
    9.González-Flecha B. Oxidant mechanisms in response to ambient air particles. Mol Aspect Med 2004;25:169-82.  
    10.Lee H, Kim OJ, Jung J, Myung W, Kim SY. Long-term exposure to particulate air pollution and incidence of Parkinson's disease: A nationwide population-based cohort study in South Korea. Environ Res 2002;212:113165.