Journal
NATURE REVIEWS NEUROLOGY
Volume 15, Issue 4, Pages 204-223Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/s41582-019-0155-7
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Funding
- NIH [R01 NR014852, R01NS096008]
- NIH/National Center for Advancing Translational Sciences Clinical and Translational Science Awards [UL1TR001427, KL2TR001429, TL1TR001428]
- Parkinson's Foundation
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Parkinson disease (PD) treatment options have conventionally focused on dopamine replacement and provision of symptomatic relief. Current treatments cause undesirable adverse effects, and a large unmet clinical need remains for treatments that offer disease modification and that address symptoms resistant to levodopa. Advances in high-throughput drug screening methods for small molecules, developments in disease modelling and improvements in analytical technologies have collectively contributed to the emergence of novel compounds, repurposed drugs and new technologies. In this Review, we focus on disease-modifying and symptomatic therapies under development for PD. We review cellular therapies and repurposed drugs, such as nilotinib, inosine, isradipine, iron chelators and anti-inflammatories, and discuss how their success in preclinical models has paved the way for clinical trials. We provide an update on immunotherapies and vaccines. In addition, we review non-pharmacological interventions targeting motor symptoms, including gene therapy, adaptive deep brain stimulation (DBS) and optogenetically inspired DBS. Given the many clinical phenotypes of PD, individualization of therapy and precision of treatment are likely to become important in the future.
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