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The implication of cardio-oncology on Parkinson's disease: answers begin to emerge
Fulvio A. Scorzaa,b,
, Antonio-Carlos G. de Almeidab,c, Josef Finstererb,d, Ludhmila A. Hajjarb,e,f
Corresponding author
a Disciplina de Neurociência, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
b 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, SP, Brazil
c Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), São João del-Rei, MG, Brazil
d Klinikum Landstrasse, Messerli Institute, Vienna, Austria
e Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
f Instituto do Câncer, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Scorza, Antonio-Carlos G. de Almeida, Josef Finsterer, Ludhmila A. Hajjar" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Fulvio A." "apellidos" => "Scorza" "email" => array:1 [ 0 => "scorza@unifesp.br" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0001" ] ] ] 1 => array:3 [ "nombre" => "Antonio-Carlos G." "apellidos" => "de Almeida" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0003" ] ] ] 2 => array:3 [ "nombre" => "Josef" "apellidos" => "Finsterer" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0004" ] ] ] 3 => array:3 [ "nombre" => "Ludhmila A." "apellidos" => "Hajjar" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0005" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0006" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Disciplina de Neurociência, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil" "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "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, SP, Brazil" "etiqueta" => "b" "identificador" => "aff0002" ] 2 => array:3 [ "entidad" => "Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), São João del-Rei, MG, Brazil" "etiqueta" => "c" "identificador" => "aff0003" ] 3 => array:3 [ "entidad" => "Klinikum Landstrasse, Messerli Institute, Vienna, Austria" "etiqueta" => "d" "identificador" => "aff0004" ] 4 => array:3 [ "entidad" => "Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil" "etiqueta" => "e" "identificador" => "aff0005" ] 5 => array:3 [ "entidad" => "Instituto do Câncer, Universidade de São Paulo (USP), São Paulo, SP, Brazil" "etiqueta" => "f" "identificador" => "aff0006" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0001" class="elsevierStylePara elsevierViewall">Parkinson's Disease (PD) is a progressive, incurable, and symptomatically devastating neurodegenerative disease.<a class="elsevierStyleCrossRefs" href="#bib0001"><span class="elsevierStyleSup">1-3</span></a> PD is the second most common neurodegenerative disease affecting up to ten million people worldwide.<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> Clinically, PD presents with tremor, rigidity, bradykinesia/akinesia, and postural instability due to the progressive loss of neurons in the Substantia Nigra pars compacta <span class="elsevierStyleItalic">(</span>SNpc) and extensive intracellular aggregation of α-synuclein.<a class="elsevierStyleCrossRefs" href="#bib0003"><span class="elsevierStyleSup">3-5</span></a> In addition, molecular mechanisms such as mitochondrial dysfunction, excitotoxicity, impaired autophagy, oxidative stress, and genetic mutations are implicated in the degeneration of dopaminergic neurons in PD.<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> Available therapies for PD only affect the symptoms of the disease and mainly focus on the dopaminergic pathway.<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> The most common non-motor symptoms associated with PD involve neurobehavioral complications, sensory problems, and autonomic dysfunction.<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> Several studies have found autonomic dysfunction to be a valuable predictor of cardiovascular morbidity and mortality in PD patients.<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> Despite the tremendous clinical and epidemiological relevance of these studies, Sudden Death in PD (SUDPAR), a rare but fatal event, contributes to the increased mortality in PD patients.<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a></p><p id="para0002" class="elsevierStylePara elsevierViewall">Although the authors experienced an enlightening phase in PD research in the last decade,<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> data on the influence of comorbidities on morbidity and mortality in PD are still lacking. Previous studies showed that hypertension, back problems, arthritis, dementia, cataracts, diabetes <span class="elsevierStyleItalic">mellitus</span> type II, non-specific hyperlipidemia, depressive disorder, atrial fibrillation, and urinary incontinence were the most common comorbidities in PD patients.<a class="elsevierStyleCrossRefs" href="#bib0011"><span class="elsevierStyleSup">11-13</span></a> There is also growing evidence that PD and cancer may be closely linked.<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> In fact, cancer incidence increases with age, as does the incidence of PD.<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> On the one hand, an increased incidence of melanoma and other skin tumors, brain cancer, thyroid, and breast cancer has been demonstrated in PD patients.<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> On the other hand, other studies showed that PD is associated with a significantly reduced risk of lung cancer, genitourinary cancers, gastrointestinal cancers, and hematological cancers.<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> Although these data are controversial, there is a putative link between PD and cancer that requires much caution and further studies.<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> Based on all these data and the worrying situation, the authors think it is appropriate to relate PD to the multidisciplinary specialty known as cardio-oncology.<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> In particular, the main goal of cardio-oncology is the prevention and treatment of cancer therapy-related cardiotoxicity to optimize cardiovascular health outcomes in cancer patients or after cancer.<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> In fact, it is already recognized that some cancer treatments can lead to atrial tachyarrhythmias, ventricular arrhythmias, and bradyarrhythmias.<a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> Therefore, based on the authors’ experience of more than a decade with the cardio-oncology program in Brazil,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> it is necessary to apply this knowledge to patients with PD as well. Certainly, the authors fully agree<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> that this valuable clinical convergence will enable us to identify PD patients at risk for cardiac complications and to develop precise cardioprotective strategies.</p><p id="para0003" class="elsevierStylePara elsevierViewall">What lessons have the authors learned overall in recent years? Firstly, with an aging population and rising life expectancy worldwide, PD is estimated to increase by more than 50% by 2030.<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> Second, PD is a systemic disease with cases of premature death. SUDPAR is a rare event, but it is common in PD patients with positive family history and risk factors for cardiovascular disease. Third, several studies suggest that cancer may be associated with PD. Furthermore, as extraordinary advances in translational neuroscience have changed our understanding of PD in the last decade,<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> it is extremely important to integrate the concept of cardio-oncology in centers for movement disorders. In fact, as cancer survival has increased over time due to improvements in treatment, it is reasonable to expect that the significant risk of cardiovascular complications for survivors will remain high in the near future.<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> In these lines, the authors are in agreement that new lines of research should converge the research expertise of not only cardiologists and oncologists, but potentially others, including neurologists, and those with translational research experience.<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> Finally, all medical specialties must work together in research, education, and collaboration to ensure healthy lives of the patients in cardio-oncology.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-06-21" "fechaAceptado" => "2022-07-04" "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ten-Year relative survival from the diagnosis of Parkinson's disease: a nationwide database study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "HG Seo" 1 => "SJ Byun" 2 => "BM Oh" 3 => "SJ. 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| Year/Month | Html | Total | |
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