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3. Malnutrition status and cognitive functions correlation in patients with Parkinson's disease and atypical parkinsonisms: a preliminary study

Author

Ferri, V., primary, Barichella, M., additional, Cereda, E., additional, Castelli, C., additional, Pusani, C., additional, Bolliri, C., additional, Caronni, S., additional, Macchione, M.C., additional, Legnani, G., additional, Calandrella, D., additional, Garri', F., additional, Sacilotto, G., additional, Zini, M., additional, Del Sorbo, F., additional, Cereda, V., additional, Pozzi, B., additional, and Pezzoli, G., additional

Published
2023
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5. Does gut microbiota influence the course of Parkinson's disease? A 3-Year prospective exploratory study in de novo patients

Author

Cilia, R, Piatti, M, Cereda, E, Bolliri, C, Caronni, S, Ferri, V, Cassani, E, Bonvegna, S, Ferrarese, C, Zecchinelli, A, Barichella, M, Pezzoli, G, Cilia R., Piatti M., Cereda E., Bolliri C., Caronni S., Ferri V., Cassani E., Bonvegna S., Ferrarese C., Zecchinelli A. L., Barichella M., Pezzoli G., Cilia, R, Piatti, M, Cereda, E, Bolliri, C, Caronni, S, Ferri, V, Cassani, E, Bonvegna, S, Ferrarese, C, Zecchinelli, A, Barichella, M, Pezzoli, G, Cilia R., Piatti M., Cereda E., Bolliri C., Caronni S., Ferri V., Cassani E., Bonvegna S., Ferrarese C., Zecchinelli A. L., Barichella M., and Pezzoli G.

Abstract

Background: Although abnormalities in gut microbiota are hypothesized to influence the pathogenesis and clinical phenotype of Parkinson's disease (PD), prospective studies on de novo patients are lacking. Objective: To preliminarily investigate whether gut microbiota in early untreated PD may predict motor and non-motor features progression over a 3-year period. Methods: 16S ribosomal RNA gene amplicons were sequenced on fecal samples of 39 de novo PD patients. Multiple confounders were taken into account, including dietary habits. Motor and non-motor symptoms were assessed using validated scales at baseline and followed-up yearly for 3 years. At last follow-up, a detailed neuropsychological assessment was additionally performed. A general linear model for repeated measurements-adjusted by dopaminergic therapy at followup-was used to investigate the relationship between bacterial taxa abundance at baseline (stratified by the median of distribution at baseline) and outcome variables. Results: Twenty-five patients were included (11 refused, 2 lost at follow-up, 1 died). Lower abundance of Roseburia (Firmicutes phylum) at baseline was associated with worse evolution of motor, non-motor and cognitive functions at 3-year follow-up. Similarly, lower abundance of Ruminococcaceae and Actinobacteria at baseline was associated with faster worsening of global cognitive functions. At follow-up, frontal lobe functions were the features most robustly associated with baseline microbial abnormalities. Conclusion: In the present exploratory study on de novo PD, we found an association between abnormal distribution of specific bacterial taxa and the progression of motor and non-motor features over a 3-year period. This proof-of-principle study supports the design of a larger observational study aiming to determine whether these differences survive multiple-comparison correction and define microbiota-specific subgroups suitable for therapeutic targeting.

Published
2021

7. Gut microbiota dysbiosis in Parkinson's disease - a systematic review and pooled analysis

Author

Kleine Bardenhorst, S, Cereda, E, Severgnini, M, Barichella, M, Pezzoli, G, Keshavarzian, A, Desideri, A, Pietrucci, D, Aho V, T, Scheperjans, F, Hildebrand, F, Weis, S, Egert, M, Karch, A, Vital, M, Rübsamen, N, Kleine Bardenhorst, S, Cereda, E, Severgnini, M, Barichella, M, Pezzoli, G, Keshavarzian, A, Desideri, A, Pietrucci, D, Aho V, T, Scheperjans, F, Hildebrand, F, Weis, S, Egert, M, Karch, A, Vital, M, and Rübsamen, N

Published
2022

12. Association between malnutrition and cognitive impairment in parkinson’s disease and parkinsonism: preliminary data analysis

Author

Colosimo, S., primary, Ferri, V., additional, Frigerio, C., additional, Calati, A., additional, Cereda, E., additional, Bolliri, C., additional, Caronni, S., additional, Pusani, C., additional, Sacilotto, G., additional, Zecchinelli, A., additional, Colombo, A., additional, Reali, E., additional, Cereda, V., additional, Cassani, E., additional, Pezzoli, G., additional, and Barichella, M., additional

Published
2020
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13. Harris-Benedict equation well predicts resting energy expenditure in Parkinson's disease patients under dopaminergic treatment: A control-case study

Author

Barichella, M., primary, Piuri, G., additional, Faierman, S.A., additional, Cassani, E., additional, Cereda, E., additional, Vaccarella, E., additional, Donnarumma, O.V., additional, Ferri, V., additional, Pinelli, G., additional, Bolliri, C., additional, Caronni, S., additional, Pusani, C., additional, and Pezzoli, G., additional

Published
2019
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14. Vitamin 25(OH) D and cognitive function in parkinson’s disease

Author

Barichella, M., primary, Bolliri, C., additional, Pinelli, G., additional, Iorio, L., additional, Ferri, V., additional, Cassani, E., additional, Giana, A., additional, Caronni, S., additional, Pusani, C., additional, Del Sorbo, F., additional, Cilia, R., additional, Quacci, E., additional, Riboldazzi, G., additional, Lanfranchi, S., additional, Cereda, E., additional, and Pezzoli, G., additional

Published
2019
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16. Protein, leucine and vitamin D enhancing rehabilitation (pro-leader) in patients with Parkinson's disease or parkinsonism: a randomized clinical trial

Author

Cereda, E., primary, Pinelli, G., additional, Iorio, L., additional, Caroli, D., additional, Masiero, I., additional, Ferri, V., additional, Cassani, E., additional, Bolliri, C., additional, Caronni, S., additional, Ortelli, P., additional, Ferrazzoli, D., additional, Maras, A., additional, Riboldazzi, G., additional, Frazzitta, G., additional, Pezzoli, G., additional, and Barichella, M., additional

Published
2018
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17. Rehabilitation program with or without a muscle-targeted nutritional support in patients with Parkinson’s disease or parkinsonism: study design of a randomized, controlled trial

Author

Barichella, M., primary, Cereda, E., additional, Pinelli, G., additional, Caroli, D., additional, Masiero, I., additional, Negri, S.J., additional, Ferri, V., additional, Iorio, L., additional, Cassani, E., additional, Riboldazzi, G., additional, Frazzitta, G., additional, and Pezzoli, G., additional

Published
2018
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18. Dietary habits in Parkinson’s disease: adherence to Mediterranean diet

Author

Cassani, E., primary, Barichella, M., additional, Ferri, V., additional, Pinelli, G., additional, Iorio, L., additional, Bolliri, C., additional, Caronni, S., additional, Faierman, S., additional, Mottolese, A., additional, Pusani, C., additional, Monajemi, F., additional, Lubisco, A., additional, Pasqua, M., additional, Cereda, E., additional, Frazzitta, G., additional, Petroni, M.L., additional, and Pezzoli, G., additional

Published
2018
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20. SUN-P128: Dietary Habits in Parkinson’s Disease: Adherence to Mediterranean Diet

Author

Barichella, M., primary, Cereda, E., additional, Cassani, E., additional, Ferri, V., additional, Pinelli, G., additional, Iorio, L., additional, Bolliri, C., additional, Caronni, S., additional, Faierman, S.A., additional, Mottolese, A., additional, Pusani, C., additional, Monajemi, F., additional, Pasqua, M., additional, Lubisco, A., additional, and Pezzoli, G., additional

Published
2017
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21. SUN-P101: Sarcopenia and Dynapenia in Patients with Parkinsonism

Author

Barichella, M., primary, Pinelli, G., additional, Iorio, L., additional, Cassani, E., additional, Valentino, A., additional, Pusani, C., additional, Ferri, V., additional, Bolliri, C., additional, Pasqua, M., additional, Pezzoli, G., additional, Frazzitta, G., additional, and Cereda, E., additional

Published
2016
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22. OR10: Dietary Habits and Neurological Features of Parkinson's Disease Patients: Implications for Practice

Author

Cereda, E., primary, Barichella, M., additional, Cassani, E., additional, Pinelli, G., additional, Iorio, L., additional, Ferri, V., additional, Privitera, G., additional, Pasqua, M., additional, Valentino, A., additional, Monajemi, F., additional, Caronni, S., additional, Lignola, C., additional, Pusani, C., additional, Bolliri, C., additional, Faierman, S.A., additional, De Marco, P., additional, Mottolese, A., additional, Lubisco, A., additional, Frazzitta, G., additional, Petroni, M.L., additional, and Pezzoli, G., additional

Published
2016
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23. SUN-P199: Double-Blind, Placebo-Controlled Trial of a Fermented Milk Containing Multiple Probiotic Strains and Prebiotic Fiber for Constipation Associated with Parkinson's Disease

Author

Barichella, M., primary, Pacchetti, C., additional, Bolliri, C., additional, Cassani, E., additional, Iorio, L., additional, Pusani, C., additional, Pinelli, G., additional, Privitera, G., additional, Ilaria, C., additional, Faierman, S.A., additional, Caccialanza, R., additional, Pezzoli, G., additional, and Cereda, E., additional

Published
2016
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26. PP213-SUN: Swallowing Disturbances in Parkinson’s Disease

Author

Cereda, E., primary, Klersy, C., additional, Cilia, R., additional, Canesi, M., additional, Zecchinelli, A.L., additional, Mariani, C.B., additional, Tesei, S., additional, Sacilotto, G., additional, Meucci, N., additional, Zini, M., additional, Isaias, I.U., additional, Cassani, E., additional, Goldwurm, S., additional, Barichella, M., additional, and Pezzoli, G., additional

Published
2014
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33. PP180-MON THE EFFECTS OF PREOPERATIVE ORAL CARBOHYDRATE SUPPLEMENTATION ON POSTOPERATIVE METABOLIC STRESS RESPONSE OF PATIENTS UNDERGOING ELECTIVE ABDOMINAL SURGERY

Author

Cereda, E., primary, Vigano, J., additional, Cassani, E., additional, Caccialanza, R., additional, Barichella, M., additional, Carini, R., additional, Madio, C., additional, Cameletti, B., additional, Cancello, R., additional, Quarleri, L., additional, Spampinato, M., additional, Zini, M., additional, Dionigi, P., additional, Cilia, R., additional, and Pezzoli, G., additional

Published
2012
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40. Neural Lipids in Parkinson's Disease.

Author

Barichella, M., Pezzoli, G., Mauri, A., and Savardi, C.

Abstract

A huge scientific effort is still ongoing in order to address the main etiologic and pathologic mechanisms responsible for the onset and the progression of Parkinson's Disease, one of the most common chronic progressive neurological disorders. The key role of oxidative damage in PD has been widely studied. Exposition to different toxic agents can promote oxidative damages, for instance, via inhibition of mitochondrial functions. This can lead to the formation of dangerous reactive radical compounds and of their relative oxidation products which have been frequently discovered to be present in elevated concentration in the Substantia Nigra pars compacta neurons of PD affected patients. In particular, being cellular membranes a preferential site for lipid oxidation, of increasing importance are also the studies investigating the contribution of membrane lipids composition to the aggregation of the α-Synuclein protein in filamentous amyloid-like fibrils, giving origin to insoluble intracellular inclusions with the capacity to cause neuronal damage. More recently, the role of the Cannabinoid-based compounds on the endocannabinoid receptors is under investigation due to the suggestions of a close interaction of the dopaminergic transmission with the endocannabinoid system which could ultimately behave as a compensatory mechanism in case the functionality of previous one is compromised. These compounds could thus be considered as a potential therapy to alleviate motor symptoms and L-dopa associated dyskinesias in PD affected patients. [ABSTRACT FROM AUTHOR]

Published
2010
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41. Hydrocarbon exposure and Parkinson's disease

Author

Pezzoli, G., primary, Canesi, M., additional, Antonini, A., additional, Righini, A., additional, Perbellini, L., additional, Barichella, M., additional, Mariani, C. B., additional, Tenconi, F., additional, Tesei, S., additional, Zecchinelli, A., additional, and Leenders, K. L., additional

Published
2000
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42. Diabetes and risk of Parkinson's disease: a systematic review and meta-analysis.

Author

Cereda E, Barichella M, Pedrolli C, Klersy C, Cassani E, Caccialanza R, Pezzoli G, Cereda, Emanuele, Barichella, Michela, Pedrolli, Carlo, Klersy, Catherine, Cassani, Erica, Caccialanza, Riccardo, and Pezzoli, Gianni

Abstract

Objective: Diabetes has been associated with chronic neurodegeneration. We performed a systematic review and meta-analysis to assess the relationship between pre-existing diabetes and Parkinson's disease (PD).Research Design and Methods: Original articles in English published up to 10 May 2011 were searched for in electronic databases (PubMed, Embase, and Scopus) and by reviewing references of eligible articles. Prospective cohort and case-control studies providing risk and precision estimates relating to pre-existing diabetes and PD were considered eligible.Results: Nine studies/1,947 citations (cohort, N = 4; case-control, N = 5) fulfilled inclusion criteria for meta-analysis. In prospective studies, the onset of diabetes before onset of PD was found to be a risk factor for future PD (relative risk [RR] = 1.37 [95%CI 1.21-1.55]; P < 0.0001). This association was confirmed by secondary analyses based on estimates derived after the exclusion of participants who had vascular disease at baseline and/or who developed vascular disease during follow-up (RR = 1.34 [1.14-1.58]; P < 0.001) and by sensitivity analyses addressing the association with diabetes at baseline or during follow-up. However, the association found for case-control studies was not significant (odds ratio [OR] 0.75 [95%CI 0.50-1.11]; P = 0.835). Sensitivity analysis based on estimates adjusted for BMI confirmed the lack of a relationship between PD and diabetes (OR 0.56 [0.28-1.15]; P = 0.089).Conclusions: Although data from cohort studies suggest that diabetes is a risk factor for PD, there is no conclusive evidence on this association. Further prospective studies focused on putative pathogenic pathways and taking a broad range of confounders into account is required to clarify this relationship. [ABSTRACT FROM AUTHOR]

Published
2011
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43. Awareness and knowledge about weight status and management: results from the 1 d sensitization campaign 'Obesity Day' in northern Italy.

Author

Barichella M, Malavazos AE, Fatati G, Cereda E, Barichella, Michela, Malavazos, Alexis E, Fatati, Giuseppe, Cereda, Emanuele, and ADI Lombardia Study Group

Abstract

Objective: To evaluate the awareness and knowledge about weight status and its management.Design: A 1 d cross-sectional survey. Basic anthropometric assessments (weight, height, BMI and waist circumference) and a self-administered questionnaire were considered.Setting: Nineteen Clinical Nutrition or Endocrinology and Metabolic Disorders Units or Dietetics Services in the Italian region of Lombardy.Subjects: All adults attending the 'Obesity Day' initiative.Results: A total of 914 participants (605 female and 309 male) were recruited. Although most of the participants (83·5 %) considered obesity to be a disease, 38·5 % were likely to misperceive their weight status. In particular, 38·8 % of normal-weight adults believed themselves to be overweight, whereas 71·1 % and 37·5 % of classes I and II/III obese adults classified themselves as being overweight and mildly obese, respectively. However, most of the overweight (90·2 %), mildly (96·8 %) and moderately/severely obese adults (99·1 %) recognized the need to lose weight. In all, 37·8 % of the sample underestimated the role of physical activity in weight management. Interestingly, only 17·2 % of dieters (previous or current) declared being advised by their doctor to lose weight. Multivariate models revealed that higher age, low education and higher BMI were important determinants of poor weight control and management. In addition, previous dieting appeared not to provide better knowledge, whereas the role of physical activity was recognized mainly by those practising it.Conclusions: The present study suggests that in Italy knowledge about weight management should be improved not only in the general population but also among health-care professionals. To confirm this finding, there is now the rationale for a nationally representative survey. New educational programmes can be designed on the basis of the information collected. [ABSTRACT FROM AUTHOR]

Published
2011
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45. Use of probiotics for the treatment of constipation in Parkinson's disease patients

Author

Cassani, E., Privitera, G., Gianni Pezzoli, Pusani, C., Madio, C., Iorio, L., and Barichella, M.

Subjects
Male, Lacticaseibacillus casei, Treatment Outcome, Probiotics, Humans, Female, Parkinson Disease, Pilot Projects, Constipation, Aged
Abstract

The aim of this paper was to assess the effects of milk fermented with the probiotic strain Lactobacillus casei Shirota on constipation in Parkinson's disease patients. Constipation is a common secondary symptom in patients suffering from Parkinson's Disease (PD), generally treated with dietary therapy, soluble fiber supplements and macrogol laxatives without sodium sulfate. There are no studies on the use of probiotics in the treatment of constipation in these patients. The effects of the administration of Lactobacillus casei Shirota on gastrointestinal symptoms have been assessed in two randomized controlled trials on patients suffering from chronic constipation.Forty PD patients suffering from constipation according to Rome III criteria were recruited. We compared the characteristic of intestinal function during two periods with different treatments: in the first week the patients treated constipation only with dietetic therapy; in the following 5 weeks the patients treated constipation not only with dietetic therapy, but also taking a 65 mL fermented milk drink containing 6.5×109 CFU of Lactobacilus casei Shirota daily.They completed a daily diary for 6 weeks, recording details related to their intestinal function.After probiotic intake we observed a statistically significant increase in the number of days per week in which stools were of normal consistency (P0.01) and significant reductions in the number of days per week in which patients felt bloated (P0.01), experienced abdominal pain (P0.01) and sensation of incomplete emptying (P0.01).This pilot study showed that a regular intake of probiotics can significantly improve stool consistency and bowel habits in Parkinson's disease patients.

48. Does Gut Microbiota Influence the Course of Parkinson’s Disease? A 3-Year Prospective Exploratory Study in de novo Patients

Author

Carlotta Bolliri, Carlo Ferrarese, Gianni Pezzoli, Salvatore Bonvegna, Valentina Ferri, Erica Cassani, Serena Caronni, Anna Zecchinelli, Emanuele Cereda, Michela Barichella, Roberto Cilia, Marco Piatti, Cilia, R, Piatti, M, Cereda, E, Bolliri, C, Caronni, S, Ferri, V, Cassani, E, Bonvegna, S, Ferrarese, C, Zecchinelli, A, Barichella, M, and Pezzoli, G

Subjects
Male, 0301 basic medicine, medicine.medical_specialty, Parkinson's disease, Prognosi, Gut microbiota, Disease, Gut flora, Proof of Concept Study, Executive Function, Feces, 03 medical and health sciences, Cellular and Molecular Neuroscience, 0302 clinical medicine, RNA, Ribosomal, 16S, Internal medicine, medicine, Humans, Cognitive Dysfunction, Prospective Studies, Neuropsychological assessment, Prospective study, Prospective cohort study, Aged, MED/26 - NEUROLOGIA, medicine.diagnostic_test, biology, Sequence Analysis, RNA, business.industry, Confounding, Parkinson Disease, Middle Aged, Prognosis, biology.organism_classification, medicine.disease, Gastrointestinal Microbiome, 030104 developmental biology, Frontal lobe, Disease Progression, Dysbiosis, De novo, Female, Neurology (clinical), Roseburia, business, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract

Background: Although abnormalities in gut microbiota are hypothesized to influence the pathogenesis and clinical phenotype of Parkinson’s disease (PD), prospective studies on de novo patients are lacking. Objective: To preliminarily investigate whether gut microbiota in early untreated PD may predict motor and non-motor features progression over a 3-year period. Methods: 16S ribosomal RNA gene amplicons were sequenced on fecal samples of 39 de novo PD patients. Multiple confounders were taken into account, including dietary habits. Motor and non-motor symptoms were assessed using validated scales at baseline and followed-up yearly for 3 years. At last follow-up, a detailed neuropsychological assessment was additionally performed. A general linear model for repeated measurements— adjusted by dopaminergic therapy at follow-up— was used to investigate the relationship between bacterial taxa abundance at baseline (stratified by the median of distribution at baseline) and outcome variables. Results: Twenty-five patients were included (11 refused, 2 lost at follow-up, 1 died). Lower abundance of Roseburia (Firmicutes phylum) at baseline was associated with worse evolution of motor, non-motor and cognitive functions at 3-year follow-up. Similarly, lower abundance of Ruminococcaceae and Actinobacteria at baseline was associated with faster worsening of global cognitive functions. At follow-up, frontal lobe functions were the features most robustly associated with baseline microbial abnormalities. Conclusion: In the present exploratory study on de novo PD, we found an association between abnormal distribution of specific bacterial taxa and the progression of motor and non-motor features over a 3-year period. This proof-of-principle study supports the design of a larger observational study aiming to determine whether these differences survive multiple-comparison correction and define microbiota-specific subgroups suitable for therapeutic targeting.

Published
2021
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49. Sarcopenia, low muscle strength, cognitive functions, and quality of life in parkinsonian syndromes.

Author

Barichella M, Cereda E, Ferri V, Bolliri C, Cereda V, Colombo A, Ranghetti A, Giuffrida MF, Alessi G, Genovesi A, Sacilotto G, Isaias IU, and Pezzoli G

Subjects
Humans, Female, Male, Aged, Fatigue physiopathology, Fatigue etiology, Middle Aged, Cognitive Dysfunction physiopathology, Cognitive Dysfunction etiology, Hand Strength physiology, Aged, 80 and over, Surveys and Questionnaires, Cross-Sectional Studies, Muscle, Skeletal physiopathology, Sarcopenia physiopathology, Sarcopenia psychology, Quality of Life, Muscle Strength, Parkinsonian Disorders physiopathology, Parkinsonian Disorders complications, Parkinsonian Disorders psychology, Cognition physiology
Abstract

Objectives: Parkinsonian syndromes are disabling neurodegenerative diseases resulting in reduced muscle function/performance and sarcopenia, but clinical manifestations could be systemic, including deterioration of cognitive function. As studies have reported an association between muscle dysfunction and cognitive decline yet no information on these syndromes is available, we investigated the relationship between sarcopenia, its components, and cognitive function, fatigue, and quality of life (QoL)., Methods: Consecutive patients affected by parkinsonian syndromes were assessed for the presence of sarcopenia using the European Working Group on Sarcopenia in Older People-2 algorithm: low strength (handgrip strength: <27 kg [men]; <16 kg [women]) and low appendicular skeletal muscle index by impedance (<7.0 kg/m 2 [men]; <6.0 kg/m 2 [women]). Cognitive function was evaluated using the Montreal Cognitive Assessment, the Mini Mental State Examination and the Frontal Assessment Battery. Fatigue and QoL were assessed using the 16-item Parkinson's Disease Fatigue Scale and the 39-item Parkinson's Disease Questionnaire, respectively., Results: In total, 314 patients were included: 198 presented with low strength (63.0% probable sarcopenia); 68 (21.7%) of these were diagnosed with sarcopenia. After adjusting for multiple confounders, we observed a significant effect (poorer score) of both low strength only and sarcopenia on Montreal Cognitive Assessment, Mini Mental State Examination, and QoL. Only reduced muscle strength had a relevant impact on the outcomes considered., Conclusions: Sarcopenia is associated with worse cognitive functions and QoL in patients with parkinsonian syndromes, with muscle dysfunction playing a major role. The prognostic impact of sarcopenia and its components should be addressed in prospective studies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Published
2024
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50. Mucuna pruriens to treat Parkinson's disease in low-income countries: Recommendations and practical guidelines from the farmer to clinical trials. Paving the way for future use in clinical practice.

Author

Caronni S, Del Sorbo F, Barichella M, Fothergill-Misbah N, Denne T, Laguna J, Urasa S, Dekker MCJ, Akpalu A, Sarfo FS, Cham M, Pezzoli G, and Cilia R

Subjects
Humans, Phytotherapy, Clinical Trials as Topic, Practice Guidelines as Topic standards, Antiparkinson Agents therapeutic use, Antiparkinson Agents economics, Plant Extracts therapeutic use, Mucuna, Parkinson Disease drug therapy, Developing Countries
Abstract

Parkinson's disease (PD) is a progressive and disabling neurodegenerative disease that rapidly worsens and results in premature mortality if left untreated. Although levodopa is the gold standard treatment for PD globally, its accessibility and affordability are severely limited in low- and middle-income countries worldwide. In this scenario, Mucuna pruriens (MP), a leguminous plant growing wild in tropical regions, emerges as a potential alternative or adjunct to levodopa-based medications due to its cost-effectiveness and global natural availability. Recent studies have demonstrated that MP can significantly ameliorate motor symptoms, although tolerability may vary. The proposition that MP could play a pivotal role in providing affordable and symptomatic relief for PD in low- and middle-income countries is grounded in its promising therapeutic profile, yet caution is warranted until more comprehensive data on the long-term safety and efficacy of MP become available. This manuscript summarizes the knowledge gained about MP by the authors, focusing on how to cultivate, store, and provide it to patients in the safest and most effective way in clinical trials. We aim to increase clinical trials investigating its safety and efficacy in PD, before promoting individual use of MP on a global scale, particularly in countries where availability and affordability of levodopa-based medications is still limited., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Roberto Cilia is an Associate Editor for Parkinsonism and Related Disorders If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Published
2024
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