ANA2022 Plenary Session Spotlight: Sheng-Han Kuo, MD | Peripheral Contributions to Neurologic Disorders

Outside Factors: How non-neurological systems may shape neurodegenerative diseases

The “Peripheral Contributions to Neurologic Disorders: Adaptive Immunity and Metabolic Influences” plenary session at the ANA’s 2022 Annual Meeting, takes place Tuesday, October 25, from 8:45 to 10:45 a.mRegister now to attend ANA2022 in Chicago!

While we know a great deal about the pathogenesis of neurodegenerative diseases like Alzheimer’s and Parkinson’s within the central nervous system, new research is highlighting the role of peripheral systems—from the gut microbiome and insulin to the immune system. A plenary session at ANA2022 will highlight some of the latest discoveries.

We talked to session chair Sheng-Han Kuo, MD, Assistant Professor of Neurology at Columbia University, about this relatively new area of research. The session will be co-chaired by Matthew Robert Burns, MD, PhD, Assistant Professor of Neurology at the University of Florida College of Medicine.

What are we learning about peripheral influences on neurodegenerative disease?

Kuo: Late-onset neurological disorders like Alzheimer’s and Parkinson’s mainly occur in the central nervous system, and that’s where research has been concentrated. However, in recent years we’ve started to understand that there is a strong mind-body connection through different pathways that modulate neurodegenerative processes[KP1] —especially immune-mediated and metabolic responses as well as the microbiome. For example, for the longest time we knew that cardiovascular risk factors could also be risk factors for Alzheimer’s disease, but with recent identification of the detailed mechanism of interaction, we can finally start to explain why this is happening and harness it to treat people.

This session will discuss specific mechanisms and pathways, including novel understandings of the role of T-cells in producing a cytotoxic response in Parkinson’s patients; meningeal lymphatics and immunotherapy for Alzheimer’s disease; how sugar, insulin, and metabolic control mechanisms interact with neurodegenerative pathways; and how peripheral immune cells can migrate into the central nervous system and affect neurodegeneration.

What does this mean for therapeutics?

Kuo: Recently there have been many drawbacks in developing therapies for neurodegenerative diseases. We are targeting what’s happening in the brain with more precision, and yet many clinical trials have failed. We’re starting to understand that we need to look at peripheral contributions as an important factor that could be the missing piece to explain why therapies have been unsuccessful, help us design better clinical trials and studies, and develop better therapies.

How will this topic impact attendees’ work?

Kuo: The role of peripheral systems in neurological diseases is at the forefront of therapy development and will soon affect clinical decision making. A lot of university centers are setting up programs for the study of topics such as immunity, metabolic control, and the microbiome as they relate to neurologic disease.

This field will provide mechanistic associations and help us have a broader understanding of neurodegeneration and its causes and pathogenesis. In both therapy development and patient care, we will learn to consider factors such as diet and lifestyle change in addition to new immune modalities and biological control. Studying the interactions between neurology and the internal medicine realm is a very exciting field, with a lot of new therapies being developed and new mechanisms to consider.