Blood element | Clue | Postulate |
---|---|---|
Blood lymphocyte count | Reduced count in probands and their spouses cf contemporaneous controls. | Viral origin would fit, especially in context of:- (i) prevalent abnormal bowel function, starting prodromally in probands, and found in spouses (ii) evidence of premonitory parkinsonian state in spouses. |
Serum Immunoglobulin (IgM, IgG, IgA) concentrations | Strong associations with sporadic cardinal features of parkinsonism in controls suggest premonitory infection. | |
Serum IgM concentration | Differential effect of Helicobacter seropositivity between probands and controls. | Sequestration to site gastric inflammation no longer obtains in established parkinsonism or there is increased production of poly-specific IgM (in response to Helicobacter or SIBO). |
Serum autoantibody titres | ANA associated with failure of, and functional deterioration after, Helicobacter eradication therapy in probands. | Autoimmune element to response to Helicobacter in probands. Hence, importance of residual low-density infection. |
Serum haematinic and homocysteine concentrations | Elevated homocysteine prevalent in probands: explained only in small part by haematinics. | Immunoinflammatory activation likely cause. Importance of SIBO suggested by association of breath-hydrogen with iron absorption (ferritin & MCHC markers) in a setting where moderate/severe gastric atrophy uncommon. Reduction of gastric acid by inflammatory cytokine likely mechanism. |