05/06/2026
The other day over lunch I had an enriching discussion with my colleagues Patrick Santens and Arnout Bruggeman at Ghent University Hospital on the focus on α-synuclein (αSyn) aggregation as a target for disease modification. It is clear there are still many gaps in our understanding of the pathophysiology of Parkinson's disease (PD).
Therefore, I found it enlightening to read the new review article about the role of synaptic (vesicle) dysfunction in Parkinson's disease. It is part of a special 7th World Parkinson Congress issue ( ).
Several organelles are implicated in the pathogenesis of Parkinson's disease:
- mitochondria: can be impaired through mutations in PARK2/PRKN (parkin), PARK6 (PINK1), PARK7 (DJ-1), PARK15 (FBX07), PARK17 (VPS35), and PARK23 (VPS13C)
- lysosomes: disruption of autophagy is linked to PARK2/PRKN (parkin), PARK6 (PINK1), PARK8 (LRRK2), PARK9 (ATP13A2), PARK17 (VPS35), GBA1 (glucocerebrosidase 1), and TMEM175 (transmembrane protein 175)
- synaptic vesicles: a fascinating tightly regulated machinery critical to synaptic transmission and to prevent oxidative damage from cytoplasmic neurotransmitter accumulation.
It is fascinating to see how many proteins linked to Parkinson's disease play essential roles in the presynaptic vesicle cycle. Especially PARK1/PARK4/SNCA (α-synuclein) and PARK8 (LRRK2) emerge as key players with crucial roles in many involved pathways, but also PARK2/PRKN (parkin), PARK6 (PINK1), PARK7 (DJ-1) and GBA1 (GBA) are implicated.
Key insights from this article highlighted by the authors are:
- the often overlooked involvement of other neurotransmitters, especially glutamatergic signaling
- αSyn pathology produces region-specific changes that in lockstep with circuit-specific vulnerability may explain the selective substantia nigra pars compacta (SNc) neurodegeneration in PD
- presynaptic αSyn pathology drives postsynaptic plasticity impairments and circuit imbalances which progressively spread through interconnected pathways, providing an explanation for the varied symptoms in PD
- the recent paradigm shift that synaptic vesicle dysfunction is not just an early event in the disease but a central, targetable mechanism that drives neurodegeneration
A lot more work is needed to harness the therapeutic window for early intervention that the early appearance of synaptic deficits creates. Other fields learn us that it is possible to restore presynaptic function to a certain degree, like this spectacular video from Maria Stamelou's group demonstrates: https://link.springer.com/article/10.1007/s10072-025-08675-w . This SCA27B patient showed a dramatic symptomatic improvement on the potassium channel blocker 4-aminopyridine that restores neurotransmitter release and cerebellar Purkinje cell firing. Those were hampered by FGF14 mutations that negatively influence voltage-gated sodium channels and the synaptic vesicle cycle.
If you want to know more about the wondrous world of the tightly regulated synaptic vesicle cycle, you can read the full text here: https://journals.sagepub.com/doi/full/10.1177/1877718X261431203
by Julita Chlebowicz, Violetta Ivanova & Jacqueline Burré
Highlight written by Bruno Bergmans
Bastiaan Bloem