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Review ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.01087

Contributions of gut bacteria and diet to drug pharmacokinetics in the treatment of Parkinson’s disease

  • 1University of Groningen, Netherlands
  • 2Groningen Biomolecular Science and Biotechnology Institute (GBB), University of Groningen, Netherlands

Parkinson’s disease is the second-most common neurodegenerative disorder worldwide. Besides deciphering the mechanisms that underlie the etiology of the disease, it is important to elucidate the factors that influence the efficacy of the treatment therapeutics. Levodopa, which remains the golden treatment of the disease, is absorbed in the proximal small intestine. A reduction in levodopa absorption, leads to reduction in striatal dopamine levels and, in turn, an “off”-episode. In fact, motor fluctuations represent a major problem during the progression of the disease and alteration between “on” (mobility, dyskinesia) and “off” (immobility, akinesia) episodes contribute to a decreased quality of life. Dietary amino acids can interfere with the absorption of levodopa from the gut lumen and its transport through the blood brain barrier. In addition, higher abundance of specific gut bacteria that restrict levodopa absorption plays a significant role in motor fluctuations in a subset of Parkinson’s disease patients. Here, we review the impact of factors potentially interfering with levodopa absorption, focusing on levodopa transport, diet, and gut bacterial interference with the bioavailability of levodopa.

Keywords: Levodopa, transporters, bioavailability, Small intestinal bacterial overgrowth (SIBO), Gut motility disorders

Received: 16 Apr 2019; Accepted: 27 Sep 2019.

Copyright: © 2019 Van Kessel and El Aidy. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Sahar El Aidy, University of Groningen, Groningen, Netherlands,