What is it about?

This paper reports on a group of welders and welders helpers with a younger than expected age onset of parkinsonism. This paper builds upon my early work which found a younger age at onset of sporadic Parkinson's disease among subjects exposed to metals and and pesticides. This paper proposes the hypothesis that exosomal α-synuclein in serum of manganese exposed welders may be useful as a biomarker in investigations looking at the role of manganese exposure in age at onset of Parkinson's disease among welders and in differentiating Parkinson disease from Parkinsonism. This suggestion is based on the observation of Harischandra and colleagues (2019) who observed that exosomes isolated from serum of welders has higher misfolded α-synuclein protein content than that of healthy controls.

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Why is it important?

This paper is important because it is the first to propose using exosomal α-synuclein in serum as a biomarker to investigate age at onset of parkinsonism among welders exposed to manganese. The differential diagnosis of Parkinson's disease in welders is confounded by the fact that manganese causes parkinsonism. Parkinson's disease and welding have both been associated with an increase in exosomal α-synuclein in serum. Thus increased levels of exosomal α-synuclein in serum may therefore prove to be related to age at onset of Parkinson's disease in welders and may also permit more effective differentiation of Parkinson's disease from parkinsonism.


This paper builds on my earlier work looking at age at onset of sporadic Parkinson's disease which has since been replicated by other investigators (see Gamache et al., 2019). I am pleased to author this timely paper in which my coauthor and I propose an important new direction aimed at further elucidating the role of neurotoxicant exposures as a disease modifying factors in the age at onset of Parkinson's disease.

Dr. Marcia H. Ratner
Boston University Chobanian & Avedisian School of Medicine

Read the Original

This page is a summary of: Should Age at Onset of Parkinsonism be the End Point of Interest in Investigations of the Link Between Exosomal α-Synuclein and Manganese Exposure in Welders?, Journal of Occupational and Environmental Medicine, September 2019, Wolters Kluwer Health,
DOI: 10.1097/jom.0000000000001720.
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