Objective: To explore the potential effects of chronic Apomorphine infusion treatment on reducing brain Amyloid-b (Aβ) deposition in Parkinson’s disease (PD).

Background: A majority of PD patients develop significant cognitive decline and Aβ plaque deposits have been implicated as a contributor [1]. Transgenic Alzheimer disease mice treated with Apomorphine show a decrease of intraneuronal Aβ and an improvement of memory function [2]. In cognitively normal PD patients, a neuropathological study has shown that ante-mortem Apomorphine exposure significantly reduces Aβ deposition in the brain [3].

Method: Preliminary descriptive cross-sectional analysis of PD patients on chronic subcutaneous Apomorphine infusion treatment compared to patients not on this treatment, who underwent [18F] florbetaben PET/CT scan, as surrogate marker for brain amyloid deposition, as part of the APOMYL study at King’s College Hospital (London UK; NHS IRAS No: 214953). Clinical data was collected from medical records and Non-motor Longitudinal International Study (NILS; UKCRN No: 10084). Data is presented as median [range].

Results: 11 PD patients on Apomorphine treatment (age 70 [52-80] years, disease duration 14 [4-23] years, LEDD 1168 [750-1810] mg) and five PD patients not on Apomorphine (age 75 [49-77] years, disease duration 9 [1-14], LEDD 1128 [700-2864] mg) had undergone amyloid PET/CT scans. The patients on continuous Apomorphine infusion had been on this treatment for 51 [10-180] months. There were no group differences in baseline demographics, LEDD, MMSE scores (median 28/30 vs 29/30), motor scores, or non-motor scores (p≥0.19). The distribution of amyloid burden showed a trend towards significant change between patient on Apomorphine (72% no, 18% low, 9% moderate, and 0% high amyloid burden) and those without (20% no, 40% low, 0% moderate, and 40% high amyloid burden; p=0.09 Chi-Square test).

Conclusion: Although open label, this study provides the world-first real-life evidence that Apomorphine infusion may be protective against cerebral Ab accumulation in PD.

References: 1. Aarsland D, Creese B, Politis M, Chaudhuri KR, Ffytche DH, Weintraub D, Ballard C. Cognitive decline in Parkinson disease. Nat Rev Neurol. 2017;13(4):217-231. 2. Himeno E, Ohyagi Y, Ma L, Nakamura N, Miyoshi K, Sakae N, Motomura K, Soejima N, Yamasaki R, Hashimoto T, Tabira T, LaFerla FM, Kira J. Apomorphine treatment in Alzheimer mice promoting amyloid-β degradation. Ann Neurol. 2011;69(2):248-56. 3. Yarnall AJ, Lashley T, Ling H, Lees AJ, Coleman SY, O’Sullivan SS, Compta Y, Revesz T, Burn DJ. Apomorphine: A potential modifier of amyloid deposition in Parkinson’s disease? Mov Disord. 2016;31(5):668-75.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/apomorphine-infusion-and-amyloid-deposition-in-parkinsons-disease-apomyl-preliminary-clinical-and-amyloid-imaging-data/