Objective: This study aims to evaluate the therapeutic effect of H.pylori eradication on clinical motor symptoms in PD and the association between gut microbiomes.

Background: Previous studies have shown that H.pylori eradication therapy may improve motor function in Parkinson’s disease. The human gut microbiome has been also proposed as a plausible biological link for the pathogenesis of PD. Still, there is an underrepresented implication between H.pylori eradication and alterations in gut microbiomes.

Method: This prospective, open-label, randomized, controlled trial was conducted in patients with Parkinson’s disease to compare gut microbiomes in those with negative and positive H. pylori infection. Successful eradication was defined as a negative stool H.pylori antigen. Gut microbiota was evaluated by 16S rDNA gene sequencing and subsequent bioinformatic analysis in both groups. MDS-UDPRS III-IV scores and H&Y stages were assessed at weeks 8, 16, and 36. The GI function was quantified by using GIDS-PD. The primary outcome was changes in ON medication MDS-UPDRS motor scores from baseline to week eight. The diversity of gut microbiota was also interpreted in each group.

Results: We compared fecal microbiome of 21 PD patients with H.pylori-positive and 20 PD patients with H.pylori-negative as control subjects before and after H.pylori eradication therapy. Following H.pylori eradication, there was a significant reduction in motor symptoms over two months. While GIDS-PD score dropped from 11.0 to 7.0 (p = 0.013), MDS-UPDRS-III score decreased from 26.0 to 21.2 (p = 0.001). Analysis of microbial diversity in fecal specimens revealed a significant difference, showing that Rombutsia was enriched in patients positive for H.pylori (p = 0.001). The H.pylori-negative group showed no significant change in motor symptoms at two-month follow-up [figure1]. Post-treatment fecal analysis indicated a reduction in Bifidobacterium levels and an increase in Akkermansia in H.pylori-positive group (p = 0.006). This difference in clusters is consistent with changes in severity of motor symptoms [figure2].

Conclusion: This study examines differences in gut microbiomes between H.pylori-negative and H.pylori-positive PD patients. Additionally, eradicating H.pylori in positive group has been shown to influence clinical motor symptoms in Parkinson’s disease.

Figure 1

Figure 2

References: 1. Hashim H, Azmin S, Razlan H, Yahya NW, Tan HJ, Manaf MRA, et al. Eradication of Helicobacter pylori Infection Improves Levodopa Action, Clinical Symptoms and Quality of Life in Patients with Parkinson’s Disease. PLOS ONE. 2014;9(11):e112330.
2. Tan AH, Lim SY, Mahadeva S, Loke MF, Tan JY, Ang BH, et al. Helicobacter pylori Eradication in Parkinson’s Disease: A Randomized Placebo-Controlled Trial. Mov Disord. 2020;35(12):2250-60.
3. Lolekha P, Sriphanom T, Vilaichone R-K. Helicobacter pylori eradication improves motor fluctuations in advanced Parkinson’s disease patients: A prospective cohort study (HP-PD trial). PLOS ONE. 2021;16(5):e0251042.
4. Toh TS, Chong CW, Lim S-Y, Bowman J, Cirstea M, Lin C-H, et al. Gut microbiome in Parkinson’s disease: New insights from meta-analysis. Parkinsonism & Related Disorders. 2022;94:1-9.
5. Wallen ZD, Appah M, Dean MN, Sesler CL, Factor SA, Molho E, et al. Characterizing dysbiosis of gut microbiome in PD: evidence for overabundance of opportunistic pathogens. npj Parkinson’s Disease. 2020;6(1):11.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clustered-difference-of-gut-microbiome-in-helicobacter-pylori-negative-and-positive-group-effect-on-clinical-motor-symptoms-in-pd-helicobacter-pylori-stool-microbiome-or-hp-sm-trial/