Microbiota Intervention to Change the Response of Parkinson's Disease
Microbiota Intervention to Change the Response of Parkinson's Disease
The clinical phenotype of Parkinson's disease (PD) is quite variable, as is the response to
 and side effects from medications. While many patients respond to carbidopa/levodopa early
 on, motor fluctuations and dyskinesias can become a problem as the condition progresses,
 causing significant impairment in function and quality of life. The gut microbiome is of
 increasing interest in PD, potentially contributing to pathophysiology and clinical
 phenotype. Furthermore, gut bacteria are capable of metabolizing levodopa, which may decrease
 its ability to reach the central nervous system and could explain the variable effect seen
 clinically. Altering the population of drug-metabolizing bacteria could improve the clinical
 symptoms of PD and the benefit seen with medications. The investigators hypothesize that the
 gut microbiome in people with PD correlates with their phenotypic characteristics, which can
 be improved with targeting the microbiome through dietary or therapeutic interventions. The
 investigators propose a two-part clinical trial. First, a cross-sectional analysis will
 correlate the microbiome profile with (a) the clinical phenotype of PD and (b) medication
 response. Second, a randomized, controlled trial, will evaluate the effect of microbiome
 manipulation on clinical phenotype and medication response. The investigators plan to reduce
 the level of bacteria through antibiotic use, resetting the potentially disadvantageous
 microbiome population. Outcomes will include changes in clinical symptoms, alterations in the
 the microbiome, and changes in serum markers of inflammation. This thorough characterization
 will broaden our understanding of the gut-brain axis significantly in PD in clinically
 relevant ways that have yet to be explored.
Inclusion Criteria:

 -  Parkinson's disease

 -  Stable on levodopa therapy with fluctuations

 Exclusion Criteria:

 -  Chronic gastrointestinal disease

 -  Recent antibiotic or probiotic therapy

 -  Pregnant

 -  Immunocompromised