|Coenzyme Q and Creatine Supplements and Parkinson's Disease
| Parkinson's disease is caused by the degeneration of dopaminergic neurons of substantia nigra projecting to
striatum. Persons with Parkinson disease (PD) exhibit decreased muscular fitness including decreased muscle
mass, muscle strength, bioenergetic capabilities and increased fatigability. 
The causes for Parkinson's disease or neural-degeneration are probably related to mitochondrial malfunction,
elevated oxidative stress, apoptosis, excitotoxicity, and inflammation. [1,3] Levodopa is a popular treatment for
Parkinson's disease, but this treatment is effective for only a few years.  Other treatments newly developed
or under development include methyl- and ethyl-esterified forms of L-dopa (etilevodopa and melevodopa), Glial
cell line-derived Nuerotrophic Factor (GDNF), inhibitors of enzymes such as monoamine oxidase type-B
(monoamine oxidase inhibition, eg, rasagiline, safinamide), catechol-O-methyl transferase (eg, BIA-3202), the
monoamine re-uptake mechanism (eg, brasofensine), full or partial dopamine agonists (eg, rotigotine ,
sumanirole, piribedil and BP-897). [1-3]
Non-dopaminergic treatments include alpha2 adrenergic receptor antagonists (eg, fipamezole), adenosine A2A
receptor antagonists (eg, istradefylline), AMPA receptor antagonists (eg, talampanel), neuronal
synchronization modulators (eg, levetiracetam) and agents that interact with serotonergic systems such as
5-hydroxytryptamine (5-HT)1A agonists (eg, sarizotan) and 5-HT2A antagonists (eg, quetiapine). [1-3]
Neuroprotective agents include anti-apoptotic kinase inhibitors (eg, CEP-1347), modulators of mitochondrial
function (eg, coenzyme Q10, creatine), growth factors (eg, leteprinim), neuroimmunophilins (eg, V-10367),
estrogens (eg, MITO-4509), c-synuclein oligomerization inhibitors (eg, PAN-408), anti-inflammatory agent and
sonic hedgehog ligands. [1-3]
Does gene therapy benefit patients suffered from Parkinson's Disease?
Three genes that produce dopamine were inserted into a disabled equine virus that was then injected into the
brain. Six human volunteers began clinical trials a year ago, and the results are "extremely encouraging," as
measured in control of Parkinson's symptoms and in side effects such as brain inflammation. In a study of
acaque monkeys, ProSavin, the gene therapy restored the monkeys' levels of dopamine, corrected motor
problems and prevented dyskinesias, as jerkiness, rigidity and tremor.
Does Coenzyme Q(10) benefit Patients with Parkinson's Disease?
Coenzyme Q(10) is a key component of the mitochondrial electron transport chain (ETC). It serves as the
electron acceptor for complexes I and II in the electron transport chain; it is also an antioxidant. In Parkinson's
disease, researchers found deficiency of complex I activity and increased numbers of activated microglia in
both Parkinson's disease postmortem tissue. Researchers also found decreased levels of coenzyme Q(10) in
blood and platelet mitochondria from Parkinson's disease patients. Thus, impaired mitochondrial function and
activated microglia may both contribute to oxidative damage in Parkinson's disease. In a phase II study,
coenzyme Q(10) appeared to slow the progression of Parkinson's disease. 
Can non-steroidal anti-inflammatory drugs (NSAIDs) benefits patients with Parkinson's disease?
Researchers found activated microglia and increased levels of inflammatory mediators in the striatum of
deceased Parkinson's disease patients. Perhaps not surprisingly, some studies have shown that non-steroidal
anti-inflammatory drugs (NSAIDs) reduced the risk of developing Parkinson's disease. 
Does creatine benefit people suffered from Parkinson's disease?
Mitochondrial dysfunction plays a major role in the pathogenesis of Parkinson disease (PD). Creatine (Cr) is an
ergogenic compound that exerts neuroprotective effects in animal studies. Researchers from University of
Munich, Germany conducted a 2-year placebo-controlled randomized clinical trial on the effect of Cr in 60
patients with Parkinson disease. Creatine improved patient mood and led to a smaller dose increase of
dopaminergic therapy but had no effect on overall Unified Parkinson's Disease Rating Scale scores or
dopamine transporter SPECT. 
Researchers from Columbia University found that creatine supplementation can enhance the benefits of
resistance training, such as Chair rise performance, in patients with Parkinson disease.  Creatine is
well-tolerated in most studies. However, intake of creatine does have side effects. The common side effects of
creatine are upper respiratory symptoms, joint pain, and nausea. 
Special Notes on GDNF
Glial cell lined-derived neurotrophic factor (GDNF) is a promising treatment for Parkinson's disease, but it is at
early stage and it may have serious side effects if the delivery system / route is not right. Please read: GDNF.
More about Parkinson's Disease
Parkinson's Disease - Supplements
Parkinson's Disease - Herbs
Parkinson's Disease - Side Effects of Drugs
Parkinson's Disease - Symptoms
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Parkinson's disease. Curr Opin Investig Drugs. 2004 Jul;5(7):720-6.  Bonuccelli U, Del Dotto P. New
pharmacologic horizons in the treatment of Parkinson disease. Neurology. 2006 Oct 10;67(7 Suppl 2):S30-8.
 Beal MF. Mitochondria, oxidative damage, and inflammation in Parkinson's disease. Ann N Y Acad Sci. 2003
Jun;991:120-31.  Shults CW. Therapeutic role of coenzyme Q(10) in Parkinson's disease. Pharmacol Ther.
2005 Jul;107(1):120-30. Epub 2005 Apr 21.  Hald A, Lotharius J. Oxidative stress and inflammation in
Parkinson's disease: is there a causal link? Exp Neurol. 2005 Jun;193(2):279-90.  Bender A, et al, Creatine
supplementation in Parkinson disease: a placebo-controlled randomized pilot trial. Neurology. 2006 Oct
10;67(7):1262-4.  Hass CJ, et al, Resistance training with creatine monohydrate improves upper-body
strength in patients with Parkinson disease: a randomized trial. Neurorehabil Neural Repair. 2007
Mar-Apr;21(2):107-15.  NINDS NET-PD Investigators. A randomized, double-blind, futility clinical trial of
creatine and minocycline in early Parkinson disease. Neurology. 2006 Mar 14;66(5):664-71. Epub 2006 Feb
15.  Gene therapy for Parkinson's "encouraging" in early trials AFP Wed Oct 14, 11:07 AM PDT
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