The gut-brain axis in Parkinson’s disease: A macrophage perspective
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Parkinson’s disease (PD) is defined by the progressive accumulation of misfolded α-synuclein (αSyn) across the gut–brain axis, yet the cellular systems that normally contain this burden are only beginning to be understood. Among them, tissue-resident macrophages ...
MoreParkinson’s disease (PD) is defined by the progressive accumulation of misfolded α-synuclein (αSyn) across the gut–brain axis, yet the cellular systems that normally contain this burden are only beginning to be understood. Among them, tissue-resident macrophages (RTM) occupy strategically positioned niches and functionally interact with their microenvironment. In this Perspective, we examine how muscularis externa macrophages in the enteric nervous system, parenchymal microglia, and border-associated macrophages in the central nervous system respond to αSyn and shape disease progression. We argue that these RTM serve as early sentinels of synucleinopathy by taking up extracellular αSyn and attempting to degrade it through lysosomal pathways. However, with ageing and in the context of genetic or environmental stress, this protective function may break down. As degradative capacity declines, RTM may enter dysfunctional states marked by cellular stress, incomplete processing of αSyn, propagation of pathogenic species, and enhanced antigen presentation. In this way, RTM may influence not only the local handling of αSyn, but also the emergence of adaptive immune responses and neuroinflammation across the enteric nervous system (ENS)–central nervous system (CNS) axis. We further discuss how anatomical niche, ontogeny, and αSyn conformational diversity may shape these responses, and how restoring macrophage proteostatic function could offer therapeutic opportunities to limit disease progression.
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Viktoras Konstantellos, ... Sebastiaan De Schepper
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DOI: https://doi.org/10.70401/mc.2026.0008 - July 06, 2026