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When Canadian actor Michael J. Fox went public with his diagnosis of Parkinson's 20 years ago this week, the announcement changed not only
his life, but the lives of millions of patients living with the disease.
"He's been such an inspiration for people with Parkinson's," says Dr. Lorraine Kalia, a clinician-scientist at the Krembil Brain Institute. "Those who have read his books and take what he says to heart, I think are very much influenced by what his experience has been."
The influence of the popular star of the
Back to the Future movie franchise has also been substantial in the science community, with the founding of the Michael J. Fox Foundation for Parkinson's research in 2000.
The Foundation bills itself as the "world's largest non-profit funder of Parkinson's research," having raised more than $1 billion and funded more than 3,000 research projects internationally, including in Canada.
Its singular goal – to find a cure for Parkinson's.
Dr. Kalia herself has been the recipient of a Fox Foundation research grant for her work on an inherited form of Parkinson's.
"Clearly, the Foundation's advocacy has been tremendous," she says. "They bring together the brightest minds to come up with ideas, review grants, look hard at which research they should be funding.
"One of my projects looks at a type of Parkinson's disease due to a mutation in a gene called LRRK2. Recently, they brought together a group of researchers who are working on this type of Parkinson's to brainstorm together, which is quite unique in the grant funding arena."
Dr. Suneil Kalia, another Fox Foundation recipient for his work on a potential treatment target for Parkinson's, agrees.
"Organizations like the Michael J. Fox Foundation, as well as Parkinson's Canada, Canadian Institutes of Health Research and generous donors, have been crucial in terms of keeping Parkinson's research moving forward," he says. "To be able to do any kind of work that is trying to develop therapeutics to cure the disease requires funding.
"It allows us to take more risks, by using creative and novel approaches in the lab."
Chasing a cure for Parkinson's is a family affair for the Kalias, who first met in the anatomy lab as University of Toronto medical students, and have been married since 2001.
"There are usually two reactions," says Lorraine. "One is, 'That's crazy. I would never ever work with my spouse,' and then there's the other extreme. 'Oh that's so nice, I
wish I could work with my spouse!'"
They are both protein biochemists and molecular biologists by training, and the two do share lab space, but admit their clinical practices rarely overlap, as they bring very different skill sets to the table.
"I'm a neurologist and Suneil is a neurosurgeon, so we see the challenges of the disease from a different set of eyes," Lorraine says. "We also see different kinds of patients because of that.
"So I think that leads to asking different kinds of questions. I'm thinking, 'Can we find some molecules that could affect the neurodegeneration of Parkinson's?' Suneil also considers, 'Well, how can we get it into the brain? And I
know how to get things into the brain.'
"Both are important if we're really going to have a therapy for Parkinson's."
That is the "holy grail" in this equation – a disease modifying therapy that could slow or halt the progression of Parkinson's.
"Our synergy is in the lab, which we think is the most important part of our mission - to try and figure out how to slow the disease down, at a molecular level," Lorraine says.
There are approximately 100,000 Canadians currently living with Parkinson's, with 25 new cases every day. Patients can often be symptomatic for six to 10 years before they are diagnosed.
A lot learned over the past 20 years
"The window you have after you diagnose someone with Parkinson's to intervene or slow it down is already quite narrow, the loss of those dopamine neurons are already more than 50 per cent," says Suneil. "Thankfully, we have excellent symptomatic treatments such as dopamine replacement on the pharmacological side and Deep Brain Stimulation (DBS) on the surgical side, a technique in which electrodes are surgically placed in strategic areas in the patient's brain to improve brain circuit function, which works very well in well-selected patients."
A highly-trained, multi-disciplinary team at the Krembil Brain Institute does just under half of all of Canada's DBS cases for Parkinson's.
"There's not just a neurosurgeon, there's also a neurologist, a neuropsychologist, a neuropsychiatrist, nurse practitioners, and nurses," says Suneil. "There are a lot of people who have to get the patient through the journey from identifying whether they're a good candidate for the surgery to all of the work that's necessary afterwards, and it never stops because the disease keeps moving forward and the patient's needs may change.
"They might need different settings on their DBS device, changes to their medications, etc."
DBS can help many Parkinson's patients, but not all. No two Parkinson's cases are alike, which only makes helping those patients more challenging.
"Parkinson's is a neurodegenerative disease and currently none of these types of brain diseases have a cure. So it's a very complex problem," admits Suneil. "But scientists have learned far more about Parkinson's than they knew 20 years ago, particularly finding molecular pathways that might be relevant, which were discovered from cloning genes that cause inherited forms of the disease."
Such advancements have provided new clues for scientists, allowing them to consider new targets that may be amenable to treatment.
"We understand what underlies the neurodegeneration a lot more than we did 20 years ago," agrees Lorraine. "There are clinical trials now ongoing that are exciting in terms of their potential.
"We are hopeful that a disease modifying therapy that could potentially slow the progression of the disease is going to come to fruition in the next 10 years."
Until then, Dr. Kalia and Dr. Kalia will continue to push forward with the goal of putting themselves out of business.
"If we could stop the progression of the disease or halt it in its tracks, that would truly be life-changing for our patients," Lorraine says.