Diseases stink!

Dr Karl: G’day, Dr Karl here.

In 2012, the neurobiologist, Tilo Kunath, gave a public talk on his research into Parkinson’s Disease. At the end of the talk, a woman in the audience stood up and asked a way-out-of-left-field question.

She said: ” … that’s all well and good that you’re doing this, but why aren’t you doing something about the fact that people with Parkinson’s smell?”

Wow. Was the woman in the audience being insulting and suggesting that people with Parkinson’s Disease had poor personal hygiene? Or was she referring to the fact that people with Parkinson’s disease can sometimes lose their sense of smell? Or was it something else?

Tilo Kunath talked this over with a colleague of his, Perdita Barran, who is a Professor of Mass Spectrometry at the University of Manchester.

They weren’t sure what to do. But on someone else’s advice they tracked down this woman.

She was Joy Milne, an ex-nurse. And she could diagnose people with Parkinson’s disease using just her sense of smell!

Parkinson’s disease is a progressive disease that affects the nervous system. It starts off affecting movement, but later progresses to affecting mental function.

It’s the second most common neuro-degenerative disease after Alzheimer’s disease. It damages the brain cells that produce dopamine, in a part of the brain called the Substantia Nigra.

Parkinson’s disease becomes more common as you get older — affecting just 1% of people aged 60, but 4% of 80-year-olds. There are a few treatments to relieve some of the symptoms, but we have nothing that can cure or reverse the disease. There is also no early diagnosis. The diagnosis is based on a pattern of symptoms.

And here’s the bad news – by the time you show the first symptoms of Parkinson’s disease, you have already lost half of your neurones that make dopamine.

Now back to Joy Milne.

Joy had always had a very superior sense of smell. She could detect odours that people around her could not. She had to avoid certain aisles in the supermarket because the smells were too overpowering. She is what’s known as a “super-smeller”. People with an exceptional sense of smell like Joy are also called “noses”, when they work in the food, perfume or drink industries.

Now way back in 1982, Joy noticed that her husband, Les, was giving off a new strange musky smell. Joy knew that the smell was real — but nothing that her husband did would get rid of it.

Twelve years later, in 1994, Les was officially diagnosed with Parkinson’s Disease, and soon he joined a support group for Parkinson’s sufferers. Joy immediately noticed that everybody with Parkinson’s Disease was emitting this same strange musky greasy smell.

It was another 18 years before she met up with the expert in Parkinson’s Disease who had given the public lecture, Tilo Kunath.

When they met, Tilo gave her a test. He gave her a dozen identical T-shirts to smell. Some had been worn by people with Parkinson’s disease, and some had not.

Joy got practically all of them right — except she “wrongly” diagnosed one person to have Parkinson’s Disease when they did not. But here’s the kicker — eight months later, that person was diagnosed with Parkinson’s.

At this stage, the specialist skills of Perdita Barran as an analytical chemist were called in. Together, the three of them wanted to find some kind of biological marker – some kind of chemical that Joy was picking up with her nose.

Joy said that the smell of Parkinson’s Disease was (for her) especially strong in the upper back of the sufferers. This was very interesting.

The upper back is fairly well covered with sebum, and people with Parkinson’s Disease often suffer with seborrhoeic dermatitis.

Sebum is a fat made by sebaceous glands. It protects our skin, lubricating and waterproofing it. And our sebum can adjust itself to suit the conditions.

When the weather is hot, the constitution of sebum changes, so it spreads out the drops of sweat into a thin sheet across your skin. A thin sheet of sweat can evaporate better to cool you down. And in colder weather, the sebum increases its fat content to repel rain.

Sebum is a mix of different fats — it’s about 41% triglycerides, about 26% wax esters, about 16% fatty acids, and the rest is mostly squalene and cholesterol.

But of course the composition of sebum varies a lot. It differs from person to person, and it’s also different in different parts of your body. It changes depending on the environment. And thanks to Joy, we now know that your sebum is different if you have Parkinson’s Disease.

The university team discovered that in the sebum of people with Parkinson’s, three particular chemicals existed at higher levels, while another one was there at a lower level.

So what happens next?

Well it seems very likely that with this discovery we will soon be able to diagnose Parkinson’s Disease much earlier than before.

And perhaps this diagnosis can be done by chemical sensing machines as well as humans. Maybe earlier diagnosis will even give us clues to more effective treatments.

Meanwhile Joy’s super-smelling talent isn’t a one hit wonder. It turns out she can smell other conditions as well. Like Alzheimer’s disease (faintly vanilla), some cancer (an earthy vegetable odour) and tuberculosis (an especially harsh smell).

We are not sure where this new discovery will head — but for now it’s a good idea to let Joy’s nose lead the way.

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