Sniffing out Parkinson’s
闻出帕金森
Chemicals that give sufferers a unique smell have been identified
给予帕金森患者某种独特气味的化学物质已经可以被检测出来
Hippocrates, galen, Avicenna and other ancient physicians frequently used odour as a diagnostic tool. Although scent is not used nearly as often in modern medicine, it still has its place. Paramedics are routinely taught to spot the fruity smell on the breath of diabetics who have become hyperglycemic and gastroenterologists are trained to detect the odour of digested blood. But there has been scant evidence of a smell associated with neurodegenerative disorders. Now one has been found for Parkinson’s disease.
不论是希波克拉底，盖伦，阿维森纳，还是许多其他古代的医生都常常使用气味作为诊断工具。尽管闻诊在现代医学中很少使用，但我们不能否定其价值。医辅人员的一大常规操作就是判断糖尿病人的呼吸是否有水果味，以确定其血糖水平是否过高，肠胃病医生也需要训练自己判断消化出血发出的特殊气味。但是，很少有证据表明气味和神经退行性病变有关。如今，这一联系在帕金森病中发现了。
Frequently causing tremors, rigidity and dementia, Parkinson’s is both debilitating and substantially shortens life expectancy. The rate at which these symptoms appear and worsen cannot be stopped or slowed yet but its most harmful effects can be staved offwith drugs. As with many diseases, the earlier the intervention, the better. Yet herein lies one of the greatest challenges—there are no tests that diagnose whether Parkinson’s is actually present. The best that neurologists can do is study the symptoms and theorise about whether someone actually has the disease. Hence the search is on for a better form of diagnosis. Unexpectedly, scientists are now literally following someone’s nose.
频繁抽搐，体直僵硬，甚至痴呆，这些帕金森病带来的后遗症不仅使患者的身体越来越虚弱，它们还能够实质性地缩短一个人的寿命。这些症状出现的频率以及恶化的程度都是无法暂停或减缓的，至少目前医生们还束手无策，但是应用一些药物治疗至少可以暂时缓解这些伤害。
Joy Milne, a retired nurse from Perth, Scotland has an extraordinary sense of smell. Known as hyperosmia, Mrs Milne’s condition allows her to detect odours that are imperceptible to most people. In 1974 Mrs Milne noticed an odd musky smell around her house that had not been present before. In 1986, her husband, Les Milne, was diagnosed with Parkinson’s. He lived with the disease for a number of years and while the symptoms were initially manageable with medication, this became harder over time. Eventually, he was forced to retire and, while attending Parkinson’s support groups, Mrs Milne noted something extraordinary. Everyone with the disease had the same distinctive odour that her husband had developed in 1974. It was shortly after that realisation that she started collaborating with researchers.
乔·玛琳，是苏格兰珀斯一位退休护士，她拥有一种异乎常人的嗅觉。在医学上她这种症状被称为嗅觉过敏，玛琳女士的这种能力让她能够察觉到一些普通人感知不到的气味。在1974年，玛琳女士在他家附近注意到了一种奇特的麝香气味，这种气味以前她从来没闻到过。在1986年，他的丈夫，莱斯·玛琳被诊断为帕金森病。他患病很多年了，在初期，他还可以通过药物控制一些症状，但随着时间的推移，药物的作用越来越弱。最终，他不得不退休，在参加帕金森病互助会的时候，他的妻子发现了一件不同寻常的事情。每个患有该疾病的患者都发出这种独特的气味，就是1974年她第一次在她丈夫身上发现的那种。很快，意识到这一点的玛琳女士开始和一些研究者展开了相关合作。
Musky odour
麝香气味
By providing Mrs Milne with shirts worn by Parkinson’s patients, researchers found she was able to identify that the smell was concentrated along the upper back, and not in armpits as previously assumed. Most remarkably, of the control subjects without the disease, Mrs Milne found one to have the musky odour. Nine months later that person was diagnosed with the disease.
研究者向玛琳女士提供了几件帕金森患者穿过的衬衫，发现她能够辨识出这种味道最集中的区域是上背部，而不是研究者之前以为的腋窝部。最令人称奇的是，玛琳女士发现一位控制组的受试者（非患者）也有这种气味，九个月后这个人就被诊断为了帕金森病。
All this led Perdita Barran of the University of Manchester, in Britain, to set out to discover what was producing the telltale odour that Mrs Milne could detect. Previous work found that patients with Parkinson’s had a tendency to overproduce a waxy compound on the skin of their upper backs. Known as sebum, Dr Barran speculated that something trapped within this compound was producing the odour. Keen to find out, Dr Barran and her colleagues set up an experiment.
这些发现促使曼彻斯特大学的博迪塔·巴伦博士开始探索到底是什么物质产生了这种指示性气味，使得玛琳女士可以据此判断帕金森病。以前的研究表明，帕金森病患者会频繁并过量分泌一种蜡状复合物，分泌部位常常位于上背部的皮肤表面。这种物质被称为皮脂，巴伦博士推测这类复合物中所含的物质可能会产生这种气味。想要探究其中原因，巴伦博士和她的同事展开了一项实验。
The team analysed sebum samples from 43 people suffering from Parkinson’s and 21 who were not. The sebum samples were collected on gauze and warmed to release any volatile compounds that might be found within them. Mass spectrometry and gas chromatography were then used to identify whether there were volatiles present and what they were. For a subset of the patient samples, Mrs Milne smelled the compounds before they entered the mass spectrometer and pressed a button when the distinctive odour was present.
这个研究团队采集并分析了43份患者和21份非患者的皮脂样本。这些样本被置于纱布表面，在加热后，其中蕴含的一些挥发性物质会释放出来。通过质谱分析和气相色谱分析，研究人员便能够辨识出这些挥发物质是否存在，以及其中具体的化学成分。在一组病人的样本通过质谱分析之前，玛琳女士就闻到了这种物质的存在，她随即按下了按钮，表示她识别出了这种特殊的气味。
As Dr Barran reports in acs Central Science, the mass spectrometer identified four compounds, perillic aldehyde, hippuric acid, eicosane and octadecanal, in the vaporised sebum of the Parkinson’s disease patients that were at entirely different levels to those in the healthy group. To test whether these different levels of compounds were generating the smell that Mrs Milne was detecting, Dr Barran presented them to her and confirmed that they were, indeed, responsible for the musky odour.
巴伦博士在《ASC中心科学》所发表的研究报告指出，质谱分析仪检测出了四种化合物，分别是紫苏醛、马尿酸、二十烷和十八烷，这些物质通过气化帕金森患者的皮脂所得，同时这些物质的浓度水平在帕金森患者体内和健康人群体内是完全不同的。为了测试这些化合物在不同浓度水平时是否会产生气味，即那种能被玛琳女士识别出的气味，巴伦博士将这些物质呈给放在她面前。研究者最终得出结论，它们确实能够产生那种麝香气味。
While relatively small in size, Dr Barran’s experiment is the first to reveal the specific compounds that generate the unique smell of Parkinson’s. Assuming larger follow-up experiments replicate her findings, the work paves the way for the development of a device, a sort of electronic nose, that could sniff the upper backs of patients to quickly determine who has the disease and who does not. That would allow drugs to help mitigate the symptoms to be administered all the sooner.
尽管巴伦博士的实验规模并不大，但这次实验首次向人们揭示了到底是哪些化合物能够让金森病人散发出特殊气味。这项研究推测到，更大型的后续实验也会得到相同的结果，同时这一研究为后续电子嗅觉装置的研发提供了思路，这种装置能够从患者的上背部闻出其是否患有帕金森病。这样的话，尽早发现的患者就可以尽快使用药物治疗，以减轻其症状。
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