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High levels of urate in serum or cerebrospinal fluid are associated with slower rate of decline in Parkinson's disease, according to a new study. The authors evaluated urate from samples collected in the DATATOP study. Patients were grouped into quintiles based on baseline urate concentration. Among all patients, those in the highest quintile (>6.2 mg/dL serum urate) were less likely to progress to require levodopa therapy (the primary endpoint of DATATOP) compared to those in the lowest quintile (<3.9 mg/dL) (p=0.02). The trend for slower progression with higher urate across the 5 groups was also significant. When stratified by vitamin E treatment (one of the treatment arms in the study), the trend remained significant only for those patients not receiving vitamin E. Selegiline treatment did not affect the trend. As with serum urate, higher CSF urate also correlated with slower progression, but only in patients not receiving vitamin E. "Taken together, these data establish urate as the first molecular predictor of clinical progression in PD," the authors conclude, "and provide a rationale for investigating the possibility that a therapeutic increase of urate in patients with PD might act favorably to slow the disease course." They also note their data raise the possibility that an interaction between urate and vitamin E "may have obscured a protective effect [of vitamin E] among those subjects with low baseline concentrations of urate in the DATATOP trial," and suggest it may be worth investigating whether vitamin E is useful in those with low urate. Urate as a clinical predictor of the rate of clinical decline in Parkinson disease A Ascherio, P LeWitt, K Xu, S Eberly, A Watts, WR Mason, C Marras, K Kieburtz, A Rudolph, MB Bogdanov, SR Schwid, M Tennis, CM Tanner, MF Beal, AE Lang, D Oakes, S Fahn, I Shoulson, MA Schwarzschild, PSG Datatop Investigators Arch Neurol, 2009;66:published online 12 October 2009 Doi:10.1001/archneurol.2009.247 ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn