Cardiovascular autonomic failure correlates with cutaneous autonomic denervation in PD and MSA

Figures

• 

  Fig. 1. Supine noradrenaline levels in patients with MSA and PD, with and without OH. Supine noradrenaline levels were significantly lower in the PD + OH group compared with the MSA group (P = 0.04), with intermediate results in the PD without OH group. All patients with MSA who had plasma noradrenaline measured had OH

• 

  Fig. 2. Comparison of pilomotor adrenergic innervation between patients with and without orthostatic hypotension and controls. Pilomotor adrenergic innervation was lowest in the OH group (10.6 [0.4–21.4] fibres/mm), followed by the non-OH group (36.1 [28.4–45.7] fibres/mm) and the control group (52 [49.5–55] fibres/mm), with a significant difference between the OH and control groups (P ≤ 0.001)

• 

  Fig. 3. Severity of OH correlated with cutaneous adrenergic denervation, patient reported symptoms and disease severity. Severity of OH, as measured by the fall in systolic blood pressure on standing, correlated with pilomotor nerve fibre density with the adrenergic marker DβH (A). OH severity also correlated with patient reported autonomic symptoms on the COMPASS-31 questionnaire (B) and disease status as measured by the Hoehn–Yahr scale (C)

• 

  Fig. 4. Cardiac MIBG and cutaneous innervation in a patient with MSA (case 1). MIBG study performed as part of clinical work-up. Images acquired 10 min (A) and 4 h (A1) post-injection showed good tracer uptake in the myocardium with a heart to mediastinum ratio of 1.73, indicating preserved postganglionic innervation. However, punch skin biopsies from the distal legs bilaterally revealed severe cutaneous denervation with marked loss of intraepidermal (0.1–1.1 fibres/mm), pilomotor (15.2–32.0 fibres/mm) and sudomotor fibres (0.4 nm/µm3) with the pan-neuronal marker PGP (B–D, control; B1–D1, patient), and a complete loss of pilomotor and sudomotor fibres with the cholinergic marker VIP (data not shown). Scale bar: 100 µm