NF-κB/NLRP3 inflammasome axis and risk of Parkinson's disease in Type 2 diabetes mellitus: A narrative review and new perspective

Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's disease (AD). Genetic predisposition and immune dysfunction are involved in the pathogenesis of PD. Notably, peripheral inflammatory disorders and neuroinflammation are associated with PD neuropathology. Type 2 diabetes mellitus (T2DM) is associated with inflammatory disorders due to hyperglycaemia-induced oxidative stress and the release of pro-inflammatory cytokines. Particularly, insulin resistance (IR) in T2DM promotes the degeneration of dopaminergic neurons in the substantia nigra (SN). Thus, T2DM-induced inflammatory disorders predispose to the development and progression of PD, and their targeting may reduce PD risk in T2DM. Therefore, this narrative review aims to find the potential link between T2DM and PD by investigating the role of inflammatory signalling pathways, mainly the nuclear factor kappa B (NF-?B) and the nod-like receptor pyrin 3 (NLRP3) inflammasome. NF-kappa B is implicated in the pathogenesis of T2DM, and activation of NF-kappa B with induction of neuronal apoptosis was also confirmed in PD patients. Systemic activation of NLRP3 inflammasome promotes the accumulation of a-synuclein and degeneration of dopaminergic neurons in the SN. Increasing a-synuclein in PD patients enhances NLRP3 inflammasome activation and the release of interleukin (IL)-1 beta followed by the development of systemic inflammation and neuroinflammation. In conclusion, activation of the NF-kappa B/NLRP3 inflammasome axis in T2DM patients could be the causal pathway in the development of PD. The inflammatory mechanisms triggered by activated NLRP3 inflammasome lead to pancreatic beta-cell dysfunction and the development of T2DM. Therefore, attenuation of inflammatory changes by inhibiting the NF-kappa B/NLRP3 inflammasome axis in the early T2DM may reduce future PD risk.