The therapeutic management of
Parkinson's disease (PD) is challenging and has not been fully resolved. The main challenges include motor fluctuations and
levodopa-induced
dyskinesia. Moreover, no disease-modifying or neuroprotective
therapy is currently available. Areas covered: This review focuses on α-
synuclein aggregation inhibitors and their therapeutic role in PD, with special attention to
heat shock proteins, immunotherapy (active and passive), the potential of targeting the Ser129 phosphorylation site, and the
antibiotic possibilities. Expert opinion: The induction of chaperones may provide beneficial strategy to target
synucleinopathies, but further investigations are needed to find the best options. The promising preclinical results with
immunotherapy suggest that it may be a valuable disease-modifying
therapy in PD in the future. Clinical trials are currently in the initial phases, and future studies need to confirm the beneficial
therapeutic effect in humans and clarify open questions as regards the exact mode of action and potential safety concerns. In case of covalent modifications, phosphorylation of α-
synuclein is of outstanding importance; however, conflicting results and open questions exist which necessitate clarification. In vitro results suggest that several
antibiotics may also influence α-
synuclein aggregation, but these results are to be confirmed in the future.