Fig. 1: IF and aSyn-SAA findings.

A Phosphorylated α-synuclein (p-syn) deposits in autonomic skin nerves in a patient with iRBD. Confocal microscope (400X) study of p-syn aggregates in skin nerves of a iRBD patient. Pathological p-syn deposits were found in autonomic nerves of a sweat gland. These fibers are identified by PGP 9.5 (in green) whereas p-syn aggregates were depicted by staining the phosphorylation at Ser 129 (in red). This merged image showed that abnormal p-syn deposits correspond to PGP 9.5 staining as neuritic inclusions (arrows). B Pathological aSyn-SAA spectra of CSF from patients with RBD. The pathological α-syn seeding activity of CSF from representative iRBD patients and RBD-NT1 patients or controls was detected by RT-QuIC assay. The positive (iRBD) and negative (RBD-NT1 patients) results are defined by the threshold (red dashed line) that is determined based on the average plus 4 standard deviations of non-iRBD controls. The ThT fluorescence response started to increase at approximately 20 h in samples from the iRBD patient, but not from the RBD-NT1 patients or controls. C Skin pathological α-syn seeding activity tested by aSyn-SAA. Skin αSynP fluorescence enhancement kinetics at each time point (0–55 h) from representative iRBD and control patients. The ThT fluorescence response was similar to that found for CSF and started to increase at approximately 15–20 h in samples from the iRBD patients.