Acupuncture for Parkinson's disease: targeting programmed cell death mechanisms and therapeutic prospects

As the population ages, Parkinson's disease (PD) has become a prevalent neurodegenerative disorder, posing a significant threat to the health and quality of life of the elderly. The core pathological features include progressive loss of dopaminergic neurons in the substantia nigra pars compacta and the formation of Lewy bodies, which result from aberrant aggregation of α-synuclein (α-syn). The pathogenesis of PD involves multi-level, cross-system cellular mechanisms. Recent evidence reveals that classical forms of programmed cell death (PCD)-including autophagy, apoptosis, pyroptosis, necroptosis, and ferroptosis-interact through key nodes such as neuroinflammation, mitochondrial dysfunction, and oxidative stress. This interplay drives dopaminergic neuron death and α-syn aggregation, thereby accelerating PD progression. Acupuncture has emerged as a prominent non-pharmacological therapeutic strategy for PD, showing beneficial effects by targeting multiple PCD pathways. This review systematically delineates the roles of autophagy, apoptosis, pyroptosis, necroptosis, and ferroptosis in PD pathogenesis. Furthermore, it identifies key molecular mediators and physiological outcomes through which acupuncture ameliorates PD by regulating PCD-related signaling, thereby providing a mechanistic rationale for the development of targeted interventions.