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. 2023 May 2;14:2501. doi: 10.1038/s41467-023-38248-4

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© The Author(s) 2023

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — We recruited subjects according to the proposed staging model of α-synucleinopathy, which aptly represented the pathological staging of Parkinson’s disease (i.e., Braak staging). Four different clinical stages were controls (Braak stage 0–1), RBD-FDR (stage 0–2), patients with RBD (stage 2–3) and early PD (stage 3–4). Early PD refers to patients who had clinically confirmed PD with motor symptoms onset less than 5 years. Control subjects with probable RBD as diagnosed by using structured clinical interview were excluded. Besides, subjects with neurodegenerative diseases (except early PD group) and severe gastrointestinal diseases were excluded from this study. In the end, a total of 452 subjects successfully collected stool samples, while 11 of them were removed for subsequent analysis due to the low quality of sequencing data (i.e., total read count <1000). RBD REM sleep behavior disorder, RBD-FDR first-degree relatives of patients with RBD, PD Parkinson’s disease.