Retrospective analysis of 1,315 PPMI participants found a nonlinear association between serum AST/ALT ratio and familial versus sporadic PD—strong above a threshold of 1.503—with a predictive model AUC of 0.758.
AST/ALT is an inexpensive, routinely available serum marker that could aid PD subtyping and trial stratification, offering translational potential despite limited mechanistic insight and the need for prospective validation.