Fig. 1

Both genetic and environmental factors influence MSA risk. Genetic factors, whose expression is influenced by epigenetics and ethnicity, include genes associated with monogenic forms of PD, genes related to oxidative stress, genes with repeat expansions, genes related to inflammation, other genes related to PD and genes identified through MSA GWAS. The pathophysiology is further complicated by complex gene–gene and gene-environment interactions that have yet to be fully elucidated. GWAS genome-wide association study, MSA Multiple System Atrophy, PD Parkinson’s Disease