β-Glucocerebrosidase activity in <i>GBA</i>-linked Parkinson disease: The type of mutation matters.

Abstract

To test the relationship between clinically relevant types of <i>GBA</i> mutations (none, risk variants, mild mutations, severe mutations) and β-glucocerebrosidase activity in patients with Parkinson disease (PD) in cross-sectional and longitudinal case-control studies. A total of 481 participants from the Harvard Biomarkers Study (HBS) and the NIH Parkinson's Disease Biomarkers Program (PDBP) were analyzed, including 47 patients with PD carrying <i>GBA</i> variants (<i>GBA</i>-PD), 247 without a <i>GBA</i> variant (idiopathic PD), and 187 healthy controls. Longitudinal analysis comprised 195 participants with 548 longitudinal measurements over a median follow-up period of 2.0 years (interquartile range, 1-2 years). β-Glucocerebrosidase activity was low in blood of patients with <i>GBA</i>-PD compared to healthy controls and patients with idiopathic PD, respectively, in HBS (<i>p</i> < 0.001) and PDBP (<i>p</i> < 0.05) in multivariate analyses adjusting for age, sex, blood storage time, and batch. Enzyme activity in patients with idiopathic PD was unchanged. Innovative enzymatic quantitative trait locus (xQTL) analysis revealed a negative linear association between residual β-glucocerebrosidase activity and mutation type with <i>p</i> < 0.0001. For each increment in the severity of mutation type, a reduction of mean β-glucocerebrosidase activity by 0.85 μmol/L/h (95% confidence interval, -1.17, -0.54) was predicted. In a first longitudinal analysis, increasing mutation severity types were prospectively associated with steeper declines in β-glucocerebrosidase activity during a median 2 years of follow-up (<i>p</i> = 0.02). Residual activity of the β-glucocerebrosidase enzyme measured in blood inversely correlates with clinical severity types of <i>GBA</i> mutations in PD. β-Glucocerebrosidase activity is a quantitative endophenotype that can be monitored noninvasively and targeted therapeutically.