A Comprehensive Assessment of Qualitative and Quantitative Prodromal Parkinsonian Features in Carriers of Gaucher Disease-Identifying Those at the Greatest Risk

Michal Becker-Cohen, Ari Zimran, Tama Dinur, Maayan Tiomkin, Claudia Cozma, Arndt Rolfs, David Arkadir, Elena Shulman, Orly Manor, Ora Paltiel, Gilad Yahalom, Daniela Berg, Shoshana Revel-Vilk, Michal Becker-Cohen, Ari Zimran, Tama Dinur, Maayan Tiomkin, Claudia Cozma, Arndt Rolfs, David Arkadir, Elena Shulman, Orly Manor, Ora Paltiel, Gilad Yahalom, Daniela Berg, Shoshana Revel-Vilk

Abstract

Carriers of GBA1 gene variants have a significant risk of developing Parkinson’s disease (PD). A cohort study of GBA carriers between 40−75 years of age was initiated to study the presence of prodromal PD features. Participants underwent non-invasive tests to assess different domains of PD. Ninety-eight unrelated GBA carriers were enrolled (43 males) at a median age (range) of 51 (40−74) years; 71 carried the N370S variant (c.1226A > G) and 25 had a positive family history of PD. The Montreal Cognitive Assessment (MoCA) was the most frequently abnormal (23.7%, 95% CI 15.7−33.4%), followed by the ultrasound hyperechogenicity (22%, 95% CI 14−32%), Unified Parkinson’s Disease Rating Scale part III (UPDRS-III) (17.2%, 95% CI 10.2−26.4%), smell assessment (12.4%, 95% CI 6.6−20.6%) and abnormalities in sleep questionnaires (11%, 95% CI 5.7−19.4%). Significant correlations were found between tests from different domains. To define the risk for PD, we assessed the bottom 10th percentile of each prodromal test, defining this level as “abnormal”. Then we calculated the percentage of “abnormal” tests for each subject; the median (range) was 4.55 (0−43.5%). Twenty-two subjects had more than 15% “abnormal” tests. The limitations of the study included ascertainment bias of individuals with GBA-related PD in relatives, some incomplete data due to technical issues, and a lack of well-characterized normal value ranges in some tests. We plan to enroll additional participants and conduct longitudinal follow-up assessments to build a model for identifying individuals at risk for PD and investigate interventions aiming to delay the onset or perhaps to prevent full-blown PD.

Keywords: Gaucher disease carriers; Parkinson’s disease; carriers of GBA1 variants; prodromal Parkinson disease.

Conflict of interest statement

The SZMC Gaucher Unit receives support from Sanofi/Genzyme for participation in the ICGG Registry, from Takeda for the GOS Registry, and Pfizer for TALIAS. The Unit also receives research grants from Takeda, Pfizer, Sanofi/Genzyme, and Centogene. M.B.-C., T.D., M.T., C.C., D.A., E.S., O.M. and O.P., have no conflict of interest to declare. C.C. is an employee of Centogene GmbH. A.R. is the founder and was the CEO of Centogene GmbH during the study. A.Z. receives honoraria from Takeda, Pfizer, and BioEvents and consultancy fees from Takeda, NLC Pharma, Insightec, and Prevail therapeutics. G.Y. received consultation fee from Abbvie, Medison, Truemed and Takeda. D.B. receives honoraria from AbbVie, Biogen, BIAL, UCB Pharma GmbH Zambon, Desitin, Novartis, consultancy fees from Biogen, BIAL, UCB Pharma GmbH, AC Immune SA., and research grants from Deutsche Forschungsgemeinschaft (DFG), German Parkinson’s Disease Association (dPV), BMBF, Parkinson Fonds Deutschland gGmbH, UCB Pharma GmbH, EU, Novartis Pharma GmbH, Lundbeck, Damp foundation, Michael J Fox Foundation., S.R.-V. receives grant/research support, honoraria, and advisory fee from Takeda, Pfizer, and Sanofi/Genzyme.

Figures

Figure 1
Figure 1
Correlation analysis of prodromal tests lined on a scale from worse to best. Correlation strengths were defined as strong > 0.75, moderate 0.5−0.75, weak 0.25−0.5 and no relationship

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