Genetic modifiers of risk and age at onset in GBA associated Parkinson's disease and Lewy body dementia

Cornelis Blauwendraat, Xylena Reed, Lynne Krohn, Karl Heilbron, Sara Bandres-Ciga, Manuela Tan, J. Raphael Gibbs, Dena G. Hernandez, Ravindran Kumaran, Rebekah Langston, Luis Bonet-Ponce, Roy N. Alcalay, Sharon Hassin-Baer, Lior Greenbaum, Hirotaka Iwaki, Hampton L. Leonard, Francis P. Grenn, Jennifer A. Ruskey, Marya Sabir, Sarah AhmedMary B. Makarious, Lasse Pihlstrøm, Mathias Toft, Jacobus J. Van Hilten, Johan Marinus, Claudia Schulte, Kathrin Brockmann, Manu Sharma, Ari Siitonen, Kari Majamaa, Johanna Eerola-Rautio, Pentti J. Tienari, Alexander Pantelyat, Argye E. Hillis, Ted M. Dawson, Liana S. Rosenthal, Marilyn S. Albert, Susan M. Resnick, Luigi Ferrucci, Christopher M. Morris, Olga Pletnikova, Juan Troncoso, Donald Grosset, Suzanne Lesage, Jean Christophe Corvol, Alexis Brice, Alastair J. Noyce, Eliezer Masliah, Nick Wood, John Hardy, Lisa M. Shulman, Joseph Jankovic, Joshua M. Shulman, Peter Heutink, Thomas Gasser, Paul Cannon, Sonja W. Scholz, Huw Morris, Mark R. Cookson, Mike A. Nalls, Ziv Gan-Or, Andrew B. Singleton

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Parkinson's disease is a genetically complex disorder. Multiple genes have been shown to contribute to the risk of Parkinson's disease, and currently 90 independent risk variants have been identified by genome-wide association studies. Thus far, a number of genes (including SNCA, LRRK2, and GBA) have been shown to contain variability across a spectrum of frequency and effect, from rare, highly penetrant variants to common risk alleles with small effect sizes. Variants in GBA, encoding the enzyme glucocerebrosidase, are associated with Lewy body diseases such as Parkinson's disease and Lewy body dementia. These variants, which reduce or abolish enzymatic activity, confer a spectrum of disease risk, from 1.4- to >10-fold. An outstanding question in the field is what other genetic factors that influence GBA-associated risk for disease, and whether these overlap with known Parkinson's disease risk variants. Using multiple, large case-control datasets, totalling 217 165 individuals (22 757 Parkinson's disease cases, 13 431 Parkinson's disease proxy cases, 622 Lewy body dementia cases and 180 355 controls), we identified 1691 Parkinson's disease cases, 81 Lewy body dementia cases, 711 proxy cases and 7624 controls with a GBA variant (p.E326K, p.T369M or p.N370S). We performed a genome-wide association study and analysed the most recent Parkinson's disease-associated genetic risk score to detect genetic influences on GBA risk and age at onset. We attempted to replicate our findings in two independent datasets, including the personal genetics company 23andMe, Inc. and whole-genome sequencing data. Our analysis showed that the overall Parkinson's disease genetic risk score modifies risk for disease and decreases age at onset in carriers of GBA variants. Notably, this effect was consistent across all tested GBA risk variants. Dissecting this signal demonstrated that variants in close proximity to SNCA and CTSB (encoding cathepsin B) are the most significant contributors. Risk variants in the CTSB locus were identified to decrease mRNA expression of CTSB. Additional analyses suggest a possible genetic interaction between GBA and CTSB and GBA p.N370S induced pluripotent cell-derived neurons were shown to have decreased cathepsin B expression compared to controls. These data provide a genetic basis for modification of GBA-associated Parkinson's disease risk and age at onset, although the total contribution of common genetics variants is not large. We further demonstrate that common variability at genes implicated in lysosomal function exerts the largest effect on GBA associated risk for disease. Further, these results have implications for selection of GBA carriers for therapeutic interventions.

Original languageEnglish (US)
Pages (from-to)234-248
Number of pages15
Issue number1
StatePublished - Jan 1 2020


  • CTSB
  • GBA
  • Modifiers
  • Parkinson's disease
  • SNCA

ASJC Scopus subject areas

  • Clinical Neurology


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