Quantification profiles of enzyme activity, secretion, and psychosine levels of Krabbe disease galactosylceramidase missense variants.

Krabbe disease is an autosomal recessive, demyelinating disorder caused by mutations in the GALC gene. Missense mutation variants (MMVs) account for most pathogenic alleles in patients; however, their mechanistic implications and correlations to clinical phenotype remain unclear. To address these questions, we generated a GALC knockout human oligodendrocytic cell line to conduct a robust GALC-MMVs expression study using a panel of 31 GALC-MMVs. Twenty-six clinically relevant variants dramatically reduced enzyme activity (92-100%). Notably, residual GALC activity strongly correlated with the age of disease-onset in reported cases (Pearson's r > 0.94, p < 0.0001), suggesting that enzyme activity resulting from MMV expression in this model may serve as a readout for clinical prognostication. In addition, we identified p.I562T, a predominant pseudodeficiency variant in the newborn screening programs, which synergistically impairs protein function and likely triggers disease-onset when inherited co-allelic with certain MMVs. We also identified MMVs that increased protein retention intracellularly and/or decreased secretion. This quantitative analysis of misfolding characteristics could be valuable for identifying MMVs amenable to pharmacological chaperone therapy. Finally, we observed an inverse correlation between residual GALC activity and endogenous psychosine levels in the MMV panel. Given the importance of psychosine as a biomarker for diagnosis and newborn screening, the psychosine accumulation phenotype in our model highlights its potential use for drug discovery. Overall, this study provides a comprehensive overview of the functional deficits and mis-trafficking caused by GALC-MMVs, deepens our understanding of molecular genetics and genotype-phenotype correlations in Krabbe disease, and highlights the potential of our platform for genetic and therapeutic applications.