GBA1 Variants with Unknown Classification Are Modest Contributors to Parkinson's Disease Susceptibility.

BACKGROUND

GBA1 variants cause Gaucher's disease (GD) in biallelic forms and increase Parkinson's disease (PD) risk in heterozygous carriers. Carriers of mild or severe variants (causing GD type 1 or types 2-3) can enroll in clinical trials, whereas those with GBA1 variants classified as unknown are typically excluded.

OBJECTIVE

We assessed the contribution of unknown variants to PD risk and their relevance for trial stratification.

METHODS

We meta-analyzed 34 case-control studies (24,060 PD cases, 14,465 controls). Odds ratios (ORs) were estimated using random-effects models and stratified by the American College of Medical Genetics and Genomics (ACMG) criteria.

RESULTS

Unknown variants also classified as variants of uncertain significance (VUSs) per ACMG criteria were associated with PD (OR = 1.59, 95% confidence interval [CI]: 1.25-2.02; I2 = 0%). VUSs + likely pathogenic + pathogenic also showed an association (OR = 1.63, 95% CI: 1.28-2.06; I2 = 0%).

CONCLUSIONS

Unknown GBA1 variants may be considered provisionally in clinical trials if also classified as VUS, likely pathogenic, or pathogenic per ACMG criteria. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.