Lrrk2 and Lewy body disease

Background and objectivesParkinson’s disease (PD) is a common neurodegenerative disorder affecting 1% of the elderly. The disease causes a significant burden of illness and cost to society. The causes of PD have remained unknown, and the influence of genetic factors used to be controversial. In 2004, several mutations were identified in familial PD within two genes: PINK1 and the novel gene LRRK2. The aims of this thesis were to further investigate genetic, clinical and pathological aspects of these genes in PD and other neurodegenerative disorders causing parkinsonism. Five papers based on data from studies of these genes are included in this thesis.Methods- DNA from probands of families with autosomal dominant parkinsonism were sequenced to identify novel mutations in the LRRK2 gene. After the identification of a novel heterozygous LRRK2 mutation, we assessed the frequency of this mutation in a total of 248 families from different populations. We also screened samples of patients with idiopathic PD from three populations (Norway, Ireland, and Poland). Family members of mutation carriers were examined, and analyses of segregation, mutation haplotypes and penetrance were performed (Paper I).- A clinicogenetic study of PD in Central Norway was initiated several years ago at the Department of Neurology, St. Olav’s University Hospital in Trondheim. We screened 435 Norwegian patients diagnosed with PD and 519 control subjects from this study for the presence of seven known LRRK2 mutations. The clinical presentation of disease was studied in patients with mutations (Paper II).-A series of 242 patients from a clinicogenetic study of dementia in Central Norway (Tronderbrain) were screened for the presence of seven known pathogenic mutations previously reported in the LRRK2 gene (Paper III).- We examined several brain banks for cases with clinical or pathological features of parkinsonian disorders. DNA was obtained from frozen brain tissue of cases with parkinsonism, other neurodegenerative disorders and controls (total n=1584) and genotyped for the exon 41 LRRK2 g.6055G>A (G2019S) mutation. Available medical records of mutation carriers were reviewed and neuropathological examination was performed (Paper IV).- Comprehensive PINK1 mutation analysis was performed in a total of 131 patients from Norway with early-onset parkinsonism (onset =50 years) or familial late-onset PD. Mutations identified were examined in 350 Norwegian control individuals (Paper V).Results- We identified a novel heterozygous LRRK2 g.6055G>A mutation (G2019S). Seven of 248 families with autosomal dominant parkinsonism (2.8%) and six of 806 patients with idiopathic PD (0.7%) carried this mutation. All patients with this mutation shared an ancestral haplotype, indicative of a common founder. The mutation segregates with disease (multipoint LOD score 2.41). Penetrance is age dependent, increasing from 17% at age 50 years to 85% at age 70 years (Paper I).- Ten Norwegian PD patients were found to be heterozygote carriers of the Lrrk2 G2019S mutation. The clinical features included asymmetric resting tremor, bradykinesia, and rigidity with a good response to levodopa and could not be distinguished from idiopathic Parkinson’s disease. No Parkinson’s disease patient carried any of the other LRRK2 mutations (Paper II). We did not identify LRRK2 mutations in our series of dementia patients (Paper III).- Lrrk2 G2019S was found in 2% (n=8) of the pathologically confirmed PD/Lewy body disease (LBD) cases (n=405). Neuropathological examination showed typical LBD in all cases (Paper IV).-Heterozygous missense mutations in PINK1 were found in three of 131 patients; homozygous or compound heterozygous mutations were not identified. A parkinsonian phenotype, with asymmetric onset and without atypical features, characterised these patients clinically (Paper V).ConclusionsWe identified a novel mutation in the LRRK2 gene, g.6055G>A (G2019S). This mutation is a relatively common cause of both familial and sporadic PD, and it is found in a number of populations from North America and Europe, including Norway. This specific mutation is today the most prevalent known cause of PD, but seems to be rare in other neurodegenerative disorders.Clinically, patients with the Lrrk2 G2019S substitution present with a levodopa–responsive parkinsonian syndrome with asymmetric resting tremor, bradykinesia, and rigidity. Both clinically and pathologically LRRK2-associated PD appears to be indistinguishable from idiopathic disease.PINK1 mutations were rare in our Norwegian population, but heterozygote mutation carriers might be at increased risk for disease.