Association between Early-Onset Parkinson's Disease and Mutations in the Parkin Gene
Christoph B. Lücking, M.D., Alexandra Dürr, M.D., Ph.D., Vincenzo Bonifati, M.D., Jenny Vaughan, M.D., Giuseppe De Michele, M.D., Thomas Gasser, M.D., Biswadjiet S. Harhangi, M.D., Giuseppe Meco, M.D., Patrice Denèfle, Ph.D., Nicholas W. Wood, M.D., Ph.D., Yves Agid, M.D., Ph.D., Alexis Brice, M.D., for The European Consortium on Genetic Susceptibility in Parkinson's Disease and The French Parkinson's Disease Genetics Study Group
Background Mutations in the parkin gene have recently been identifiedin patients with early-onset Parkinson's disease, but the frequencyof the mutations and the associated phenotype have not beenassessed in a large series of patients.
Methods We studied 73 families in which at least one of theaffected family members was affected at or before the age of45 years and had parents who were not affected, as well as 100patients with isolated Parkinson's disease that began at orbefore the age of 45 years. All subjects were screened for mutationsin the parkin gene with use of a semiquantitative polymerase-chain-reactionassay that simultaneously amplified several exons. We sequencedthe coding exons in a subgroup of patients. We also comparedthe clinical features of patients with parkin mutations andthose without mutations.
Results Among the families with early-onset Parkinson's disease,36 (49 percent) had parkin mutations. The age at onset rangedfrom 7 to 58 years. Among the patients with isolated Parkinson'sdisease, mutations were detected in 10 of 13 patients (77 percent)with an age at onset of 20 years or younger, but in only 2 of64 patients (3 percent) with an age at onset of more than 30years. The mean (±SD) age at onset in the patients withparkin mutations was younger than that in those without mutations(32±11 vs. 42± 11 years, P<0.001), and theywere more likely to have symmetric involvement and dystoniaat onset, to have hyperreflexia at onset or later, to have agood response to levodopa therapy, and to have levodopa-induceddyskinesias during treatment. Nineteen different rearrangementsof exons (deletions and multiplications) and 16 different pointmutations were detected.
Conclusions Mutations in the parkin gene are a major cause ofearly-onset autosomal recessive familial Parkinson's diseaseand isolated juvenile-onset Parkinson's disease (at or beforethe age of 20 years). Accurate diagnosis of these cases cannotbe based only on the clinical manifestations of the disease.
Source Information
From INSERM Unité 289, Hôpital de la Salpêtrière, Paris (C.B.L., A.D., Y.A., A.B.); the Dipartimento di Scienze Neurologiche, Università La Sapienza, Rome (V.B., G.M.); the Institute of Neurology, London (J.V., N.W.W.); the Dipartimento di Scienze Neurologiche, Università Federico II, Naples, Italy (G.D.); the Neurologische Klinik, Klinikum Großhadern, Ludwig Maximilians Universität, Munich, Germany (T.G.); the Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, the Netherlands (B.S.H); and Evry Genomics Center, Aventis Pharma France, Evry, France (P.D.). Other authors were D. Nicholl, M.D. (University of Birmingham, Birmingham, United Kingdom); M.M.B. Breteler, M.D. (Erasmus University Medical School, Rotterdam, the Netherlands); B.A. Oostra, M.D. (Erasmus University, Rotterdam, the Netherlands); M. De Mari, M.D. (Università degli Studi di Bari, Bari, Italy); R. Marconi, M.D. (Ospedale della Misericordia, Grosseto, Italy); A. Filla, M.D. (Università Federico II, Naples, Italy); A.-M. Bonnet, M.D. (Hôpital de la Salpêtrière, Paris); E. Broussolle, M.D. (Hôpital Pierre Wertheimer, Lyons, France); P. Pollak, M.D. (Centre Hospitalier Universitaire de Grenoble, Grenoble, France); O. Rascol, M.D. (INSERM Unité 455, Toulouse, France); and M. Rosier, Ph.D., and I. Arnould, Ph.D. (Aventis Pharma France, Evry, France).
Address reprint requests to Dr. Brice at INSERM Unité 289, Hôpital de la Salpêtrière, 47 Blvd. de l'Hôpital, 75651 Paris CEDEX 13, France, or at brice{at}ccr.jussieu.fr.
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