Thesis (MScMedSc)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Please see fulltext for abstract / AFRIKAANSE OPSOMMING: Parkinson se siekte ( PD ) is 'n toenemend algemene neurodegeneratiewe siekte wat die progressiewe verlies van dopaminergiese neurone in die substantia nigra pars compacta behels, wat lei tot die ontwrigting van die motororiese senuweestelsel. ’n Neuronale verlies van meer as 50% van die normale vlakke is nodig vir die ontwikkeling van die kliniese simptome, insluitende bewing, spier rigiditeit, bradykinesia, en posturale onstabiliteit. Alhoewel beskikbare medikasies vir PD wel simptome onderdruk, is dit nie in staat om die siekte te voorkom of vordering daarvan te verhoed nie. Een van die mees bedeidende risikofaktore vir PD is toenemende ouderdom. Huidige epidemiologiese studies voorspel ‘n toename in populasie ouderdom wat belangrike implikasies vir die voorkoms van PD kan inhou. Die molekulere meganismes onderliggend aan die neurale agteruitgang in PD is steeds onbekend, maar dit blyk dat ‘n aantal genetiese faktore (in kombinasie met omgewingsfaktore) bydra tot die komplekse patogeniese agteruitgang van die siekte. Agt bevestigde gene is gevind om direk betrokke te wees by die etiologie van PD, naamlik: parkin, PINK1, DJ-1, ATP13A2, SNCA, LRRK2, VPS35, en EIF4G1. Hierdie gene is oorwegend geïdentifiseer en bestudeer in die Europese, Noord-Amerikaanse en Asiatiese bevolkings; terwyl die bestudering van Sub -Sahara- Afrika (SSA) bevolkings, veral dié van Swart Afrika afkoms, onderverteenwoordig bly in genetiese studies. Siende dat resultate verkry vanaf ander bevolkings nie verwant is aan die SSA bevolking nie, en ook nie ‘n voorspelling van wereldwye toename van die siekte kan verteenwoordig nie, is dit van belang dat omvattende genetiese studies uitgevoer word op hierdie onderbestudeerde bevolkings van SSA. Desnieteenstaande, die doel van die studie was om die molekulere etiologie van PD in ‘n groep Swart Suid-Afrikaanse (SA) PD pasiente te ondersoek. ‘n Totaal van 47 pasiente is gewerf vir die studie waarvan 26% ‘n famielie geskiedenis het vir die afwyking. Die gemiddelde ouderdom van aanvang vir die pasiente was 55.3 ± 11.2 jaar. Mutasie volgorderbepaling vir alle bekende PD gene is uitgevoer. Addisionele mutasie volgorderbepaling vir die GBA is ook uitgevoer siende dat heterosigotiese mutasies in die geen dien as ‘n sterk risikofaktor vir die ontwikkeling van PD. ‘n Verskeidenheid mutasie volgordebepalingstegnieke is geinkorporeer vir die studie, naamlik: Sanger volgordebepaling en hoë resolusie smelt tegniek (vir die identifisering van missense mutasies asook kleinskaalse invoegings of weglatings), en multiplex-afbinding afhanklike ondersoek versterkingstoets (vir die opsporing van veranderinge in kopiegetal). Verder is volgende generasie volgordebepaling gebruik vir die sistematiese ondersoek van die bekende PD gene, asook vir 160 kandidaat gene wat vooraf bepaal is. Fluoreserend-geetiketeerde polymerase ketting reaksie primers is gebruik vir genotipering van CAG herhalings uitbreidings in die ataxin-2 (SCA2) en die ataxin-7 (SCA7) gene, gevolg deur elektroforese met behulp van die “ABI 3130x1 Genetic Analyzer”. Mutasie volgordebepaling het voor die lig gebring dat die bekende PD gene klaarblyklik nie ‘n beduidende oorsaaklike rol speel in die patogenese van die siekte in die huidige groep Swart SA pasiente nie, want slegs 2 uit die 47 (43%) pasiente koester mutasies in parkin. Een van die pasiente besit ‘n heterosigotiese duplikasie van ekson 2 en ‘n heterosigotiese weglating van ekson 9; in die ander pasient is ‘n heterosigotiese ekson 4 weglating en ‘n heterosigotiese G430D mutasie geïdentifiseer. Verder is ‘n Q311K verandering in parkin gevind asook vier nuwe variante (I610T, H1758P, N2133S en T2423S) in die LRRK2 geen. Die patogenisiteit van hierdie variante moet egter nog bepaal word. Geen patogeniese herhaalings uitbreidings is gevind in die SCA2 en SCA7 lokusse nie, en die moontlikheid van die twee spinocerebellar ataksie subtipes as genetiese bepalers vir PD is uitgekanselleer. Geen patogeniese mutasies is gevind in enige van die oorblywende bekende PD gene nie, dit is dus waarskeinlik dat die pasiente wel mutasies in nuwe PD-geassosieerde gene besit. Hierdie is die eerste molekulere genetiese studie uitgevoer op uitsluitlik Swart SA PD pasiente, en ook die eerste omvattende ondersoek van al die bekende PD gene in ‘n SSA bevolking. Die algemene patogeniese mutasies in gene, wat voorheen bewys is as siekte veroorsakend in ‘n aantal Europese bevolkings, is nie bespeur in die huidige studie nie en kan dus nie verantwoordelik gehou word vir die voorkoms van PD in hierdie pasiente nie. Maar, siende dat die steekproefgrootte in hierdie studie relatief klein was, kan addisionele volgordebepaling van ‘n groter pasient groep voordelig wees in die bepaal van nuwe siekte-veroorsakende gene wat die potensiaal het om huidige hipoteses, dat die genetiese etiologie van PD duidelik verskil oor verskeie etniese groepe wereldwyd, te weerlê of bevestig. Die voortsetting van genetiese ondersoeke onder hierdie groep pasiente kan bydra tot insig met betrekking tot bevolking-spesifieke genetiese bepalers, en uiteindelik tot die identifisering van nuwe teikens vir medikasies teen die siekte.

Background: Parkinson’s disease (PD) is a complex disease with a multi-factorial aetiology, comprising both genetic and environmental risk factors. The disease pathology is progressive and neurodegenerative where dopaminergic nerve cell death occurs predominantly in the substantia nigra pars compacta (SNpc) with the subsequent loss of the dopamine neurotransmitter in the basal ganglia. The most significant risk factors for PD include an advancing age and a family history of the disease, while environmental and lifestyle risk factors such as pesticide exposure and smoking are widely accepted as risk altering exposures. Currently up to 10% of PD is attributed to Mendelian inherited PD at one of 13 PARK loci in 9 genes. The pursuit of common susceptibility alleles for idiopathic PD has proven challenging with only a few loci reproducibility associated with an altered risk. The aim of this thesis is to study, using a candidate gene case-control design, the potential role of genetic variants in PD. The APOE candidate gene was hypothesized to modify the risk of PD as it is a proven modifier of Alzheimer’s disease (AD). The common pathological finding in PD of elevated levels of iron within the SNpc is proposed to increase the oxidative state of the nerve cells and predispose the dopaminergic neurons to apoptosis. Therefore, susceptibility alleles within the candidate genes that regulate iron metabolism and homeostasis are hypothesized to alter iron metabolism and predispose to iron-induced neurodegeneration in PD. Missense variants and common “tagging” SNPs with the HFE, Transferrin and Transferrin Receptor genes are investigated extensively in this thesis. Finally, autosomal recessively inherited PD can result from mutations in the parkin gene at the PARK2 locus. The final hypothesis explored in this thesis suggests that non-deleterious missense variants in the parkin gene modify the risk for developing sporadic PD. Further genetic variation in the parkin gene such as exon rearrangements is a frequently reported mutation where heterozygosity for these rearrangements may increase the risk of PD. Heterozygous deletions or duplications of exons in the parkin gene provide technical challenges for their detection. In this thesis a novel assay for the detection of these mutations is investigated. Methods: Genotyping was performed using PCR-RFLP for genetic variants in the APOE (E2 and E4 alleles), HFE (C282Y, H63D and S65C), Transferrin receptor (TfR; S142G), Transferrin (Tfn; P570S and G258S), IREB2 genes (L159V) and the parkin gene (S167N, R366W and V380L) in a cohort of 425 PD cases and 387 controls recruited from throughout Queensland, Australia. A tagged SNP high-throughput genotyping approach was then employed to try to replicate single SNP associations in 6 iron-related genes using a cohort of 1034 PD cases and 774 controls. These genetic variants were analysed for direct association with PD risk, age of onset effects as well as potential gene x gene (GxG) and gene x environment (GxE) interactions. Additionally, a quantitative PCR assay was developed to detect heterozygous deletions and duplications within the parkin gene and utilised to screen 43 YOPD cases for these mutations. Results: The initial study of the HFE C282Y variant revealed a significant protective association with PD in the two independent cohorts studied. Further study did not reveal significant associations with PD for the other HFE variants or missense variants within the Tfn and TfR genes. When analysed for GxE interactions, the C282Y, P589S and G277S variants showed evidence for an increased risk of PD in synergy with pesticide and herbicide exposure. Carriers of the risk variant and with toxin exposure were at two-fold increased risk of PD, although the number of individuals in this category was small. A further investigation of the role of common genetic polymorphisms in iron genes revealed only one of the 20 SNPs genotyped using high-throughput multiplex methods, remained significantly associated with PD after correction for age and sex. The rs198855 SNP is downstream of the HFE gene and further implicates a role for HFE in PD. The APOE E4 allele demonstrated modifying effects for the age of PD onset, restricted to the female cases. Analysis of the parkin missense variants also demonstrated a modifying effect on the age of PD onset in carriers of the S167N variant, with putative interactions between the APOE E4 allele, a family history of PD and toxin exposure that further reduced the age of onset. Twenty individuals of the 43 YOPD cases screened demonstrated heterozygous parkin exon rearrangements using the novel qPCR method. Conclusions: Non-synonymous variants within iron-related genes or the parkin gene putatively interact with herbicide and pesticide exposure to increase the risk of PD or modify the phenotype, highlighting the need for future studies to address the multi-factorial aetiology of PD in their study design and analysis. This thesis provides evidence for the association between genetic variation within the HFE locus and PD and for the APOE E4 allele as a modifier of PD.