Analysis of Genetic and Non-genetic Predictors of Levodopa Induced Dyskinesia in Parkinson's Disease

Alfonsina Tirozzi; Nicola Modugno; Nicole Piera Palomba; Rosangela Ferese; Alessia Lombardi; Enrica Olivola; Alessandro Gialluisi; Teresa Esposito

doi:10.3389/fphar.2021.640603

Analysis of Genetic and Non-genetic Predictors of Levodopa Induced Dyskinesia in Parkinson's Disease

Front Pharmacol. 2021 Apr 29:12:640603. doi: 10.3389/fphar.2021.640603. eCollection 2021.

Authors

Alfonsina Tirozzi¹, Nicola Modugno¹, Nicole Piera Palomba¹, Rosangela Ferese¹, Alessia Lombardi¹, Enrica Olivola¹, Alessandro Gialluisi¹, Teresa Esposito^{1

2}

Affiliations

¹ IRCCS Neuromed, Pozzilli, Italy.
² Institute of Genetics and Biophysics, CNR, Naples, Italy.

Abstract

Background: Levodopa (L-Dopa), representing the therapeutic gold standard for the treatment of Parkinson disease (PD), is associated with side effects like L-Dopa induced dyskinesia (LID). Although several non-genetic and genetic factors have been investigated for association with LID risk, contrasting results were reported and its genetic basis remain largely unexplored. Methods: In an Italian PD cohort (N = 460), we first performed stepwise multivariable Cox Proportional Hazard regressions modeling LID risk as a function of gender, PD familiarity, clinical subtype, weight, age-at-onset (AAO) and years-of-disease (YOD), L-Dopa dosage, severity scores, and scales assessing motor (UPDRS-III), cognitive (MoCA), and non-motor symptoms (NMS). Then we enriched the resulting model testing two variants-rs356219 and D4S3481-increasing the expression of the SNCA gene, previously suggested as a potential mechanism of LID onset. To account for more complex (non-linear) relations of these variables with LID risk, we built a survival random forest (SRF) algorithm including all the covariates mentioned above. Results: Among tested variables (N = 460 case-complete, 211 LID events; total follow-up 31,361 person-months, median 61 months), disease duration showed significant association (p < 0.005), with 6 (3-8)% decrease of LID risk per additional YOD. Other nominally significant associations were observed for gender-with women showing a 39 (5-82)% higher risk of LID-and AAO, with 2 (0.3-3)% decrease of risk for each year increase of PD onset. The SRF algorithm confirmed YOD as the most prominent feature influencing LID risk, with a variable importance of about 8% in the model. In genetic models, no statistically significant effects on incident LID risk was observed. Conclusions: This evidence supports a protective effect of late PD onset and gender (men) against LID risk and suggests a new independent protective factor, YOD. Moreover, it underlines the importance of personalized therapeutic protocols for PD patients in the future.

Keywords: D4S3481; Parkinson disease; SNCA; levodopa induced dyskinesia; rs356219; α-synuclein.