An overlooked distal regulatory signal on a shared haplotype drives the neuroinflammatory cascade underlying GBA1-associated Parkinson's disease

BACKGROUNDThe persistent puzzle of how GBA1 coding variants underlying monogenic Gaucher disease confer such strong risk for polygenic Parkinsons disease (PD) remains unresolved. Here, we sought to resolve this long-standing paradox. METHODSUsing the Parkinsons Progression Markers Initiative resource, we integrated whole-genome sequencing from sporadic PD cases and controls with matched transcriptomic, epigenomic and cerebrospinal fluid proteomic data across Northern European and Ashkenazi Jewish populations. Ancestry-specific genetic maps enabled precise integration of disease localisation with eQTL, pQTL and chromatin architecture, linking genetic association to molecular mechanism, while evolutionary genetic analyses resolved the regional haplotypic architecture. RESULTSWe identified a PD-associated regulatory signal located 150 kilobases distal to GBA1 that robustly replicated across all molecular datasets and both ancestries. Integrative mapping identified rs77268551-G as the candidate regulatory variant, which we show resides on an extended haplotype also carrying the Gaucher disease-causing N370S allele. Evolutionary analyses reveal a clear signature of recent positive selection acting on the Gaucher disease-causing N370S allele, giving rise to this extended shared haplotype that likely concealed the underlying distal PD-associated regulatory signal. rs77268551-G resides within a neuronal enhancer with features consistent with super-enhancer activity that orchestrates hierarchical enhancer-to-enhancer-to-promoter interactions with eleven cis-target genes, including ADAR, IL6R and GBA1, driving a coordinated transcriptional programme. Proteomic profiling identified genotype-specific cerebrospinal fluid protein signatures, including PARK7, BIN1 and SAA1, consistent with a neuroinflammatory programme. CONCLUSIONSThe findings support a dual-hit model in which a distal regulatory element is the primary driver of PD-associated molecular programmes, while co-inherited GBA1 protein-coding variation on the same haplotype modifies and amplifies the risk established by the regulatory variant, giving rise to the clinically distinct GBA1-associated PD phenotype. Regulatory activation and GBA1-related functional effects converge on neuroinflammatory and lysosomal pathways, and the resulting molecular signatures suggest genotype-linked biomarkers with potential clinical relevance.