Patients with Gaucher disease display systemic oxidative stress dependent on therapy status

Reena V Kartha; Marcia R Terluk; Roland Brown; Abigail Travis; Usha R Mishra; Kyle Rudser; Heather Lau; Jeanine R Jarnes; James C Cloyd; Neal J Weinreb

doi:10.1016/j.ymgmr.2020.100667

Patients with Gaucher disease display systemic oxidative stress dependent on therapy status

Mol Genet Metab Rep. 2020 Dec 9:25:100667. doi: 10.1016/j.ymgmr.2020.100667. eCollection 2020 Dec.

Authors

Reena V Kartha^{1

2}, Marcia R Terluk^{1

2}, Roland Brown³, Abigail Travis^{1

2}, Usha R Mishra^{1

2}, Kyle Rudser³, Heather Lau⁴, Jeanine R Jarnes^{2

5}, James C Cloyd^{1

2

6}, Neal J Weinreb⁷

Affiliations

¹ Center for Orphan Drug Research, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, United States.
² Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, United States.
³ Division of Biostatistics, University of Minnesota, Minneapolis, MN 55455, United States.
⁴ Division of Neurogenetics, Department of Neurology, New York University, New York, NY, United States.
⁵ University of Minnesota Medical Center/Fairview Health Systems, Minneapolis, MN 55455, United States.
⁶ Department of Neurology, University of Minnesota, Minneapolis, MN 55455, United States.
⁷ Department of Human Genetics and Medicine (Hematology), Leonard Miller School of Medicine of University of Miami, Miami, FL, United States.

Abstract

Gaucher disease is an autosomal recessive metabolic disorder caused by mutations in GBA1, which encodes for the lysosomal hydrolase enzyme, β-glucocerebrosidase. The resulting misfolded protein can trigger endoplasmic reticulum stress and an unfolded protein response within the affected cells. The enzyme deficiency leads to accumulation of its substrates, glucosylceramide and glucosylsphingosine, within macrophage lysosomes and with prominent disease manifestations in macrophage rich tissues. Resultant lysosomal pathology and impaired autophagy leads to redox imbalance, mitochondrial dysfunction and intracellular oxidative stress. Here we have systematically examined a role for oxidative stress in individuals affected by Gaucher disease. We compared multiple oxidative stress biomarkers in plasma and red blood cell samples from patients who are currently untreated, with those who are stable on standard-of-care therapy, and with healthy controls. We found significant differences in key oxidative stress biomarkers in untreated patients compared to healthy control. In treated patients, results generally fell between the controls and the untreated patients. Interestingly, even asymptomatic and minimally symptomatic untreated patients had evidence of significant systemic oxidative stress. We conclude that underlying oxidative stress may contribute to Gaucher disease pathophysiology including long-term adverse outcomes such as Parkinsonism and malignancies. Therapies targeting oxidative stress may prove useful as adjuvant treatments for Gaucher disease and other lysosomal storage disorders.

Keywords: ACE, angiotensin converting enzyme; Antioxidants; CHITO, chitotriosidase; CNS, central nervous system; ERT, enzyme replacement therapy; GCase, glucocerebrosidase; GD, Gaucher disease; GD1, Type 1 Gaucher disease; GD2, Type 2 Gaucher disease; GD3, Type 3 Gaucher disease; GPG, Glycine-Proline-Glutamate; GPx, glutathione peroxidase; GSH, glutathione; GSSG, inactive, oxidized form of glutathione; Gaucher disease; Glutathione; HPLC, high performance liquid chromatography; LC-MS/MS, liquid chromatography-tandem mass spectrometry; Lipid peroxidation; Lyso-GL1, glucosylsphingosine; MDA, malondialdehyde; NYU, New York University; Oxidative stress; RBC, red blood cell; ROS, reactive oxygen species; SOD, superoxide dismutase; SRT, substrate reduction therapy; TAC, total antioxidant capacity; TBARS, thiobarbituric acid reactive substances; TRAP, tartrate resistant acid phosphatase; UMN, University of Minnesota.