Heterozygous PRKN mutations are common but do not increase the risk of Parkinson’s disease

ABSTRACT PRKN mutations are the most common recessive cause of Parkinson’s disease (PD) and are a promising target for gene and cell replacement therapies. Identification of biallelic PRKN patients (PRKN-PD) at the population scale, however, remains a challenge, as roughly half are copy number variants (CNVs) and many single nucleotide polymorphisms (SNPs) are of unclear significance. Additionally, the true prevalence and disease risk associated with heterozygous PRKN mutations is unclear, as a comprehensive assessment of PRKN SNPs and CNVs has not been performed at a population scale. To address these challenges, we evaluated PRKN mutations in 2 cohorts analyzed with both a genotyping array and exome or genome sequencing: the NIH PD cohort, a deeply phenotyped cohort of PD patients, and the UK Biobank, a population scale cohort with nearly half a million participants. Genotyping array identified the majority of PRKN mutations and at least 1 mutation in most biallelic PRKN mutation carriers in both cohorts. Additionally, in the NIH-PD cohort, functional assays of patient fibroblasts resolved variants of unclear significance in biallelic carriers and ruled out cryptic loss of function variants in monoallelic carriers. In the UK Biobank, we identified 2,692 PRKN CNVs from genotyping array data from nearly half a million participants (the largest collection to date). Deletions or duplications involving exons 2 accounted for roughly half of all CNVs and the vast majority (88%) involved exons 2, 3, or 4. Combining estimates from whole exome sequencing (from ∼200,000 participants) and genotyping array data, we found a pathogenic PRKN mutation in 1.8% of participants and 2 mutations in ∼1/7,800 participants. Those with 1 PRKN pathogenic variant were as likely as non-carriers to have PD (OR = 0.91, CI= 0.58 – 1.38, p-value = 0.76) or a parent with PD (OR = 1.12, CI = 0.94 – 1.31, p-value = 0.19). Together our results demonstrate that heterozygous pathogenic PRKN mutations are common in the population but do not increase the risk of PD. Additionally, they suggest a cost-effective framework to screen for biallelic PRKN patients at the population scale for targeted studies.