Loss of activity of the lysosomal glycosidase β-glucocerebrosidase (GCase) causes the lysosomal storage disease Gaucher disease (GD) and has emerged as the greatest genetic risk factor for the development of both Parkinson disease (PD) and dementia with Lewy bodies. There is significant interest into how GCase dysfunction contributes to these diseases, however, progress toward a full understanding is complicated by presence of endogenous cellular factors that influence lysosomal GCase activity. Indeed, such factors are thought to contribute to the high degree of variable penetrance of GBA mutations among patients. Robust methods to quantitatively measure GCase activity within lysosomes are therefore needed to advance research in this area, as well as to develop clinical assays to monitor disease progression and assess GCase-directed therapeutics. Here, we report a selective fluorescence-quenched substrate, LysoFQ-GBA, which enables measuring endogenous levels of lysosomal GCase activity within living cells. LysoFQ-GBA is a sensitive tool for studying chemical or genetic perturbations of GCase activity using either fluorescence microscopy or flow cytometry. We validate the quantitative nature of measurements made with LysoFQ-GBA using various cell types and demonstrate that it accurately reports on both target engagement by GCase inhibitors and the GBA allele status of cells. Furthermore, through comparisons of GD, PD, and control patient-derived tissues, we show there is a close correlation in the lysosomal GCase activity within monocytes, neuronal progenitor cells, and neurons. Accordingly, analysis of clinical blood samples using LysoFQ-GBA may provide a surrogate marker of lysosomal GCase activity in neuronal tissue.

Biallelic mutations in GBA1 that lead to reduced β-glucocerebrosidase (GCase) activity result in the monogenic lysosomal storage disease Gaucher disease (GD). Variants in one GBA1 allele are the most common genetic risk factor for multiple synucleinopathies including Parkinson’s disease (PD). Therapies to increase GCase activity in the brain hold great promise for the treatment of these diseases. To this end, we have developed blood-brain barrier penetrant therapeutic molecules by fusing antibody moieties that bind the transferrin receptor (TfR) to murine or human GCase (referred to as mGCase-mBS or hGCase-hBS, respectively). We demonstrate that these fusion proteins maintain full enzymatic activity and, while their total cellular uptake is only marginally increased compared to the enzyme alone, they have up to 100-fold better lysosomal uptake and function. Uptake and efficacy of GCase-BS relies primarily on binding to the TfR, rather than to mannose phosphate receptors (M6PRs) as conventional enzyme replacement therapy. In a GD cellular model, GCase-BS rapidly rescues the lysosomal proteome and lipid accumulations beyond known GCase substrates. Intravenous injection of mGCase-mBS leads to significant reduction of brain lysosomal membrane lipids in a GD mouse model which is sustained for four weeks. Monthly dosing over six months shows sustained efficacy and reduces neurofilament-light chain (NFL) plasma levels. Collectively, these findings demonstrate the great potential of TfR-targeted GCase for treating GBA1-associated neurodegeneration, provide insight into candidate biomarkers of GD lysosomal dysfunction, and ultimately may open a new treatment paradigm for lysosomal storage diseases (LSDs) extending beyond the central nervous system (CNS).

Mutations in glucocerebrosidase cause the lysosomal storage disorder Gaucher’s disease and are the most common risk factor for Parkinson’s disease. Therapies to restore the enzyme’s function in the brain hold great promise for treating the neurological implications. Thus, we developed blood-brain barrier penetrant therapeutic molecules by fusing transferrin receptor-binding moieties to β-glucocerebrosidase (referred to as GCase-BS). We demonstrate that these fusion proteins show significantly increased uptake and lysosomal efficiency compared to the enzyme alone. In a cellular disease model, GCase-BS rapidly rescues the lysosomal proteome and lipid accumulations beyond known substrates. In a mouse disease model, intravenous injection of GCase-BS leads to a sustained reduction of glucosylsphingosine and can lower neurofilament-light chain plasma levels. Collectively, these findings demonstrate the potential of GCase-BS for treating GBA1-associated lysosomal dysfunction, provide insight into candidate biomarkers, and may ultimately open a promising treatment paradigm for lysosomal storage diseases extending beyond the central nervous system.