# Clinical Variability and Genotype–Phenotype Correlation in Spanish Patients with Type 1 Gaucher Disease: A Focus on Non-c.[1226A>G]; [1448T>C] Genotypes

## TL;DR

This study explores how different genetic variations in Spanish Gaucher disease patients affect their symptoms, showing that some genotypes lead to more severe health issues.

## Contribution

The study identifies specific GBA1 genotypes beyond the common N370S; L444P combination that correlate with more severe clinical outcomes in Gaucher disease.

## Key findings

- Patients with N370S combined with non-L444P variants had higher rates of advanced bone disease.
- Non-N370S; L444P genotypes were strongly linked to increased risk of Parkinsonism.
- Genotype stratification improves prediction of skeletal and neurological complications in GD1.

## Abstract

The clinical heterogeneity of type 1 Gaucher disease (GD1) underscores the limited correlation between the GBA1 genotype and phenotype. This study examined GD1 patients from the Spanish Gaucher Disease Registry carrying heterozygous GBA1 genotypes distinct from NM_000157: c.[1226A>G](N370S); [1448T>C](L444P). Among 374 patients with GD1, 195 (52.1%) had alternative heterozygous combinations, including variants corresponding to severe (37.9%) or moderate (42.1%) mutation, whereas only 20% patients harbored mild variants—all of them in combination with N370S. Descriptive statistics and predictive models based on logistic regression and decision trees were applied. Patients carrying N370S with a different L444P variant showed significantly higher rates of advanced bone disease (59.9%) compared to those with homozygous N370S (38.3%) or N370S; L444P (41.0%) (p = 0.002). Decision tree analysis identified the bone marrow burden score (S-MRI) as the strongest predictor of osteopenia/osteoporosis at diagnosis. Genotype also emerged as a key discriminator for Parkinson’s disease: patients with non-N370S; L444P genotypes showed a markedly higher likelihood of developing Parkinsonism. Overall, GD1 patients with genotypes other than N370S; L444P present more severe phenotypes, particularly with greater skeletal involvement and neurological complications. These findings highlight the importance of genotype stratification and predictive modeling in improving risk assessment and clinical management in GD1.