Question
At which node of the GBA—α-synuclein feedback loop (lysosomal GBA activity, chaperone-mediated autophagy, α-synuclein fibril seeding) should therapeutic intervention be prioritized to maximally slow Parkinson's progression?
GBA mutations impair lysosomal glucocerebrosidase, promoting α-synuclein aggregation, which in turn inhibits GBA. This vicious cycle amplifies pathology. Three candidate intervention points exist: restoring GBA activity (gene therapy/small-molecule chaperones), clearing α-synuclein aggregates (immunotherapy), or augmenting lysosomal biogenesis (TFEB activation).
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