Urine bis(Monoacylglycerol)Phosphate and risk of freezing of gait in parkinson’s disease

Urine bis(monoacylglycero)phosphate (BMP) levels are reportedly increased in GBA variants carriers of patients with Parkinson's disease (PD). Freezing of gait (FOG) is a common PD patients, we aimed to evaluate the association of urinary BMP with the risk of FOG development in a large PD cohort. A total of 354 PD patients from the Parkinson's Progression Markers Initiative (PPMI) were included in this study, and urinary BMPs, including total di-22:6-BMP and 2,2'-di-22:6-BMP, were evaluated at baseline. They were followed up for up to 5 years to examine the progression of FOG. The cumulative incidence of FOG and risk factors for FOG were assessed via Kaplan‒Meier and Cox regression analyses. At baseline, the future FOG group presented higher baseline total di-22:6-BMP levels and 2,2'-di-22:6-BMP levels. During follow-up, baseline urinary 2,2'-di-22:6-BMP was associated with the progression of FOG. In the multivariable Cox analysis, urinary 2,2'-di-22:6-BMP remained an independent predictor of FOG (HR 1.030; 95% CI 1.010-1.051; p = 0.010). In the subgroup analyses, the "high-level" group had a significantly greater incidence of FOG than the "low-level" group and GBA variants independently increased the risk of FOG in the "high-level" group.We found that baseline urinary 2,2'-di-22:6-BMP was a predictor of FOG development in early PD patients.