BACKGROUND: Neurodegeneration with brain iron accumulation (NBIA) are a group of clinically and genetically heterogeneous diseases characterized by iron overload in basal ganglia and progressive neurodegeneration. Little is known about the epidemiology of NBIA disorders. In the absence of large-scale population-based studies, obtaining reliable epidemiological data requires innovative approaches. METHODS: All pathogenic variants were collected from the 13 genes associated with autosomal recessive NBIA (PLA2G6, PANK2, COASY, ATP13A2, CP, AP4M1, FA2H, CRAT, SCP2, C19orf12, DCAF17, GTPBP2, REPS1). The allele frequencies of these disease-causing variants were assessed in exome/genome collections: the Genome Aggregation Database (gnomAD) and our in-house database. Lifetime risks were calculated from the sum of allele frequencies in the respective genes under assumption of Hardy-Weinberg equilibrium. FINDINGS: The combined estimated lifetime risk of all 13 investigated NBIA disorders is 0.88 (95% confidence interval 0.70-1.10) per 100,000 based on the global gnomAD dataset (n = 282,912 alleles), 0.92 (0.65-1.29) per 100,000 in the European gnomAD dataset (n = 129,206), and 0.90 (0.48-1.62) per 100,000 in our in-house database (n = 44,324). Individually, the highest lifetime risks (>0.15 per 100,000) are found for disorders caused by variants in PLA2G6, PANK2 and COASY. INTERPRETATION: This population-genetic estimation on lifetime risks of recessive NBIA disorders reveals frequencies far exceeding previous population-based numbers. Importantly, our approach represents lifetime risks from conception, thus including prenatal deaths. Understanding the true lifetime risk of NBIA disorders is important in estimating disease burden, allocating resources and targeting specific interventions. FUNDING: This work was carried out in the framework of TIRCON ("Treat Iron-Related Childhood-Onset Neurodegeneration").

• Keywords
• Autosomal recessive NBIA disorders, CoPAN, Lifetime risk, Neurodegeneration, PKAN, PLAN,
• MeSH
• Databases, Genetic MeSH
• Child MeSH
• Nuclear Proteins MeSH
• Ubiquitin-Protein Ligase Complexes MeSH
• Humans MeSH
• Mitochondrial Proteins genetics   MeSH
• Brain pathology   MeSH
• Neuroaxonal Dystrophies * epidemiology   genetics   pathology   MeSH
• Neurodegenerative Diseases * epidemiology   genetics   pathology   MeSH
• Iron Metabolism Disorders * genetics   pathology   MeSH
• Calcium-Binding Proteins MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• C19orf12 protein, human MeSH Browser
• DCAF17 protein, human MeSH Browser
• Nuclear Proteins MeSH
• Ubiquitin-Protein Ligase Complexes MeSH
• Mitochondrial Proteins MeSH
• Calcium-Binding Proteins MeSH
• REPS1 protein, human MeSH Browser