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Woollacott IO, Nicholas JM, Heller C, Foiani MS, Moore KM, Russell LL, Paterson RW, Keshavan A, Schott JM, Warren JD, Heslegrave A, Zetterberg H, Rohrer JD. Cerebrospinal Fluid YKL-40 and Chitotriosidase Levels in Frontotemporal Dementia Vary by Clinical, Genetic and Pathological Subtype. Dement Geriatr Cogn Disord 2020; 49:56-76. [PMID: 32344399 PMCID: PMC7513620 DOI: 10.1159/000506282] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Chronic glial dysfunction may contribute to the pathogenesis of frontotemporal dementia (FTD). Cerebrospinal fluid (CSF) levels of glia-derived proteins YKL-40 and chitotriosidase are increased in Alzheimer's disease (AD) but have not been explored in detail across the spectrum of FTD. METHODS We investigated whether CSF YKL-40 and chitotriosidase levels differed between FTD patients and controls, across different clinical and genetic subtypes of FTD, and between individuals with a clinical FTD syndrome due to AD versus non-AD (frontotemporal lobar degeneration, FTLD) pathology (based on CSF neurodegenerative biomarkers). Eighteen healthy controls and 64 people with FTD (behavioural variant FTD, n = 20; primary progressive aphasia [PPA], n = 44: nfvPPA, n = 16, svPPA, n = 11, lvPPA, n = 14, PPA-NOS, n = 3) were included. 10/64 had familial FTD, with mutations in GRN(n = 3), MAPT(n = 4), or C9orf72 (n = 3). 15/64 had neurodegenerative biomarkers consistent with AD pathology. Levels were measured by immunoassay and compared using multiple linear regressions. We also examined relationships of YKL-40 and chitotriosidase with CSF total tau (T-tau), phosphorylated tau 181 (P-tau) and β-amyloid 1-42 (Aβ42), with each other, and with age and disease du-ration. RESULTS CSF YKL-40 and chitotriosidase levels were higher in FTD, particularly lvPPA (both) and nfvPPA (YKL-40), compared with controls. GRN mutation carriers had higher levels of both proteins than controls and C9orf72 expansion carriers, and YKL-40 was higher in MAPT mutation carriers than controls. Individuals with underlying AD pathology had higher YKL-40 and chitotriosidase levels than both controls and those with likely FTLD pathology. CSF YKL-40 and chitotriosidase levels were variably associated with levels of T-tau, P-tau and Aβ42, and with each other, depending on clinical syndrome and underlying pathology. CSF YKL-40 but not chitotriosidase was associated with age, but not disease duration. CONCLUSION CSF YKL-40 and chitotriosidase levels are increased in individuals with clinical FTD syndromes, particularly due to AD pathology. In a preliminary analysis of genetic groups, levels of both proteins are found to be highly elevated in FTD due to GRN mutations, while YKL-40 is increased in individuals with MAPT mutations. As glia-derived protein levels generally correlate with T-tau and P-tau levels, they may reflect the glial response to neurodegeneration in FTLD.
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Affiliation(s)
- Ione O.C. Woollacott
- Dementia Research Centre, Department of Neurodegenerative Disease, Queen Square UCL Institute of Neurology, London, United Kingdom
| | - Jennifer M. Nicholas
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Carolin Heller
- UK Dementia Research Institute, Department of Neurodegenerative Disease, Queen Square UCL Institute of Neurology, London, United Kingdom
| | - Martha S. Foiani
- UK Dementia Research Institute, Department of Neurodegenerative Disease, Queen Square UCL Institute of Neurology, London, United Kingdom
| | - Katrina M. Moore
- Dementia Research Centre, Department of Neurodegenerative Disease, Queen Square UCL Institute of Neurology, London, United Kingdom
| | - Lucy L. Russell
- Dementia Research Centre, Department of Neurodegenerative Disease, Queen Square UCL Institute of Neurology, London, United Kingdom
| | - Ross W. Paterson
- Dementia Research Centre, Department of Neurodegenerative Disease, Queen Square UCL Institute of Neurology, London, United Kingdom
| | - Ashvini Keshavan
- Dementia Research Centre, Department of Neurodegenerative Disease, Queen Square UCL Institute of Neurology, London, United Kingdom
| | - Jonathan M. Schott
- Dementia Research Centre, Department of Neurodegenerative Disease, Queen Square UCL Institute of Neurology, London, United Kingdom
| | - Jason D. Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, Queen Square UCL Institute of Neurology, London, United Kingdom
| | - Amanda Heslegrave
- UK Dementia Research Institute, Department of Neurodegenerative Disease, Queen Square UCL Institute of Neurology, London, United Kingdom
| | - Henrik Zetterberg
- UK Dementia Research Institute, Department of Neurodegenerative Disease, Queen Square UCL Institute of Neurology, London, United Kingdom,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Jonathan D. Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, Queen Square UCL Institute of Neurology, London, United Kingdom,*Dr. Jonathan D. Rohrer, Dementia Research Centre, Department of Neurodegenerative Disease, Queen Square UCL Institute of Neurology, London WC1N 3BG (UK),
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van der Ende EL, Meeter LH, Poos JM, Panman JL, Jiskoot LC, Dopper EGP, Papma JM, de Jong FJ, Verberk IMW, Teunissen C, Rizopoulos D, Heller C, Convery RS, Moore KM, Bocchetta M, Neason M, Cash DM, Borroni B, Galimberti D, Sanchez-Valle R, Laforce R, Moreno F, Synofzik M, Graff C, Masellis M, Carmela Tartaglia M, Rowe JB, Vandenberghe R, Finger E, Tagliavini F, de Mendonça A, Santana I, Butler C, Ducharme S, Gerhard A, Danek A, Levin J, Otto M, Frisoni GB, Cappa S, Pijnenburg YAL, Rohrer JD, van Swieten JC, Warren JD, Fox NC, Woollacott IO, Shafei R, Greaves C, Guerreiro R, Bras J, Thomas DL, Nicholas J, Mead S, van Minkelen R, Barandiaran M, Indakoetxea B, Gabilondo A, Tainta M, de Arriba M, Gorostidi A, Zulaica M, Villanua J, Diaz Z, Borrego-Ecija S, Olives J, Lladó A, Balasa M, Antonell A, Bargallo N, Premi E, Cosseddu M, Gazzina S, Padovani A, Gasparotti R, Archetti S, Black S, Mitchell S, Rogaeva E, Freedman M, Keren R, Tang-Wai D, Öijerstedt L, Andersson C, Jelic V, Thonberg H, Arighi A, Fenoglio C, Scarpini E, Fumagalli G, Cope T, Timberlake C, Rittman T, Shoesmith C, Bartha R, Rademakers R, Wilke C, Karnath HO, Bender B, Bruffaerts R, Vandamme P, Vandenbulcke M, Ferreira CB, Miltenberger G, Maruta C, Verdelho A, Afonso S, Taipa R, Caroppo P, Di Fede G, Giaccone G, Prioni S, Redaelli V, Rossi G, Tiraboschi P, Duro D, Rosario Almeida M, Castelo-Branco M, João Leitão M, Tabuas-Pereira M, Santiago B, Gauthier S, Schonecker S, Semler E, Anderl-Straub S, Benussi L, Binetti G, Ghidoni R, Pievani M, Lombardi G, Nacmias B, Ferrari C, Bessi V. Serum neurofilament light chain in genetic frontotemporal dementia: a longitudinal, multicentre cohort study. Lancet Neurol 2019; 18:1103-1111. [PMID: 31701893 DOI: 10.1016/s1474-4422(19)30354-0] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/26/2019] [Accepted: 08/13/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Neurofilament light chain (NfL) is a promising blood biomarker in genetic frontotemporal dementia, with elevated concentrations in symptomatic carriers of mutations in GRN, C9orf72, and MAPT. A better understanding of NfL dynamics is essential for upcoming therapeutic trials. We aimed to study longitudinal NfL trajectories in people with presymptomatic and symptomatic genetic frontotemporal dementia. METHODS We recruited participants from 14 centres collaborating in the Genetic Frontotemporal Dementia Initiative (GENFI), which is a multicentre cohort study of families with genetic frontotemporal dementia done across Europe and Canada. Eligible participants (aged ≥18 years) either had frontotemporal dementia due to a pathogenic mutation in GRN, C9orf72, or MAPT (symptomatic mutation carriers) or were healthy at-risk first-degree relatives (either presymptomatic mutation carriers or non-carriers), and had at least two serum samples with a time interval of 6 months or more. Participants were excluded if they had neurological comorbidities that were likely to affect NfL, including cerebrovascular events. We measured NfL longitudinally in serum samples collected between June 8, 2012, and Dec 8, 2017, through follow-up visits annually or every 2 years, which also included MRI and neuropsychological assessments. Using mixed-effects models, we analysed NfL changes over time and correlated them with longitudinal imaging and clinical parameters, controlling for age, sex, and study site. The primary outcome was the course of NfL over time in the various stages of genetic frontotemporal dementia. FINDINGS We included 59 symptomatic carriers and 149 presymptomatic carriers of a mutation in GRN, C9orf72, or MAPT, and 127 non-carriers. Nine presymptomatic carriers became symptomatic during follow-up (so-called converters). Baseline NfL was elevated in symptomatic carriers (median 52 pg/mL [IQR 24-69]) compared with presymptomatic carriers (9 pg/mL [6-13]; p<0·0001) and non-carriers (8 pg/mL [6-11]; p<0·0001), and was higher in converters than in non-converting carriers (19 pg/mL [17-28] vs 8 pg/mL [6-11]; p=0·0007; adjusted for age). During follow-up, NfL increased in converters (b=0·097 [SE 0·018]; p<0·0001). In symptomatic mutation carriers overall, NfL did not change during follow-up (b=0·017 [SE 0·010]; p=0·101) and remained elevated. Rates of NfL change over time were associated with rate of decline in Mini Mental State Examination (b=-94·7 [SE 33·9]; p=0·003) and atrophy rate in several grey matter regions, but not with change in Frontotemporal Lobar Degeneration-Clinical Dementia Rating scale score (b=-3·46 [SE 46·3]; p=0·941). INTERPRETATION Our findings show the value of blood NfL as a disease progression biomarker in genetic frontotemporal dementia and suggest that longitudinal NfL measurements could identify mutation carriers approaching symptom onset and capture rates of brain atrophy. The characterisation of NfL over the course of disease provides valuable information for its use as a treatment effect marker. FUNDING ZonMw and the Bluefield project.
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Affiliation(s)
- Emma L van der Ende
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Lieke H Meeter
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jackie M Poos
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jessica L Panman
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Lize C Jiskoot
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Elise G P Dopper
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Janne M Papma
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Frank Jan de Jong
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Inge M W Verberk
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Charlotte Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Carolin Heller
- Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Rhian S Convery
- Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Katrina M Moore
- Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Martina Bocchetta
- Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Mollie Neason
- Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - David M Cash
- Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Neurology unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Daniela Galimberti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurodegenerative Diseases Unit, Milan, Italy; University of Milan, Centro Dino Ferrari, Milan, Italy
| | - Raquel Sanchez-Valle
- Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Fermin Moreno
- Department of Neurology, Hospital Universitario Donostia, Gipuzkoa, Spain
| | - Matthis Synofzik
- Hertie-Institute for Clinical Brain Research Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE) Tübingen, Tübingen, Germany
| | - Caroline Graff
- Karolinska Institutet, Dept NVS, Division of Neurogeriatrics, Stockholm, Sweden; Unit of Hereditary Dementia, Theme Aging, Karolinska University Hospital-Solna, Stockholm, Sweden
| | | | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada
| | | | | | - Isabel Santana
- Center for Neuroscience and Cell Biology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Chris Butler
- Department of Clinical Neurology, University of Oxford, Oxford, UK
| | - Simon Ducharme
- Montreal Neurological Institute and McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Alex Gerhard
- Faculty of Medical and Human Sciences, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Adrian Danek
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Johannes Levin
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Neurodegenerative Diseases, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Markus Otto
- Department of Neurology, Universität Ulm, Ulm, Germany
| | - Giovanni B Frisoni
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Stefano Cappa
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam and Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center, location VU University Medical Center, Amsterdam, Netherlands
| | - Jonathan D Rohrer
- Dementia Research Institute, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - John C van Swieten
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands.
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Sani TP, Bond RL, Marshall CR, Hardy CJ, Russell LL, Moore KM, Slattery CF, Paterson RW, Woollacott IO, Wendi IP, Crutch SJ, Schott JM, Rohrer JD, Eriksson SH, Dijk DJ, Warren JD. Sleep symptoms in syndromes of frontotemporal dementia and Alzheimer's disease: A proof-of-principle behavioural study. eNeurologicalSci 2019; 17:100212. [PMID: 31828228 PMCID: PMC6889070 DOI: 10.1016/j.ensci.2019.100212] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 10/04/2019] [Accepted: 10/28/2019] [Indexed: 11/17/2022] Open
Abstract
Sleep is a key concern in dementias but their sleep phenotypes are not well defined. We addressed this issue in major FTD and AD syndromes versus healthy older controls. We surveyed sleep duration, quality and disruptive events, and daytime somnolence. Sleep symptoms were frequent in FTD and AD and distinguished these diseases. Sleep disturbance is an important clinical issue across major FTD and AD syndromes.
Sleep disruption is a key clinical issue in the dementias but the sleep phenotypes of these diseases remain poorly characterised. Here we addressed this issue in a proof-of-principle study of 67 patients representing major syndromes of frontotemporal dementia (FTD) and Alzheimer’s disease (AD), in relation to 25 healthy older individuals. We collected reports on clinically-relevant sleep characteristics - time spent overnight in bed, sleep quality, excessive daytime somnolence and disruptive sleep events. Difficulty falling or staying asleep at night and excessive daytime somnolence were significantly more frequently reported for patients with both FTD and AD than healthy controls. On average, patients with FTD and AD retired earlier and patients with AD spent significantly longer in bed overnight than did healthy controls. Excessive daytime somnolence was significantly more frequent in the FTD group than the AD group; AD syndromic subgroups showed similar sleep symptom profiles while FTD subgroups showed more variable profiles. Sleep disturbance is a significant clinical issue in major FTD and AD variant syndromes and may be even more salient in FTD than AD. These preliminary findings warrant further systematic investigation with electrophysiological and neuroanatomical correlation in major proteinopathies.
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Affiliation(s)
- Tara P. Sani
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
- Neurology Department, Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Rebecca L. Bond
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Charles R. Marshall
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Chris J.D. Hardy
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Lucy L. Russell
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Katrina M. Moore
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Catherine F. Slattery
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Ross W. Paterson
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Ione O.C. Woollacott
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Indra Putra Wendi
- Department of Chemistry and Biochemistry, Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Sebastian J. Crutch
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Jonathan M. Schott
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Jonathan D. Rohrer
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Sofia H. Eriksson
- Department of Clinical and Experiential Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, University of Surrey, UK
- Dementia Research Institute, UK
| | - Jason D. Warren
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
- Corresponding author at: Dementia Research Centre, UCL Institute of Neurology, University College London, London WC1N 3BG, UK.
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