The clinical and pathological phenotype of C9ORF72 hexanucleotide repeat expansions.
There is increasing evidence that frontotemporal dementia and amyotrophic lateral sclerosis are part of a disease continuum. Recently, a hexanucleotide repeat expansion in C9orf72 was identified as a major cause of both sporadic and familial frontotemporal dementia and amyotrophic lateral sclerosis. The aim of this study was to investigate clinical and neuropathological characteristics of hexanucleotide repeat expansions in C9orf72 in a large cohort of Dutch patients with frontotemporal dementia. Repeat expansions were successfully determined in a cohort of 353 patients with sporadic or familial frontotemporal dementia with or without amyotrophic lateral sclerosis, and 522 neurologically normal controls. Immunohistochemistry was performed in a series of 10 brains from patients carrying expanded repeats using a panel of antibodies. In addition, the presence of RNA containing GGGGCC repeats in paraffin-embedded sections of post-mortem brain tissue was investigated using fluorescence in situ hybridization with a locked nucleic acid probe targeting the GGGGCC repeat. Hexanucleotide repeat expansions in C9orf72 were found in 37 patients with familial (28.7%) and five with sporadic frontotemporal dementia (2.2%). The mean age at onset was 56.9 ± 8.3 years (range 39-76), and disease duration 7.6 ± 4.6 years (range 1-22). The clinical phenotype of these patients varied between the behavioural variant of frontotemporal dementia (n = 34) and primary progressive aphasia (n = 8), with concomitant amyotrophic lateral sclerosis in seven patients. Predominant temporal atrophy on neuroimaging was present in 13 of 32 patients. Pathological examination of the 10 brains from patients carrying expanded repeats revealed frontotemporal lobar degeneration with neuronal transactive response DNA binding protein-positive inclusions of variable type, size and morphology in all brains. Fluorescence in situ hybridization analysis of brain material from patients with the repeat expansion, a microtubule-associated protein tau or a progranulin mutation, and controls did not show RNA-positive inclusions specific for brains with the GGGGCC repeat expansion. The hexanucleotide repeat expansion in C9orf72 is an important cause of frontotemporal dementia with and without amyotrophic lateral sclerosis, and is sometimes associated with primary progressive aphasia. Neuropathological hallmarks include neuronal and glial inclusions, and dystrophic neurites containing transactive response DNA binding protein. Future studies are needed to explain the wide variation in clinical presentation.
Department of Clinical Genetics, VU University Medical Centre, 1007 MB Amsterdam, The Netherlands.
Javier
J
Simón-Sánchez
Elise G P
EG
Dopper
Petra E
PE
Cohn-Hokke
Renate K
RK
Hukema
Nayia
N
Nicolaou
Harro
H
Seelaar
J Roos A
JR
de Graaf
Inge
I
de Koning
Natasja M
NM
van Schoor
Dorly J H
DJ
Deeg
Marion
M
Smits
Joost
J
Raaphorst
Leonard H
LH
van den Berg
Helenius J
HJ
Schelhaas
Christine E M
CE
De Die-Smulders
Danielle
D
Majoor-Krakauer
Annemieke J M
AJ
Rozemuller
Rob
R
Willemsen
Yolande A L
YA
Pijnenburg
Peter
P
Heutink
John C
JC
van Swieten
D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000235:genetics* / Q000473:pathology* / Q000523:psychology; D001344:Autopsy; D000073885:C9orf72 Protein; D015331:Cohort Studies; D042622:DNA Repeat Expansion; D004268:DNA-Binding Proteins / Q000235:genetics; D005260:Female; D057180:Frontotemporal Dementia / Q000235:genetics* / Q000473:pathology* / Q000523:psychology; D005838:Genotype; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D036341:Intercellular Signaling Peptides and Proteins / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009474:Neurons / Q000473:pathology; D009483:Neuropsychological Tests; D010375:Pedigree; D016133:Polymerase Chain Reaction; D000077153:Progranulins; D011506:Proteins / Q000235:genetics*; D014015:Tissue Banks; D016875:tau Proteins / Q000235:genetics
D000073885:C9orf72 Protein; C568651:C9orf72 protein, human; D004268:DNA-Binding Proteins; C492314:GRN protein, human; D036341:Intercellular Signaling Peptides and Proteins; D000077153:Progranulins; D011506:Proteins; D016875:tau Proteins