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Frontotemporal dementia and its subtypes: a genome-wide association study - 17/06/14

Doi : 10.1016/S1474-4422(14)70065-1 
Raffaele Ferrari, PhD a, b, *, Dena G Hernandez, MSc b, c, *, Michael A Nalls, PhD c, *, Jonathan D Rohrer, PhD b, bw, *, Adaikalavan Ramasamy, PhD b, cm, John B J Kwok, PhD f, g, Carol Dobson-Stone, PhD f, g, William S Brooks, MBBS f, g, Peter R Schofield, ProfDSc f, g, Glenda M Halliday, ProfPhD f, g, John R Hodges, ProfMD f, g, Olivier Piguet, PhD f, g, Lauren Bartley, MSc f, Elizabeth Thompson, MD h, i, Eric Haan, ProfMBBS h, i, Isabel Hernández, MD j, Agustín Ruiz, MD j, Mercè Boada, MD j, k, Barbara Borroni, MD l, Alessandro Padovani, ProfMD l, Carlos Cruchaga, PhD m, n, Nigel J Cairns, ProfPhD n, o, Luisa Benussi, PhD p, Giuliano Binetti, MD p, Roberta Ghidoni, PhD q, Gianluigi Forloni, PhD r, Daniela Galimberti, PhD s, t, Chiara Fenoglio, PhD s, t, Maria Serpente, PhD s, t, Elio Scarpini, MD s, t, Jordi Clarimón, PhD u, v, Alberto Lleó, MD u, v, Rafael Blesa, MD u, v, Maria Landqvist Waldö, MD w, Karin Nilsson, PhD w, Christer Nilsson, PhD x, Ian R A Mackenzie, ProfMD y, Ging-Yuek R Hsiung, MD z, David M A Mann, ProfPhD aa, Jordan Grafman, ProfPhD ab, ac, ad, Christopher M Morris, PhD ab, ac, ae, af, ag, Johannes Attems, ProfMD ab, ac, ae, af, Timothy D Griffiths, ProfFMedSci ab, ac, ae, ag, Ian G McKeith, ProfMD ah, Alan J Thomas, ProfPhD af, P Pietrini, ProfMD ai, aj, Edward D Huey, MD ak, Eric M Wassermann, MD al, Atik Baborie, MD am, Evelyn Jaros, PhD af, an, Michael C Tierney, MSc al, Pau Pastor, MD v, ao, ap, Cristina Razquin, PhD ao, Sara Ortega-Cubero, MD v, ao, Elena Alonso, BSc ao, Robert Perneczky, MD aq, ar, as, Janine Diehl-Schmid, MD as, Panagiotis Alexopoulos, MD as, Alexander Kurz, MD as, Innocenzo Rainero, MD at, au, Elisa Rubino, MD at, au, Lorenzo Pinessi, ProfMD at, au, Ekaterina Rogaeva, PhD av, Peter St George-Hyslop, MD av, aw, Giacomina Rossi, PhD ax, Fabrizio Tagliavini, MD ax, Giorgio Giaccone, MD ax, James B Rowe, PhD ay, az, ba, Johannes C M Schlachetzki, MD bb, bc, James Uphill, BSc bd, John Collinge, ProfMD bd, Simon Mead, ProfPhD bd, Adrian Danek, MD be, bf, Vivianna M Van Deerlin, PhD bg, Murray Grossman, ProfMD bg, John Q Trojanowski, ProfPhD bg, Julie van der Zee, PhD bh, bi, William Deschamps, MSc bh, bi, Tim Van Langenhove, MD bh, bi, Marc Cruts, PhD bh, bi, Christine Van Broeckhoven, ProfPhD bh, bi, Stefano F Cappa, ProfMD bj, Isabelle Le Ber, MD bk, bl, Didier Hannequin, ProfMD bm, Véronique Golfier, MD bn, Martine Vercelletto, MD bo, Alexis Brice, MD bk, bl, Benedetta Nacmias, PhD bp, Sandro Sorbi, ProfPhD bp, Silvia Bagnoli, PhD bp, Irene Piaceri, PhD bp, Jørgen E Nielsen, MD bq, br, Lena E Hjermind, MD bq, br, Matthias Riemenschneider, ProfMD bs, bt, Manuel Mayhaus, PhD bt, Bernd Ibach, PhD bu, Gilles Gasparoni, PhD bt, Sabrina Pichler, MSc bt, Wei Gu, PhD bt, bv, Martin N Rossor, ProfMD bw, Nick C Fox, ProfMD bw, Jason D Warren, PhD bw, Maria Grazia Spillantini, ProfPhD bx, Huw R Morris, ProfPhD by, Patrizia Rizzu, PhD bz, Peter Heutink, ProfPhD bz, Julie S Snowden, ProfPhD e, Sara Rollinson, PhD e, Anna Richardson, MB ca, Alexander Gerhard, MD cb, Amalia C Bruni, MD cc, Raffaele Maletta, MD cc, Francesca Frangipane, MD cc, Chiara Cupidi, MD cc, Livia Bernardi, PhD cc, Maria Anfossi, PhD cc, Maura Gallo, PhD cc, Maria Elena Conidi, PhD cc, Nicoletta Smirne, BSc cc, Rosa Rademakers, ProfPhD cd, Matt Baker, BSc cd, Dennis W Dickson, ProfMD cd, Neill R Graff-Radford, ProfMD ce, Ronald C Petersen, ProfMD cf, David Knopman, ProfMD cf, Keith A Josephs, ProfMD cf, Bradley F Boeve, ProfMD cf, Joseph E Parisi, ProfMD cg, William W Seeley, MD ch, Bruce L Miller, ProfMD ch, Anna M Karydas, BA ch, Howard Rosen, ProfMD ch, John C van Swieten, ProfMD ci, cj, Elise G P Dopper, MD ci, Harro Seelaar, PhD ci, Yolande A L Pijnenburg, MD ck, Philip Scheltens, ProfMD ck, Giancarlo Logroscino, MD cl, Rosa Capozzo, MD cl, Valeria Novelli, PhD cn, Annibale A Puca, MD co, cp, Massimo Franceschi, MD cq, Alfredo Postiglione, ProfMD cr, Graziella Milan, MD cs, Paolo Sorrentino, MD cs, Mark Kristiansen, PhD ct, Huei-Hsin Chiang, PhD cu, cv, Caroline Graff, ProfMD cu, cv, Florence Pasquier, ProfMD cw, Adeline Rollin, MD cw, Vincent Deramecourt, MD cw, Florence Lebert, MD cw, Dimitrios Kapogiannis, MD cx, Luigi Ferrucci, MD d, Stuart Pickering-Brown, ProfPhD e, Andrew B Singleton, PhD c, †, John Hardy, ProfPhD b, ⁎, † , Parastoo Momeni, PhD a, †
a Laboratory of Neurogenetics, Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas, USA 
b Reta Lila Weston Research Laboratories, Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK 
c Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA 
d Clinical Research Branch, National Institute on Aging, Baltimore, MD, USA 
e Institute of Brain, Behaviour and Mental Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK 
f Neuroscience Research Australia, Sydney, NSW, Australia 
g University of New South Wales, Sydney, NSW, Australia 
h South Australian Clinical Genetics Service, SA Pathology at Women’s and Children’s Hospital, North Adelaide, SA, Australia 
i Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia 
j Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain 
k Hospital Universitari Vall d’Hebron–Institut de Recerca, Universitat Autonoma de Barcelona (VHIR-UAB), Barcelona, Spain 
l Neurology Clinic, University of Brescia, Brescia, Italy 
m Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, USA 
n Hope Center, Washington University School of Medicine, St Louis, Missouri, USA 
o Department of Pathology and Immunology, Washington University, St Louis, Missouri, USA 
p NeuroBioGen Lab—Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy 
q Proteomics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy 
r Biology of Neurodegenerative Disorders, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy 
s University of Milan, Milan, Italy 
t Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy 
u Memory Unit, Neurology Department and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain 
v Center for Networker Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain 
w Unit of Geriatric Psychiatry, Department of Clinical Sciences, Lund University, Sweden 
x Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Sweden 
y Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada 
z Division of Neurology, University of British Columbia, Vancouver, Canada 
aa Institute of Brain, Behaviour and Mental Health, University of Manchester, Salford Royal Hospital, Stott Lane, Salford, UK 
ab Rehabilitation Institute of Chicago, Departments of Physical Medicine and Rehabilitation, Psychiatry, and Cognitive Neurology and Alzheimer’s Disease Center, IL, USA 
ac Feinberg School of Medicine, Northwestern University, IL, USA 
ad Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, IL, USA 
ae Newcastle Brain Tissue Resource, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK 
af Newcastle University, Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle upon Tyne, UK 
ag Institute of Neuroscience, Newcastle University Medical School, Newcastle upon Tyne, UK 
ah Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK 
ai Clinical Psychology Branch, Pisa University Hospital, Pisa, Italy 
aj Laboratory of Clinical Biochemistry and Molecular Biology, University of Pisa, Pisa, Italy 
ak Taub Institute, Departments of Psychiatry and Neurology, Columbia University, New York, NY, USA 10032 
al Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA 
am Neuropathology Department, Walton Centre FT, Liverpool, UK 
an Neuropathology/Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK 
ao Neurogenetics Laboratory, Division of Neurosciences, Center for Applied Medical Research, Universidad de Navarra, Pamplona, Spain 
ap Department of Neurology, Clínica Universidad de Navarra, University of Navarra School of Medicine, Pamplona, Spain 
aq Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, The Imperial College of Science, Technology and Medicine, London, UK 
ar West London Cognitive Disorders Treatment and Research Unit, West London Mental Health Trust, London TW8 8 DS, UK 
as Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany 
at Neurology I, Department of Neuroscience, University of Torino, Italy 
au AO Città della Salute e della Scienza di Torino, Italy 
av Tanz Centre for Research in Neurodegenerative Diseases and Department of Medicine, University of Toronto, Toronto, Ontario, Canada 
aw Cambridge Institute for Medical Research and the Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK 
ax Division of Neurology V and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy 
ay Cambridge University Department of Clinical Neurosciences, Cambridge CB2 0SZ, UK 
az MRC Cognition and Brain Sciences Unit, Cambridge, UK 
ba Behavioural and Clinical Neuroscience Institute, Cambridge, UK 
bb Department of Psychiatry and Psychotherapy, University of Freiburg Medical School, Germany 
bc Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany 
bd MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK 
be Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Munich, Germany 
bf German Center for Neurodegenerative Diseases (DZNE), Munich, Germany 
bg University of Pennsylvania Perelman School of Medicine, Department of Neurology and Penn Frontotemporal Degeneration Center, Philadelphia, PA, USA 
bh Neurodegenerative Brain Diseases group, Department of Molecular Genetics, VIB, Antwerp, Belgium 
bi Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium 
bj Neurorehabilitation Unit, Deptartment Of Clinical Neuroscience, Vita-Salute University and San Raffaele Scientific Institute, Milan, Italy 
bk Inserm, UMR_S975, CRICM, F-75013; UPMC Univ Paris 06, UMR_S975, F-75013; and CNRS UMR 7225, F-75013, Paris, France 
bl AP-HP, Hôpital de la Salpêtrière, Département de Neurologie-Centre de Références des Démences Rares, F-75013, Paris, France 
bm Service de Neurologie, Inserm U1079, CNR-MAJ, Rouen University Hospital, France 
bn Service de neurologie, CH Saint Brieuc, France 
bo Service de Neurologie, CHU Nantes, France 
bp Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA) University of Florence, Florence, Italy 
bq Danish Dementia Research Centre, Neurogenetics Clinic, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark 
br Department of Cellular and Molecular Medicine, Section of Neurogenetics, The Panum Institute, University of Copenhagen, Denmark 
bs Saarland University Hospital, Department for Psychiatry and Psychotherapy, Homburg/Saar, Germany 
bt Saarland University, Laboratory for Neurogenetics, Kirrberger, Homburg/Saar, Germany 
bu University Regensburg, Department of Psychiatry, Psychotherapy and Psychosomatics, Universitätsstr 84, Regensburg, Germany 
bv Luxembourg Centre For Systems Biomedicine (LCSB), University of Luxembourg, Luxembourg 
bw Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK 
bx University of Cambridge, Department of Clinical Neurosciences, John Van Geest Brain Repair Centre, Cambridge, UK 
by MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, School of Medicine, Cardiff, UK 
bz German Center of Neurodegenerative Diseases-Tübingen, Tübingen, Germany 
ca Salford Royal Foundation Trust, Faculty of Medical and Human Sciences, University of Manchester, UK 
cb Institute of Brain, Behaviour and Mental Health, The University of Manchester, Withington, Manchester, UK 
cc Regional Neurogenetic Centre, ASPCZ, Lamezia Terme, Italy 
cd Department of Neuroscience, Mayo Clinic Jacksonville, Jacksonville, FL, USA 
ce Department of Neurology, Mayo Clinic Jacksonville, Jacksonville, FL, USA 
cf Department of Neurology, Mayo Clinic Rochester, Rochester, MN, USA 
cg Department of Pathology, Mayo Clinic Rochester, Rochester, MN, USA 
ch Department of Neurology, University of California, San Francisco, CA, USA 
ci Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands 
cj Department of Medical Genetics, VU University Medical Centre, Amsterdam, The Netherlands 
ck Alzheimer Centre and Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands 
cl Department of Basic Medical Sciences, Neurosciences and Sense Organs of the Aldo Moro, University of Bari, Italy 
cm Department of Medical and Molecular Genetics, King’s College London, Guy’s Hospital, London, UK 
cn Department of Molecular Cardiology, IRCCS Fondazione S Maugeri, Pavia, Italy 
co Cardiovascular Research Unit, IRCCS Multimedica, Milan, Italy 
cp Department of Medicine and Surgery, University of Salerno, Baronissi (SA), Italy 
cq Neurology Department, IRCCS Multimedica, Milan, Italy 
cr Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy 
cs Geriatric Center Frullone-ASL Napoli 1 Centro, Naples, Italy 
ct UCL Genomics, Institute of Child Health (ICH), UCL, London, UK 
cu Karolinska Institutet, Department NVS, KI-Alzheimer Disease Research Center, Stockholm, Sweden 
cv Department of Geriatric Medicine, Genetics Unit, Karolinska Universtiy Hospital, Stockholm 
cw Université Lille Nord de France, Lille, France 
cx Laboratory of Neurosciences, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA 

* Correspondence to: Prof John Hardy, Reta Lila Weston Research Laboratories, Department of Molecular Neuroscience, University College London Institute of Neurology, London WC1N 3BG, UK

Summary

Background

Frontotemporal dementia (FTD) is a complex disorder characterised by a broad range of clinical manifestations, differential pathological signatures, and genetic variability. Mutations in three genes—MAPT, GRN, and C9orf72—have been associated with FTD. We sought to identify novel genetic risk loci associated with the disorder.

Methods

We did a two-stage genome-wide association study on clinical FTD, analysing samples from 3526 patients with FTD and 9402 healthy controls. To reduce genetic heterogeneity, all participants were of European ancestry. In the discovery phase (samples from 2154 patients with FTD and 4308 controls), we did separate association analyses for each FTD subtype (behavioural variant FTD, semantic dementia, progressive non-fluent aphasia, and FTD overlapping with motor neuron disease [FTD-MND]), followed by a meta-analysis of the entire dataset. We carried forward replication of the novel suggestive loci in an independent sample series (samples from 1372 patients and 5094 controls) and then did joint phase and brain expression and methylation quantitative trait loci analyses for the associated (p<5 × 10−8) single-nucleotide polymorphisms.

Findings

We identified novel associations exceeding the genome-wide significance threshold (p<5 × 10−8). Combined (joint) analyses of discovery and replication phases showed genome-wide significant association at 6p21.3, HLA locus (immune system), for rs9268877 (p=1·05 × 10−8; odds ratio=1·204 [95% CI 1·11–1·30]), rs9268856 (p=5·51 × 10−9; 0·809 [0·76–0·86]) and rs1980493 (p value=1·57 × 10−8, 0·775 [0·69–0·86]) in the entire cohort. We also identified a potential novel locus at 11q14, encompassing RAB38/CTSC (the transcripts of which are related to lysosomal biology), for the behavioural FTD subtype for which joint analyses showed suggestive association for rs302668 (p=2·44 × 10−7; 0·814 [0·71–0·92]). Analysis of expression and methylation quantitative trait loci data suggested that these loci might affect expression and methylation in cis.

Interpretation

Our findings suggest that immune system processes (link to 6p21.3) and possibly lysosomal and autophagy pathways (link to 11q14) are potentially involved in FTD. Our findings need to be replicated to better define the association of the newly identified loci with disease and to shed light on the pathomechanisms contributing to FTD.

Funding

The National Institute of Neurological Disorders and Stroke and National Institute on Aging, the Wellcome/MRC Centre on Parkinson’s disease, Alzheimer’s Research UK, and Texas Tech University Health Sciences Center.

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