Developing an evidence base for trials in genetic frontotemporal dementia - measures of disease onset and progression
Lead Research Organisation:
University College London
Department Name: Institute of Neurology
Abstract
Frontotemporal dementia (FTD) is a common cause of young onset dementia. The only known risk factors for FTD at present are genetic with three genes accounting for the majority of familial FTD, called progranulin, tau and chromosome 9 open reading frame 72. There are now promising avenues for treatment of these disorders but we still do not know when drugs should be started or how we should measure the response to treatment. This study plans to investigate people who have genetic FTD, including both people who have developed symptoms and also people who have a risk of developing symptoms in the future because they carry the abnormal genetic mutation. This allows a window into the earliest changes in the disease process. 30 study subjects from families with genetic FTD will have psychology testing, brain imaging, blood tests and spinal fluid collection annually at three time-points in order to investigate the patterns of change in these different tests at different stages of the disorder. Brain imaging will include not only magnetic resonance imaging but also the novel technique of tau positron emission tomography which may be able to identify the presence of tau pathology in the brains of people with tau mutations for the first time during life. The study subjects will be part of a larger multicentre study called the Genetic Frontotemporal dementia Initiative (GENFI) and data will be available for analysis from over 300 subjects who take part in that initiative. The key outcomes of the study will be to develop markers which help identify the disease at its earliest stage as well as markers that allow the progression of the disease to be tracked. These markers can then be used in future clinical trials of drugs in genetic FTD.
Technical Summary
Frontotemporal dementia (FTD) is a common cause of young onset dementia, approximately equal in frequency to Alzheimer's disease in people below the age of 65. Its effect particularly on people of working age with young families represents a major health and economic burden on society. The only known risk factors for FTD are genetic, and around a third of FTD is familial. The aim of the study is to understand the ordering and temporal evolution of imaging and fluid biomarker change in genetic FTD and their clinical associations, forming an evidence base for future clinical trials. In particular, through comprehensive longitudinal phenotyping, the key objectives are to: characterise the earliest neuropsychological and behavioural changes; identify the earliest anatomical changes that occur and how these change over time; evaluate how measures of structural and functional connectivity change over time; examine the role of tau PET imaging as a marker of tau pathology; and correlate changes in CSF and serum markers with changes in neuroimaging. The experimental plan uses cross-sectional and longitudinal measures of behaviour, cognition, neuroimaging and both CSF and serum markers to elucidate the patterns of biomarker change in genetic FTD with the overarching hypothesis being that biomarkers can aid in the identification of disease and tracking of disease progression. The study aims to be the foundation for clinical trials in genetic FTD with the key outcomes being identification of markers of disease onset including those including those indicative of optimal time to start disease-modifying therapy and markers of disease progression that can be used as outcome measures in clinical trials, as well as estimations of the sample sizes necessary for those trials.
Planned Impact
The outcomes of this study will lead to improvement in the recognition and diagnosis of genetic FTD as well as provide improved prognostic information for patients and members of their family in the first instance. This will be important to clinicians and policymakers in that it will allow a better representation of the incidence of genetic FTD in the UK. This study in combination with GENFI will provide a platform for clinical trials in genetic FTD, likely to occur in the next five years: finding a disease-modifying therapy in this disorder will be hugely beneficial both for the patient and their families at risk of the disorder, as well as improving the nation's health and wealth by altering a disease process that affects people generally of working age. Based on the current understanding of the pathophysiology of the disease, it is probable that effective interventions for genetic FTD due to progranulin mutations will become available either by repurposing or from novel agents. Rapid evaluation will support the G8 declaration of a treatment for dementia by 2025. This would have significant UK political benefit building on the UK lead internationally in the G8 dementia summit.
The outcomes of this study in terms of biomarkers of disease onset and progression will feed into pharmaceutical industry-led studies, providing the knowledge required to identify the primary and secondary outcomes used in clinical trials and the timing of when the trials should take place.
The outcomes of this study in terms of biomarkers of disease onset and progression will feed into pharmaceutical industry-led studies, providing the knowledge required to identify the primary and secondary outcomes used in clinical trials and the timing of when the trials should take place.
People |
ORCID iD |
Jonathan Daniel Rohrer (Principal Investigator / Fellow) |
Publications
Adams-Carr K
(2019)
A case of TDP-43 type C pathology presenting as nonfluent variant primary progressive aphasia
in Neurocase
Ahmed RM
(2021)
Tackling clinical heterogeneity across the amyotrophic lateral sclerosis-frontotemporal dementia spectrum using a transdiagnostic approach.
in Brain communications
Altmann A
(2020)
Analysis of brain atrophy and local gene expression in genetic frontotemporal dementia.
in Brain communications
Barbier M
(2021)
SLITRK2, an X-linked modifier of the age at onset in C9orf72 frontotemporal lobar degeneration.
in Brain : a journal of neurology
Belder CRS
(2024)
Primary progressive aphasia: six questions in search of an answer.
in Journal of neurology
Belder CRS
(2022)
The problematic syndrome of right temporal lobe atrophy: Unweaving the phenotypic rainbow.
in Frontiers in neurology
Benatar M
(2022)
Preventing amyotrophic lateral sclerosis: insights from pre-symptomatic neurodegenerative diseases.
in Brain : a journal of neurology
Benussi A
(2024)
Diagnostic accuracy of research criteria for prodromal frontotemporal dementia.
in Alzheimer's research & therapy
Description | Developing a platform trial for frontotemporal dementia |
Amount | $490,988 (USD) |
Organisation | Milken Institute |
Sector | Charity/Non Profit |
Country | United States |
Start | 03/2024 |
End | 02/2026 |
Description | Novel fluid biomarkers of progranulin-associated FTD |
Amount | $219,999 (USD) |
Organisation | Bluefield Project |
Sector | Charity/Non Profit |
Country | United States |
Start | 01/2019 |
End | 12/2020 |
Title | Additional file 1 of Differential chemokine alteration in the variants of primary progressive aphasia-a role for neuroinflammation |
Description | Additional file 1: Supplementary Figure 1. Mean normalized protein expression values for the chemokines in controls and each of PPA groups in plasma. Significant differences with p values are shown on the graphs. |
Type Of Material | Database/Collection of data |
Year Produced | 2021 |
Provided To Others? | Yes |
URL | https://springernature.figshare.com/articles/dataset/Additional_file_1_of_Differential_chemokine_alt... |
Title | Additional file 1 of Differential chemokine alteration in the variants of primary progressive aphasia-a role for neuroinflammation |
Description | Additional file 1: Supplementary Figure 1. Mean normalized protein expression values for the chemokines in controls and each of PPA groups in plasma. Significant differences with p values are shown on the graphs. |
Type Of Material | Database/Collection of data |
Year Produced | 2021 |
Provided To Others? | Yes |
URL | https://springernature.figshare.com/articles/dataset/Additional_file_1_of_Differential_chemokine_alt... |
Title | GENFI XNAT database |
Description | Database of biomarker data from the GENFI 1 and GENFI 2 projects (presymptomatic and early symptomatic genetic FTD). |
Type Of Material | Database/Collection of data |
Year Produced | 2014 |
Provided To Others? | Yes |
Impact | 30 current analyses ongoing across multiple centres within GENFI. |
Description | Frontotemporal dementia Prevention Initiative - FPI |
Organisation | University of California, San Francisco |
Department | Memory and Ageing Centre UCSF |
Country | United States |
Sector | Academic/University |
PI Contribution | This is a collaboration of the GENFI study led by me with other international studies - ARTFL/LEFFTDS in the US and DINAD in Australia. I jointly lead the initiative |
Collaborator Contribution | The PIs of the studies jointly run this collaboration - we have developed shared guidelines for academic-pharma partnerships for future clinical trials in FTD as well as a shared dataset. |
Impact | The collaboration has developed guidelines for academic-pharma partnerships which will be used in upcoming trials. |
Start Year | 2017 |
Description | Annual FTD support group seminar 2016 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Patients, carers and/or patient groups |
Results and Impact | Seminar chaired by Jonathan Rohrer (supervisor) with talk by Elizabeth Gordon (PhD studentship) about her PhD work. |
Year(s) Of Engagement Activity | 2016 |
Description | British Science Festival |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Public/other audiences |
Results and Impact | Talk on young onset dementia and presymptomatic neurodegenerative disease highlighting the work of the GENFI project as part of the national British Science Festival - around 70 people attended with both a panel discussion and personal questions afterwards. |
Year(s) Of Engagement Activity | 2015 |
URL | https://thelittleboxoffice.com/bsa/event/view/26635 |
Description | Contribution to online learning module about dementia (MOOC) |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | Videoed talk and written information provided for an online learning tool about dementia - highlighting my research and work on GENFI project. Over 10,000 people currently signed up for course (official start March 2016). |
Year(s) Of Engagement Activity | 2016 |
URL | https://www.futurelearn.com/courses/faces-of-dementia |
Description | FTD support group meeting |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Patients, carers and/or patient groups |
Results and Impact | ~70 people attended, mainly carers but also professionals, to hear about the latest research, with a question and answer session afterwards including discussion of patient involvement in future study design. |
Year(s) Of Engagement Activity | 2018 |
Description | FTD talk website |
Form Of Engagement Activity | Engagement focused website, blog or social media channel |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | I have set up and run a public engagement website dedicated to frontotemporal dementia (FTD talk) - it aims to provide information to the public about FTD, and particularly lay updates about research. There is an active blog about my research. |
Year(s) Of Engagement Activity | 2014,2015,2016,2017,2018,2019,2020,2021 |
URL | http://www.ftdtalk.org |
Description | Familial FTD support group |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Patients, carers and/or patient groups |
Results and Impact | Talk to around 100 people as part of the familial FTD support group annual day - discussion about GENFI and current research; questions and discussion about research from family members and those at risk of developing genetic FTD. |
Year(s) Of Engagement Activity | 2015 |
URL | https://www.ucl.ac.uk/drc/support-groups/fFTD-support-group |
Description | Meet the researcher Youtube video |
Form Of Engagement Activity | Engagement focused website, blog or social media channel |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | Video made to inform people about research at UCL - interview about work on FTD. |
Year(s) Of Engagement Activity | 2014,2015,2016,2017 |
URL | https://www.youtube.com/watch?v=8oMe4bgSHoY&feature=youtu.be |
Description | Pint of Science 2019 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Public/other audiences |
Results and Impact | 120 attendees at a Pint of Science event describing our research work - lots of questions and engagement in interactive activities from the audience. |
Year(s) Of Engagement Activity | 2019 |
URL | https://pintofscience.co.uk/event/speechless |
Description | Pint of Science 2022 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Public/other audiences |
Results and Impact | Talk on our FTD research work as part of the Pint of Science annual meeting in 2022 - to ~140 members of public. |
Year(s) Of Engagement Activity | 2022 |
Description | Pint of Science Festival |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Public/other audiences |
Results and Impact | Around 100 people attended an event as part of the national Pint of Science Festival - discussion regarding young onset dementias and the work we are doing to find biomarkers and an evidence base for clinical trials - lots of questions and discussion afterwards and personal feedback from audience regarding how much they learned about the area. |
Year(s) Of Engagement Activity | 2015 |
Description | Talk at FTD support group annual seminar 2017 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Patients, carers and/or patient groups |
Results and Impact | Increased awareness of FTD research and the work we are doing to FTD support group consisting mainly of carers. |
Year(s) Of Engagement Activity | 2017 |
Description | Talk to event for UK magistrates |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Other audiences |
Results and Impact | Talk on frontotemporal dementia to a UK magistrates event to inform them about forensic nature of symptomatology of FTD and how our research is exploring this further - long discussion afterwards about how this might inform the work of magistrates, particularly in considering dementia as a underlying problem with people who have been involved in crimes and therefore may change their practice. |
Year(s) Of Engagement Activity | 2015 |
Description | The Science Museum - Science Lates - Dementia |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Public/other audiences |
Results and Impact | Organised and presented at a section of the Science Museum 'Science Lates' evening in April 2016. My section had 5 stands (manned by 10 of my team) each focused on different parts of clinical and imaging dementia research that represented our current research work, particularly focusing on young onset and genetic dementias. >4000 people attended the event. Many people said that their views and understanding about dementia changed as a result of visiting our section. |
Year(s) Of Engagement Activity | 2016 |