The UK GENetic Frontotemporal dementia Initiative (UK GENFI)
Lead Research Organisation:
University College London
Department Name: Institute of Neurology
Abstract
Frontotemporal dementia (FTD) is a common cause of young onset dementia. Its effect on people of working age with young families represents a major health and economic burden on society. The only known risk factors for FTD at present are genetic with abnormalities (mutations) in 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 investigates people who have genetic (inherited) FTD, including both people who have developed symptoms and also their first-degree relatives who are at 50% risk of carrying the genetic mutation and therefore developing symptoms in the future. By studying individuals who carry the disease mutation and are thus destined to develop the disease we can understand the development from the very earliest changes, which would be the best time to start any treatment whilst the person remains well. A pilot phase of the study between 2011 and 2014 has created a common platform for studying genetic FTD and a standardized testing protocol. This study builds on the pilot phase by creating a UK-wide study of genetic FTD (at University College London, University of Cambridge, University of Manchester and the University of Oxford) over the next five years. It is expected that 200 participants will be seen, being assessed three times in total. Study participants will have psychology testing (tests of memory, language, behaviour etc.), brain imaging, blood tests and spinal fluid collection (by lumbar puncture) in order to investigate the patterns of change in these different tests at different stages of the disorder. The key outcomes of the study are to (1) improve understanding of how brain systems break down in genetic FTD and how this breakdown relates to the underlying behavioural and cognitive symptoms, (2) develop markers which help identify the disease at its earliest stage, and (3) develop markers that allow the progression of the disease to be tracked. The eventual aim will be to use these markers in future clinical trials of drugs in genetic FTD. The results of this project will also lead to improvement in the recognition and diagnosis of genetic FTD as well as provide improved information about prognosis for patients and members of their family.
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 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. There are currently no treatments that can delay the onset or prevent the progression of genetic FTD but there are now potential disease-modifying therapies in development. However, there are still no biomarkers of genetic FTD that can confidently predict when disease-modifying therapy should be initiated or how the response to it should be monitored. By studying participants who carry a mutation and are thus destined to develop the disease we can explore the entire disease pathway, using mutation negative first-degree relatives as controls. A pilot study has created a common methodological platform to study genetic FTD. This follow-on study aims to capitalize on the work of the pilot, extending both the platform and expertise generated to a UK-wide study of genetic FTD. Specifically, we will establish a UK-wide familial FTD cohort of 200 participants which will (1) lead to greater understanding of the biological underpinning of the cognitive and behavioural deficits seen in FTD; (2) permit large-scale cohesive and integrated longitudinal biomarker studies of familial FTD with the specific remit of informing clinical trial design; and (3) provide a "readiness" cohort of patients for disease-modifying drug trials. The experimental plan includes longitudinal clinical and neuropsychological assessments, neuroimaging and both blood and spinal fluid sampling, with the key outcomes including improved understanding regarding the selective vulnerability of the specific neural systems affected in FTD, robust biomarkers of disease onset and progression, and estimation of sample sizes required for trials.
Planned Impact
The outcomes of UK GENFI 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. UK 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 UK GENFI 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 UK GENFI 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.
Publications
Chelban V
(2018)
An update on advances in magnetic resonance imaging of multiple system atrophy
in Journal of Neurology
Marshall CR
(2018)
Motor signatures of emotional reactivity in frontotemporal dementia.
in Scientific reports
Paterson RW
(2018)
Cerebrospinal fluid in the differential diagnosis of Alzheimer's disease: clinical utility of an extended panel of biomarkers in a specialist cognitive clinic.
in Alzheimer's research & therapy
Young AL
(2018)
Uncovering the heterogeneity and temporal complexity of neurodegenerative diseases with Subtype and Stage Inference.
in Nature communications
Bocchetta M
(2018)
Hippocampal Subfield Volumetry: Differential Pattern of Atrophy in Different Forms of Genetic Frontotemporal Dementia.
in Journal of Alzheimer's disease : JAD
Hardy CJD
(2018)
Sensitivity of Speech Output to Delayed Auditory Feedback in Primary Progressive Aphasias.
in Frontiers in neurology
Marshall CR
(2018)
Primary progressive aphasia: a clinical approach.
in Journal of neurology
Fumagalli GG
(2018)
Distinct patterns of brain atrophy in Genetic Frontotemporal Dementia Initiative (GENFI) cohort revealed by visual rating scales.
in Alzheimer's research & therapy
Hardy CJD
(2018)
Retained capacity for perceptual learning of degraded speech in primary progressive aphasia and Alzheimer's disease.
in Alzheimer's research & therapy
Meeter LHH
(2018)
Poly(GP), neurofilament and grey matter deficits in C9orf72 expansion carriers.
in Annals of clinical and translational neurology
Bocchetta M
(2019)
Amygdala subnuclei are differentially affected in the different genetic and pathological forms of frontotemporal dementia.
in Alzheimer's & dementia (Amsterdam, Netherlands)
Van Der Ende EL
(2019)
Serum neurofilament light chain in genetic frontotemporal dementia: a longitudinal, multicentre cohort study.
in The Lancet. Neurology
Tavares TP
(2019)
Ventricular volume expansion in presymptomatic genetic frontotemporal dementia.
in Neurology
Meeter LHH
(2019)
Clinical value of cerebrospinal fluid neurofilament light chain in semantic dementia.
in Journal of neurology, neurosurgery, and psychiatry
Desmarais P
(2019)
Therapeutic trial design for frontotemporal dementia and related disorders.
in Journal of neurology, neurosurgery, and psychiatry
Parker TD
(2019)
Differences in hippocampal subfield volume are seen in phenotypic variants of early onset Alzheimer's disease.
in NeuroImage. Clinical
Koriath C
(2019)
ApoE4 lowers age at onset in patients with frontotemporal dementia and tauopathy independent of amyloid-ß copathology.
in Alzheimer's & dementia (Amsterdam, Netherlands)
Lamb R
(2019)
A novel TBK1 mutation in a family with diverse frontotemporal dementia spectrum disorders.
in Cold Spring Harbor molecular case studies
Premi E
(2019)
The inner fluctuations of the brain in presymptomatic Frontotemporal Dementia: The chronnectome fingerprint.
in NeuroImage
Gazzina S
(2019)
Education modulates brain maintenance in presymptomatic frontotemporal dementia.
in Journal of neurology, neurosurgery, and psychiatry
Convery R
(2019)
Review: Clinical, genetic and neuroimaging features of frontotemporal dementia.
in Neuropathology and applied neurobiology
Hardy CJD
(2019)
Findings of Impaired Hearing in Patients With Nonfluent/Agrammatic Variant Primary Progressive Aphasia.
in JAMA neurology
Rittman T
(2019)
Functional network resilience to pathology in presymptomatic genetic frontotemporal dementia.
in Neurobiology of aging
Mutsaerts HJMM
(2019)
Cerebral perfusion changes in presymptomatic genetic frontotemporal dementia: a GENFI study.
in Brain : a journal of neurology
Marshall CR
(2019)
The functional neuroanatomy of emotion processing in frontotemporal dementias.
in Brain : a journal of neurology
Lu K
(2019)
Cognition at age 70: Life course predictors and associations with brain pathologies.
in Neurology
Foiani MS
(2019)
Searching for novel cerebrospinal fluid biomarkers of tau pathology in frontotemporal dementia: an elusive quest.
in Journal of neurology, neurosurgery, and psychiatry
Bocchetta M
(2019)
Segmentation of medial temporal subregions reveals early right-sided involvement in semantic variant PPA.
in Alzheimer's research & therapy
Greaves CV
(2019)
An update on genetic frontotemporal dementia.
in Journal of neurology
Zetterberg H
(2019)
Review: Fluid biomarkers for frontotemporal dementias.
in Neuropathology and applied neurobiology
Sani TP
(2019)
Sleep symptoms in syndromes of frontotemporal dementia and Alzheimer's disease: A proof-of-principle behavioural study.
in eNeurologicalSci
Bocchetta M
(2020)
Thalamic nuclei in frontotemporal dementia: Mediodorsal nucleus involvement is universal but pulvinar atrophy is unique to C9orf72.
in Human brain mapping
Convery RS
(2020)
Abnormal pain perception is associated with thalamo-cortico-striatal atrophy in C9orf72 expansion carriers in the GENFI cohort.
in Journal of neurology, neurosurgery, and psychiatry
Convery RS
(2020)
Basal forebrain atrophy in frontotemporal dementia.
in NeuroImage. Clinical
Bocchetta M
(2020)
Automated Brainstem Segmentation Detects Differential Involvement in Atypical Parkinsonian Syndromes.
in Journal of movement disorders
Tavares TP
(2020)
Early symptoms in symptomatic and preclinical genetic frontotemporal lobar degeneration.
in Journal of neurology, neurosurgery, and psychiatry
Moore K
(2020)
Age at symptom onset and death and disease duration in genetic frontotemporal dementia: an international retrospective cohort study
in The Lancet Neurology
Van Der Ende EL
(2020)
Neuronal pentraxin 2: a synapse-derived CSF biomarker in genetic frontotemporal dementia.
in Journal of neurology, neurosurgery, and psychiatry
Koriath C
(2020)
Predictors for a dementia gene mutation based on gene-panel next-generation sequencing of a large dementia referral series.
in Molecular psychiatry
Altmann A
(2020)
Analysis of brain atrophy and local gene expression in genetic frontotemporal dementia.
in Brain communications
Shafei R
(2020)
Two pathologically confirmed cases of novel mutations in the MAPT gene causing frontotemporal dementia.
in Neurobiology of aging
Woollacott IOC
(2020)
Microglial burden, activation and dystrophy patterns in frontotemporal lobar degeneration.
in Journal of neuroinflammation
Bocchetta M
(2020)
In vivo staging of frontotemporal lobar degeneration TDP-43 type C pathology.
in Alzheimer's research & therapy
Altmann A
(2020)
A comprehensive analysis of methods for assessing polygenic burden on Alzheimer's disease pathology and risk beyond APOE.
in Brain communications
Heller C
(2020)
Plasma glial fibrillary acidic protein is raised in progranulin-associated frontotemporal dementia.
in Journal of neurology, neurosurgery, and psychiatry
Description | Development of a methodological framework of presymptomatic clinical trials |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Membership of a guideline committee |
Description | Bluefield Project Grants - Developing a GENFI Biobank |
Amount | $148,222 (USD) |
Organisation | Bluefield Project |
Sector | Charity/Non Profit |
Country | United States |
Start | 03/2016 |
End | 04/2018 |
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 | JPND - Working Groups to Inform Cohort Studies in Neurodegenerative Disease Research |
Amount | € 34,178 (EUR) |
Organisation | EU Joint Programme - Neurodegenerative Disease Research (JPND) |
Sector | Public |
Country | European Union (EU) |
Start | 09/2014 |
End | 05/2015 |
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 A panel of CSF proteins separates genetic frontotemporal dementia from presymptomatic mutation carriers: a GENFI study |
Description | Additional file 1. |
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_A_panel_of_CSF_proteins_se... |
Title | Additional file 1 of A panel of CSF proteins separates genetic frontotemporal dementia from presymptomatic mutation carriers: a GENFI study |
Description | Additional file 1. |
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_A_panel_of_CSF_proteins_se... |
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. |
Title | [Supp. Mat.] Spatiotemporal Analysis For Detection Of Pre-Symptomatic Shape Changes In Neurodegenerative Diseases: Initial Application To The Genfi Cohort |
Description | Supplementary tables and figure of paper Spatio-temporal analysis for detection of pre-symptomatic shape changes in neuro-degenerative diseases: initial application to the GENFI cohort, for testing different number of clusters of the spatio-temporal regression. The supplementary materials shows results for 2 4 6 8 12 14 and 16 clusters. The 10 clusters analysis is in the paper. |
Type Of Material | Database/Collection of data |
Year Produced | 2018 |
Provided To Others? | Yes |
URL | https://zenodo.org/record/1324233 |
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 | Patient and carer workshop - Ask the Doctor about FTD (Cambridge GENFI group - led by Prof James Rowe) |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Patients, carers and/or patient groups |
Results and Impact | Standalone PPI group for FTD within the Rowe Lab in Cambridge. By inviting patients and their carers we looked at development of research studies and ethical issues within them. |
Year(s) Of Engagement Activity | 2020 |
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 |