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
Drazich-Taylor EHS
(2023)
Q351R MAPT mutation is associated with a mixed 3R/4R tauopathy and a slowly progressive cognitive, behavioural and parkinsonian syndrome.
in Journal of neurology, neurosurgery, and psychiatry
Ferrari R
(2017)
Genetic architecture of sporadic frontotemporal dementia and overlap with Alzheimer's and Parkinson's diseases.
in Journal of neurology, neurosurgery, and psychiatry
Fiford CM
(2018)
Patterns of progressive atrophy vary with age in Alzheimer's disease patients.
in Neurobiology of aging
Fiford CM
(2017)
White matter hyperintensities are associated with disproportionate progressive hippocampal atrophy.
in Hippocampus
Finger E
(2023)
Neurodevelopmental effects of genetic frontotemporal dementia in young adult mutation carriers.
in Brain : a journal of neurology
Foiani MS
(2018)
Plasma tau is increased in frontotemporal dementia.
in Journal of neurology, neurosurgery, and psychiatry
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
Foster PH
(2022)
Examining empathy deficits across familial forms of frontotemporal dementia within the GENFI cohort.
in Cortex; a journal devoted to the study of the nervous system and behavior
Franklin H
(2021)
The Revised Self-Monitoring Scale detects early impairment of social cognition in genetic frontotemporal dementia within the GENFI cohort
in Alzheimer's Research & Therapy
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
Galimberti D
(2018)
Progranulin plasma levels predict the presence of GRN mutations in asymptomatic subjects and do not correlate with brain atrophy: results from the GENFI study.
in Neurobiology of aging
Gazzina S
(2022)
Structural brain splitting is a hallmark of Granulin-related frontotemporal dementia.
in Neurobiology of aging
Gazzina S
(2019)
Education modulates brain maintenance in presymptomatic frontotemporal dementia.
in Journal of neurology, neurosurgery, and psychiatry
Ge YJ
(2023)
Prioritization of Drug Targets for Neurodegenerative Diseases by Integrating Genetic and Proteomic Data From Brain and Blood.
in Biological psychiatry
Gordon E
(2016)
Advances in neuroimaging in frontotemporal dementia.
in Journal of neurochemistry
Gordon E
(2021)
A comparison of automated atrophy measures across the frontotemporal dementia spectrum: Implications for trials.
in NeuroImage. Clinical
Greaves CV
(2019)
An update on genetic frontotemporal dementia.
in Journal of neurology
Hardy CJ
(2023)
Symptom-led staging for primary progressive aphasia.
in medRxiv : the preprint server for health sciences
Hardy CJD
(2018)
Retained capacity for perceptual learning of degraded speech in primary progressive aphasia and Alzheimer's disease.
in Alzheimer's research & therapy
Hardy CJD
(2017)
Functional neuroanatomy of speech signal decoding in primary progressive aphasias.
in Neurobiology of aging
Hardy CJD
(2018)
Sensitivity of Speech Output to Delayed Auditory Feedback in Primary Progressive Aphasias.
in Frontiers in neurology
Hardy CJD
(2017)
Behavioural and neuroanatomical correlates of auditory speech analysis in primary progressive aphasias.
in Alzheimer's research & therapy
Hardy CJD
(2019)
Findings of Impaired Hearing in Patients With Nonfluent/Agrammatic Variant Primary Progressive Aphasia.
in JAMA neurology
Harper L
(2022)
Prenatal gyrification pattern affects age at onset in frontotemporal dementia
in Cerebral Cortex
Heller C
(2020)
Plasma glial fibrillary acidic protein is raised in progranulin-associated frontotemporal dementia.
in Journal of neurology, neurosurgery, and psychiatry
Heller C
(2020)
Plasma glial fibrillary acidic protein and neurofilament light chain are measures of disease severity in semantic variant primary progressive aphasia.
in Journal of neurology, neurosurgery, and psychiatry
Heywood WE
(2018)
CSF pro-orexin and amyloid-ß38 expression in Alzheimer's disease and frontotemporal dementia.
in Neurobiology of aging
Jabbari E
(2020)
Diagnosis Across the Spectrum of Progressive Supranuclear Palsy and Corticobasal Syndrome.
in JAMA neurology
Jiskoot LC
(2023)
The Benson Complex Figure Test detects deficits in visuoconstruction and visual memory in symptomatic familial frontotemporal dementia: A GENFI study.
in Journal of the neurological sciences
Jiskoot LC
(2023)
Addition of the FTD Module to the Neuropsychiatric Inventory improves classification of frontotemporal dementia spectrum disorders.
in Journal of neurology
Jiskoot LC
(2018)
Presymptomatic white matter integrity loss in familial frontotemporal dementia in the GENFI cohort: A cross-sectional diffusion tensor imaging study.
in Annals of clinical and translational neurology
Kenny J
(2017)
A novel prion protein variant in a patient with semantic dementia.
in Journal of neurology, neurosurgery, and psychiatry
Keshavan A
(2022)
CSF biomarkers for dementia.
in Practical neurology
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
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)
Koriath CA
(2017)
The clinical, neuroanatomical, and neuropathologic phenotype of TBK1-associated frontotemporal dementia: A longitudinal case report.
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
Lu K
(2019)
Cognition at age 70: Life course predictors and associations with brain pathologies.
in Neurology
Mahoney CJ
(2021)
Pathophysiology and Treatment of Non-motor Dysfunction in Amyotrophic Lateral Sclerosis.
in CNS drugs
Malpetti M
(2021)
Apathy in presymptomatic genetic frontotemporal dementia predicts cognitive decline and is driven by structural brain changes.
in Alzheimer's & dementia : the journal of the Alzheimer's Association
Manera AL
(2021)
MRI data-driven algorithm for the diagnosis of behavioural variant 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 |