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@ARTICLE{Zimmermann:273945,
author = {Zimmermann, Milan and Mengel, David and Raupach, Katrin and
Haack, Tobias and Neumann, Manuela and Synofzik, Matthis},
title = {{F}requency and neuropathology of {HTT} repeat expansions
in {FTD}/{ALS}: co-existence rather than causation.},
journal = {Journal of neurology},
volume = {272},
number = {1},
issn = {0367-004X},
address = {Heidelberg},
publisher = {Springer},
reportid = {DZNE-2024-01419},
pages = {58},
year = {2025},
abstract = {While ≥ 40 CAG repeat expansions in HTT present a
well-established cause of Huntington's disease (HD), an
enrichment of HTT repeat expansions was recently reported
also in patients with amyotrophic lateral sclerosis (ALS)
and frontotemporal dementia (FTD), including FTD/ALS
patients with additional HD neuropathology. This raises the
question whether the phenotypic spectrum of HTT expansions
can be extended to ALS and FTD, and whether HTT should be
considered as a new causative gene of FTD/ALS. If HTT repeat
expansions were indeed systematically related to FTD/ALS,
one would expect an increased frequency of HTT carriers in
FTD/ALS, who can clinically/neuropathologically not be
explained better than by the presence of the HTT repeat
expansions.Screening of HTT repeat expansions in 249
consecutive patients with ALS or FTD by short-read genome
sequencing took place. The post-mortem neuropathological
examination was performed in the identified HTT repeat
expansion carrier.One HTT repeat expansion [40/22 repeats
(± 1)] was identified in an ALS patient, giving a frequency
of $0.4\%$ (1/249) (frequency in the general population:
$0.03-0.18\%).$ This patient showed a classic ALS phenotype,
but no clinical or imaging signs of HD. Post-mortem brain
examination revealed-in addition to ALS-typical degeneration
of upper and lower motor neurons with TDP-43
inclusions-HD-typical polyQ-aggregates in gyrus cinguli,
striatum and frontal lobe, yet without evidence of striatal
degeneration.Our study does not support the notion of an
increased frequency of HTT repeat expansions in FTD/ALS.
Moreover, the phenotype of the HTT carrier identified can be
better explained by two co-existent, but independent
diseases: (i) ALS and (ii) presymptomatic HD, which-given
the low repeat number-is likely to become manifest only
later in life. These findings corroborate the concept that
HTT repeat expansions are likely co-existent/coincidental,
but not causative in FTD/ALS.},
keywords = {Humans / Frontotemporal Dementia: genetics / Frontotemporal
Dementia: pathology / Amyotrophic Lateral Sclerosis:
genetics / Amyotrophic Lateral Sclerosis: pathology / Male /
Female / Huntingtin Protein: genetics / Middle Aged / Aged /
Trinucleotide Repeat Expansion: genetics / Brain: pathology
/ Brain: diagnostic imaging / ALS (Other) / Amyotrophic
lateral sclerosis (Other) / Frontotemporal dementia (Other)
/ HTT (Other) / Huntington (Other) / MAPT (Other) /
Huntingtin Protein (NLM Chemicals) / HTT protein, human (NLM
Chemicals)},
cin = {AG Gasser / AG Neumann},
ddc = {610},
cid = {I:(DE-2719)1210000 / I:(DE-2719)1210003},
pnm = {353 - Clinical and Health Care Research (POF4-353) / 352 -
Disease Mechanisms (POF4-352)},
pid = {G:(DE-HGF)POF4-353 / G:(DE-HGF)POF4-352},
typ = {PUB:(DE-HGF)16},
pmc = {pmc:PMC11638390},
pubmed = {pmid:39666103},
doi = {10.1007/s00415-024-12822-2},
url = {https://pub.dzne.de/record/273945},
}