Plasma inflammation for predicting phenotypic conversion and clinical progression of autosomal dominant frontotemporal lobar degeneration

Breton M. Asken, Peter A. Ljubenkov, Adam M. Staffaroni, Kaitlin B. Casaletto, Lawren Vandevrede, Yann Cobigo, Julio C. Rojas-Rodriguez, Katherine P. Rankin, John Kornak, Hilary Heuer, Judy Shigenaga, Brian S. Appleby, Andrea C. Bozoki, Kimiko Domoto-Reilly, Nupur Ghoshal, Edward Huey, Irene Litvan, Joseph C. Masdeu, Mario F. Mendez, Belen PascualPeter Pressman, Maria Carmela Tartaglia, Walter Kremers, Leah K. Forsberg, Brad F. Boeve, Adam L. Boxer, Howie J. Rosen, Joel H. Kramer

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Measuring systemic inflammatory markers may improve clinical prognosis and help identify targetable pathways for treatment in patients with autosomal dominant forms of frontotemporal lobar degeneration (FTLD).

METHODS: We measured plasma concentrations of IL-6, TNFα and YKL-40 in pathogenic variant carriers ( MAPT, C9orf72, GRN) and non-carrier family members enrolled in the ARTFL-LEFFTDS Longitudinal Frontotemporal Lobar Degeneration consortium. We evaluated associations between baseline plasma inflammation and rate of clinical and neuroimaging changes (linear mixed effects models with standardised (z) outcomes). We compared inflammation between asymptomatic carriers who remained clinically normal ('asymptomatic non-converters') and those who became symptomatic ('asymptomatic converters') using area under the curve analyses. Discrimination accuracy was compared with that of plasma neurofilament light chain (NfL).

RESULTS: We studied 394 participants (non-carriers=143, C9orf72=117, GRN=62, MAPT=72). In MAPT, higher TNFα was associated with faster functional decline (B=0.12 (0.02, 0.22), p=0.02) and temporal lobe atrophy. In C9orf72, higher TNFα was associated with faster functional decline (B=0.09 (0.03, 0.16), p=0.006) and cognitive decline (B=-0.16 (-0.22, -0.10), p<0.001), while higher IL-6 was associated with faster functional decline (B=0.12 (0.03, 0.21), p=0.01). TNFα was higher in asymptomatic converters than non-converters (β=0.29 (0.09, 0.48), p=0.004) and improved discriminability compared with plasma NfL alone (ΔR 2=0.16, p=0.007; NfL: OR=1.4 (1.03, 1.9), p=0.03; TNFα: OR=7.7 (1.7, 31.7), p=0.007).

CONCLUSIONS: Systemic proinflammatory protein measurement, particularly TNFα, may improve clinical prognosis in autosomal dominant FTLD pathogenic variant carriers who are not yet exhibiting severe impairment. Integrating TNFα with markers of neuronal dysfunction like NfL could optimise detection of impending symptom conversion in asymptomatic pathogenic variant carriers and may help personalise therapeutic approaches.

Original languageEnglish (US)
Pages (from-to)541-549
Number of pages9
JournalJournal of Neurology, Neurosurgery and Psychiatry
Issue number7
StatePublished - Jul 1 2023


  • C9orf72 Protein/genetics
  • tau Proteins/genetics
  • Frontotemporal Dementia/diagnosis
  • Humans
  • Frontotemporal Lobar Degeneration/diagnosis
  • Inflammation
  • Mutation
  • Tumor Necrosis Factor-alpha
  • Disease Progression
  • Interleukin-6

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Surgery


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