Abstract:
OBJECTIVE:To define the natural history of the C9orf72 amyotrophic lateral sclerosis (C9ALS) patient population, develop disease biomarkers, and characterize patient pathologies. METHODS:We prospectively collected clinical and demographic data from 116 symptomatic C9ALS and 12 non-amyotrophic lateral sclerosis (ALS) full expansion carriers across 7 institutions in the United States and the Netherlands. In addition, we collected blood samples for DNA repeat size assessment, CSF samples for biomarker identification, and autopsy samples for dipeptide repeat protein (DPR) size determination. Finally, we collected retrospective clinical data via chart review from 208 individuals with C9ALS and 450 individuals with singleton ALS. RESULTS:The mean age at onset in the symptomatic prospective cohort was 57.9 ± 8.3 years, and median duration of survival after onset was 36.9 months. The monthly change was -1.8 ± 1.7 for ALS Functional Rating Scale-Revised and -1.4% ± 3.24% of predicted for slow vital capacity. In blood DNA, we found that G4C2 repeat size correlates positively with age. In CSF, we observed that concentrations of poly(GP) negatively correlate with DNA expansion size but do not correlate with measures of disease progression. Finally, we found that size of poly(GP) dipeptides in the brain can reach large sizes similar to that of their DNA repeat derivatives. CONCLUSIONS:We present a thorough investigation of C9ALS natural history, providing the basis for C9ALS clinical trial design. We found that clinical features of this genetic subset are less variant than in singleton ALS. In addition, we identified important correlations of C9ALS patient pathologies with clinical and demographic data.
journal_name
Neurologyjournal_title
Neurologyauthors
Cammack AJ,Atassi N,Hyman T,van den Berg LH,Harms M,Baloh RH,Brown RH,van Es MA,Veldink JH,de Vries BS,Rothstein JD,Drain C,Jockel-Balsarotti J,Malcolm A,Boodram S,Salter A,Wightman N,Yu H,Sherman AV,Esparza TJ,Mcdoi
10.1212/WNL.0000000000008359subject
Has Abstractpub_date
2019-10-22 00:00:00pages
e1605-e1617issue
17eissn
0028-3878issn
1526-632Xpii
WNL.0000000000008359journal_volume
93pub_type
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