Spectrum and frequency of genetic variants in sporadic amyotrophic lateral sclerosis

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Wolfgang P Ruf - , Ulm University Medical Center (Author)
  • Matej Boros - , Ulm University Medical Center (Author)
  • Axel Freischmidt - , German Center for Neurodegenerative Diseases (DZNE) - Partner Site Ulm (Author)
  • David Brenner - , Ulm University Medical Center (Author)
  • Veselin Grozdanov - , Ulm University Medical Center (Author)
  • Joao de Meirelles - , German Center for Neurodegenerative Diseases (DZNE) - Partner Site Ulm (Author)
  • Thomas Meyer - , Charité – Universitätsmedizin Berlin, Berlin Institute of Health at Charité (Author)
  • Torsten Grehl - , Alfried Krupp Krankenhaus (Author)
  • Susanne Petri - , Hannover Medical School (MHH) (Author)
  • Julian Grosskreutz - , University of Lübeck (Author)
  • Ute Weyen - , LWL University Hospital Bochum (Author)
  • Rene Guenther - , Department of Neurology (Author)
  • Martin Regensburger - , University Hospital at the Friedrich-Alexander University Erlangen-Nürnberg (Author)
  • Tim Hagenacker - , University Hospital Essen (Author)
  • Jan C Koch - , University Medical Center Göttingen (Author)
  • Alexander Emmer - , Martin Luther University Hospital (Author)
  • Annekathrin Roediger - , Jena University Hospital (Author)
  • Robert Steinbach - , Jena University Hospital (Author)
  • Joachim Wolf - , Diakonissenkrankenhaus Mannheim (Author)
  • Jochen H Weishaupt - , Universitätsmedizin Mannheim (Author)
  • Paul Lingor - , Klinikum Rechts der Isar (MRI TUM) (Author)
  • Marcus Deschauer - , Klinikum Rechts der Isar (MRI TUM) (Author)
  • Isabell Cordts - , Klinikum Rechts der Isar (MRI TUM) (Author)
  • Thomas Klopstock - , German Center for Neurodegenerative Diseases (DZNE) - Partner Site Munich (Author)
  • Peter Reilich - , Hospital of the Ludwig-Maximilians-University (LMU) Munich (Author)
  • Florian Schoeberl - , Hospital of the Ludwig-Maximilians-University (LMU) Munich (Author)
  • Berthold Schrank - , DKD Helios Klinik Wiesbaden (Author)
  • Daniel Zeller - , University Hospital of Würzburg (Author)
  • Andreas Hermann - , German Center for Neurodegenerative Diseases (DZNE) - Partner Site Rostock/Greifswald (Author)
  • Antje Knehr - , Ulm University Medical Center (Author)
  • Kornelia Günther - , Ulm University Medical Center (Author)
  • Johannes Dorst - , German Center for Neurodegenerative Diseases (DZNE) - Partner Site Ulm (Author)
  • Joachim Schuster - , German Center for Neurodegenerative Diseases (DZNE) - Partner Site Ulm (Author)
  • Reiner Siebert - , Ulm University Medical Center (Author)
  • Albert C Ludolph - , German Center for Neurodegenerative Diseases (DZNE) - Partner Site Ulm (Author)
  • Kathrin Müller - , Ulm University Medical Center (Author)

Abstract

Therapy of motoneuron diseases entered a new phase with the use of intrathecal antisense oligonucleotide therapies treating patients with specific gene mutations predominantly in the context of familial amyotrophic lateral sclerosis. With the majority of cases being sporadic, we conducted a cohort study to describe the mutational landscape of sporadic amyotrophic lateral sclerosis. We analysed genetic variants in amyotrophic lateral sclerosis-associated genes to assess and potentially increase the number of patients eligible for gene-specific therapies. We screened 2340 sporadic amyotrophic lateral sclerosis patients from the German Network for motor neuron diseases for variants in 36 amyotrophic lateral sclerosis-associated genes using targeted next-generation sequencing and for the C9orf72 hexanucleotide repeat expansion. The genetic analysis could be completed on 2267 patients. Clinical data included age at onset, disease progression rate and survival. In this study, we found 79 likely pathogenic Class 4 variants and 10 pathogenic Class 5 variants (without the C9orf72 hexanucleotide repeat expansion) according to the American College of Medical Genetics and Genomics guidelines, of which 31 variants are novel. Thus, including C9orf72 hexanucleotide repeat expansion, Class 4, and Class 5 variants, 296 patients, corresponding to ∼13% of our cohort, could be genetically resolved. We detected 437 variants of unknown significance of which 103 are novel. Corroborating the theory of oligogenic causation in amyotrophic lateral sclerosis, we found a co-occurrence of pathogenic variants in 10 patients (0.4%) with 7 being C9orf72 hexanucleotide repeat expansion carriers. In a gene-wise survival analysis, we found a higher hazard ratio of 1.47 (95% confidence interval 1.02-2.1) for death from any cause for patients with the C9orf72 hexanucleotide repeat expansion and a lower hazard ratio of 0.33 (95% confidence interval 0.12-0.9) for patients with pathogenic SOD1 variants than for patients without a causal gene mutation. In summary, the high yield of 296 patients (∼13%) harbouring a pathogenic variant and oncoming gene-specific therapies for SOD1/FUS/C9orf72, which would apply to 227 patients (∼10%) in this cohort, corroborates that genetic testing should be made available to all sporadic amyotrophic lateral sclerosis patients after respective counselling.

Details

Original languageEnglish
Article numberfcad152
JournalBrain Communications
Volume5
Issue number3
Publication statusPublished - 2023
Peer-reviewedYes

External IDs

PubMedCentral PMC10202555
Scopus 85160905986