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Type: Journal article
Title: A 6.4 Mb duplication of the alpha-synuclein locus causing frontotemporal dementia and parkinsonism phenotype-genotype correlations
Author: Kara, E.
Kiely, A.P.
Proukakis, C.
Giffin, N.
Love, S.
Hehir, J.
Rantell, K.
Pandraud, A.
Hernandez, D.G.
Nacheva, E.
Pittman, A.M.
Nalls, M.A.
Singleton, A.B.
Revesz, T.
Bhatia, K.P.
Quinn, N.
Hardy, J.
Holton, J.L.
Houlden, H.
Citation: JAMA Neurology, 2014; 71(9):1162-1171
Publisher: American Medical Association
Issue Date: 2014
ISSN: 2168-6149
Statement of
Eleanna Kara, Aoife P. Kiely, Christos Proukakis, Nicola Giffin, Seth Love ... Tamas Revesz ... et al.
Abstract: Importance: α-Synuclein (SNCA) locus duplications are associated with variable clinical features and reduced penetrance but the reasons underlying this variability are unknown. Objectives: To report a novel family carrying a heterozygous 6.4 Mb duplication of the SNCA locus with an atypical clinical presentation strongly reminiscent of frontotemporal dementia and late-onset pallidopyramidal syndromes and study phenotype-genotype correlations in SNCA locus duplications. Design, Setting, and Participants: We report the clinical and neuropathologic features of a family carrying a 6.4 Mb duplication of the SNCA locus. To identify candidate disease modifiers, we completed a genetic analysis of the family and conducted statistical analysis on previously published cases carrying SNCA locus duplications using regression modeling with robust standard errors to account for clustering at the family level. Main Outcomes and Measures: We assessed whether length of the SNCA locus duplication influences disease penetrance and severity and whether extraduplication factors have a disease-modifying role. Results: We identified a large 6.4 Mb duplication of the SNCA locus in this family. Neuropathological analysis showed extensive α-synuclein pathology with minimal phospho-tau pathology. Genetic analysis showed an increased burden of Parkinson disease–related risk factors and the disease-predisposing H1/H1 microtubule-associated protein tau haplotype. Statistical analysis of previously published cases suggested there is a trend toward increasing disease severity and disease penetrance with increasing duplication size. The corresponding odds ratios from the univariable analyses were 1.17 (95% CI, 0.81-1.68) and 1.34 (95% CI, 0.78-2.31), respectively. Sex was significantly associated with both disease risk and severity; men compared with women had increased disease risk and severity and the corresponding odds ratios from the univariable analyses were 8.36 (95% CI, 1.97-35.42) and 5.55 (95% CI, 1.39-22.22), respectively. Conclusions and Relevance: These findings further expand the phenotypic spectrum of SNCA locus duplications. Increased dosage of genes located within the duplicated region probably cannot increase disease risk and disease severity without the contribution of additional risk factors. Identification of disease modifiers accounting for the substantial phenotypic heterogeneity of patients with SNCA locus duplications could provide insight into molecular events involved in α-synuclein aggregation.
Keywords: Brain
Parkinsonian Disorders
Genetic Predisposition to Disease
Severity of Illness Index
Odds Ratio
Risk Factors
Age of Onset
Sex Factors
Gene Duplication
Microsatellite Repeats
Gene Dosage
Middle Aged
Genetic Loci
Genetic Association Studies
Frontotemporal Dementia
Rights: Copyright 2014 American Medical Association. All rights reserved.
DOI: 10.1001/jamaneurol.2014.994
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