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Ann Clin Transl Neurol. 2018 Sep 7;5(10):1163-1175. doi: 10.1002/acn3.629. eCollection 2018 Oct.

Novel CSF biomarkers to discriminate FTLD and its pathological subtypes.

Author information

Neurochemistry Laboratory and Biobank Department of Clinical Chemistry Neuroscience Campus Amsterdam VU University Medical Center Amsterdam The Netherlands.
Department of Neurological Sciences, Pathophysiology and Transplantation "Dino Ferrari" Center University of Milan Fondazione Ca' Granda IRCCS Ospedale Policlinico Milan Italy.
Alzheimer Centre and Department of Neurology Neuroscience Campus Amsterdam VU University Medical Centre Amsterdam The Netherlands.
Department of Neurology Erasmus Medical Center Rotterdam The Netherlands.
Department of Neurology Center for Neurodegenerative Diseases Research Alzheimer's Disease Research Center Emory University School of Medicine Atlanta Georgia.
Department of Pharmaceutical Sciences University of Perugia Perugia Italy.



Frontotemporal lobar degeneration (FTLD) is the second most prevalent dementia in young patients and is characterized by the presence of two main protein aggregates in the brain, tau (FTLD-Tau) or TDP43 (FTLD-TDP), which likely require distinct pharmacological therapy. However, specific diagnosis of FTLD and its subtypes remains challenging due to largely overlapping clinical phenotypes. Here, we aimed to assess the clinical performance of novel cerebrospinal fluid (CSF) biomarkers for discrimination of FTLD and its pathological subtypes.


YKL40, FABP4, MFG-E8, and the activities of catalase and specific lysosomal enzymes were analyzed in patients with FTLD-TDP (n = 30), FTLD-Tau (n = 20), AD (n = 30), DLB (n = 29), and nondemented controls (n = 29) obtained from two different centers. Models were validated in an independent CSF cohort (n = 188).


YKL40 and catalase activity were increased in FTLD-TDP cases compared to controls. YKL40 levels were also higher in FTLD-TDP compared to FTLD-Tau. We identified biomarker models able to discriminate FTLD from nondemented controls (MFG-E8, tTau, and Aβ 42; 78% sensitivity and 83% specificity) and non-FTLD dementia (YKL40, pTau, p/tTau ratio, and age; 90% sensitivity, 78% specificity), which were validated in an independent cohort. In addition, we identified a biomarker model differentiating FTLD-TDP from FTLD-Tau (YKL40, MFGE-8, βHexA together with βHexA/tHex and p/tTau ratios and age) with 80% sensitivity and 82% specificity.


This study identifies CSF protein signatures distinguishing FTLD and the two main pathological subtypes with optimal accuracy (specificity/sensitivity > 80%). Validation of these models may allow appropriate selection of cases for clinical trials targeting the accumulation of Tau or TDP43, thereby increasing their efficiency and facilitating the development of successful therapies.

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