There is a strong genetic influence on the clinicopathological phenotypes associated with frontotemporal lobar degeneration (FTLD) and frontotemporal dementia (FTD). Intracellular deposition of TDP-43 is the phenotypical hallmark of a frequent subgroup of cases. Mutations in the sequestosome 1 (SQSTM1) gene have rarely been found in individuals with FTD. Here we provide a comprehensive clinicopathological description of two cases with a SQSTM1 mutation. The clinical phenotype of patient 1 (mutation p.Glu396*) was compatible with the behavioural variant (bv) of FTD. TDP-43 pathology was consistent with the features of type B of FTLD-TDP pathology. However, prominent neuronal granular cytoplasmic TDP-43 immunoreactivity and abundant oligodendroglial inclusions, proven by colocalization with the oligodendroglial-marker TPPP/p25, were also seen. The clinical phenotype of patient 2 was compatible with bvFTD associated with parkinsonism and bulbar symptoms in the later stage. Genetic testing of patient 2 identified a C9orf72 repeat expansion mutation together with a missense mutation (p.Arg212Cys) in SQSTM1. TDP-43 pathology was characterized by neuritic profiles compatible mostly with type A. In contrast to patient 1, p62 pathology was seen to a greater extent as TDP-43 immunoreactivity in neurons. Using an antibody that detects poly(GP) peptides produced via repeat associated non-ATG translation associated with expanded hexanucleotide repeat in the C9orf72 gene, we confirmed the presence of pathognomonic inclusions. The present study supports previous observations on amyotrophic lateral sclerosis (ALS) that SQSTM1 mutations consistently associate with TDP-43 pathology. The co-presence of C9orf72 mutation may influence the phenotype, thus finding one FTLD (or ALS) related mutation does not exclude the presence of further influential genetic alterations. Oligodendroglial TDP-43 pathology is considerable in some forms of FTLD-TDP, thus their evaluation might be considered to be included in classification systems.

Department of Neurology and Center of Clinical Neuroscience 1st Faculty of Medicine Charles University Prague Prague Czech Republic

Department of Nuclear Medicine SMZ Ost Donauspital Vienna Austria

Department of Pathology and Molecular Medicine Thomayer Hospital Prague Czech Republic

Institute of Neurology Medical University of Vienna Vienna Austria

International Clinical Research Center St Anne's University Hospital Brno Brno Czech Republic

Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders SMZ Ost Donauspital Vienna Austria

Laboratory of Neurogenetics Institute Born Bunge University of Antwerp Antwerp Belgium

Memory Disorders Clinic Department of Neurology 2nd Faculty of Medicine Charles University Prague and Motol University Hospital Czech Republic

Neurodegenerative Brain Diseases group Department of Molecular Genetics Antwerp VIB Belgium

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