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The 43 kDa TAR DNA binding protein (TDP-43) has been identified as one of the major proteins that accumulates in the cytoplasm of brain and spinal cord from the patients affected with amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration (FTLD). Under basal conditions, TDP-43 localizes in nucleus functioning as an RNA binding protein to regulate different aspects of RNA metabolism, such as alternative splicing of messenger RNA. In ALS/FTLD brains and spinal cords, TDP-43 forms well-defined cytoplasmic granules, the behavior very similar to stress granule (SG) proteins, but the mechanisms are poorly understood. To investigate the mechanism of TDP-43 granule formation and to identify potential therapeutic targets by inhibiting the granule formation, our laboratory screened a chemical library of 75,000 compounds using the inducible PC12 cells that express EGFP-tagged wild-type human TDP-43. We used the biological effect of cycloheximide on SGs as a basis for the screen, since it is known to prevent the formation of SGs and TDP-43 granules, pointing to a novel biological pathway that regulates TDP-43 granule formation. One of the candidate compounds, Compound 8 (C8) and its analog C8j dose- dependently decreased the arsenite-induced TDP-43 granules without cytotoxicity, and reduced the protein levels of full-length, truncated, high molecular weight and phosphorylated TDP-43. In addition, we found C8j reduced the phosphorylation at novel, previously unknown Thr103-Ser104 amino acid residues of human TDP-43 under arsenite stress. The phospho-mimetic mutations at these sites induced spontaneous intracellular TDP-43 granules, indicating their regulatory role in TDP-43 granule formation. We also performed a series of gene expression analysis combined with the systems biology algorithm, mode of action by network identification (MNI), to identify the mode of action of C8, and found C8 potentially targets protein metabolism and modification processes to reduce the TDP-43 granules. Our study identified a family of non-cytotoxic chemical compounds that reduces the formation of arsenite-induced TDP-43 granules and their potential mode of action. Furthermore, we identified previously unknown TDP-43 phosphorylation sites Thr103- Ser104 that are involved in the TDP-43 granule formation. We anticipate this study will elucidate the biological pathways regulating TDP-43 aggregation and potential therapeutics for ALS/FTLD-U.

Amyotrophic lateral sclerosis and frontotemporal dementia (ALS-FTD) represents a spectrum of neurodegenerative disease with clinical presentations ranging from progressive paralysis to cognitive impairment. Approximately 15% of ALS-FTD patients initially presenting with motor symptoms also receive a diagnosis of dementia, but a majority of these patients demonstrate some level of cognitive impairment over the course of disease. Identifying molecular pathways that contribute to the development of cognitive deficits in ALS-FTD has thus far been limited by the quality of clinical information and postmortem tissue preservation as well as available technologies. This thesis aims to investigate early stages of cognitive involvement in ALS-FTD using postmortem tissues from a cohort of non-demented ALS patients who have had cognitive and pathological phenotyping. Spatially resolved transcriptome profiling of prefrontal cortex tissues from this cohort identifies dysregulated pathways in non-motor regions, contributing to our understanding of molecular perturbations underlying cognitive impairment in ALS-FTD.

As the most common motor neuron disease, Amyotrophic lateral sclerosis (ALS) affects around 4 in every 100,000 people worldwide with reports of increasing prevalence over the years. Characterized by progressive degeneration of motor neurons, ALS patients suffer impairments of movement and typically die from respiratory failure 2-5 years after diagnosis. Curiously, ALS exists on a disease continuum with Frontotemporal Dementia (FTD) where 30-50% of patients will be diagnosed with both diseases. In FTD, degeneration of cortical neurons results in diverse behavioural changes including deficits in executive and social skills as well as language and memory. A central connection between ALS and FTD is TDP-43 (encoded by TARDBP), an essential DNA/RNA binding protein known to serve critical functions in numerous cellular processes. Despite mutations in TARDBP constituting a small percentage of familial cases, TDP 43 nuclear-to-cytoplasmic mislocalization is a pathological hallmark of most ALS-FTD cases. Therefore, therapeutic targets to rectify pathology and disease may be uncovered by identifying factors that regulate TDP-43. While it is currently established TDP-43 is ubiquitinated and phosphorylated in diseased states, our lab recently found TDP-43 is SUMOylated in response to stress. Of note, perturbations in the stress response are becoming increasingly implicated in neurodegenerations. Furthermore, TDP-43 plays critical roles in the stress response which become perturbed in ALS/FTD. We developed a TDP-43 "SUMO dead" mouse allele to gain an understanding of how disrupting this may contribute to the pathogenesis of ALS-FTD. Longitudinal characterization of the model explored behavioural and histological in vivo consequences following loss of TDP-43 SUMOylation. However, the phenotypes observed in the mutant mice were less robust in comparison to established ALS/FTD mouse models. Mutant mice did not have consistent differences in tests for similar outcomes, trials of the same test, or across age. Female mutant mice presented with early hyperactivity and disinhibition along with altered social grooming behaviour. At later age, these female mice developed impairments in spatial working memory. Male mice developed apathetic behaviour and motor deficits at the middle age timepoint. Histologically, various forms of pathological TDP-43 were observed in the absence of neurodegeneration. These data reveal that TDP-43 SUMOylation may play an important role in ALS/FTD pathogenesis.

Atualmente, as demências tornam-se mais prevalentes e constituem-se como um importante problema de saúde pública mundial. A Degeneração Lobar Frontotemporal (DLFT) e a Doença de Alzheimer (DA) são as de maior incidência. A investigação dos fatores de risco para as demências degenerativas inscreve-se entre os temas mais relevantes das neurociências e a avaliação dos fatores de risco de natureza genética tem produzido contribuições importantes. Na DLFT, mutações no gene TARDBP, codificador da proteína nuclear TDP-43, estão entre as ocorrências genéticas mais descritas, enquanto que para a DA, o alelo 4 do gene da apolipoproteína E (APOE) é o principal fator de risco. Pacientes com diagnóstico clínico de DLFT (n=47) e de DA provável (n=30) recebidos do ambulatório do Grupo de Neurologia Cognitiva e do Comportamento (GNCC) da Clínica Neurológica do HC-FMUSP foram convidados a participar do estudo. Amostras de sangue foram coletadas para a realização da extração de DNA linfocitário. Os éxons de 1-6 do gene TARDBP foram amplificados por PCR e seus produtos foram sequenciados em sequenciador automático. Os polimorfismos do gene APOE foram determinados através da técnica de PCR em tempo real. A análise do gene da TDP-43 em pacientes com DLFT mostrou a presença de uma mutação na região do éxon 6 do TARDBP (g.14935A>G) em um paciente do sexo masculino, com idade de 54 anos e diagnóstico de demência semântica. Na genotipagem dos pacientes de DA, foi observado que a metodologia utilizada, através de PCR em tempo real mostrou-se eficiente em detectar os polimorfismos do gene APOE, fornecendo resultados compatíveis quando comparados aos demais estudos brasileiros publicados anteriormente / Brazil is one of the developing countries that are undergoing a process of demographic transition in which the elderly represents a significant proportion of the total population. Neurodegenerative illnesses most commonly appear at such ages. Frontotemporal lobar degeneration (FTLD) and Alzheimers disease (AD) are the most frequent causes for dementia. The investigation of risk factors for degenerative dementia is a relevant subject of neurosciences and the evaluation of the nature of genetic risk factors has produced the most important contributions. Mutations in TARDBP gene, the encoder of the TDP-43 nuclear protein, appear as the most frequent genetic occurrences for FTLD, whereas, in DA, the 4 allele of the apolipoprotein E (APOE) is the major genetic risk factor. Patients with clinical diagnosis of FTLD types of families and sporadic (n=47) and probable AD (n=30) from the ambulatory of Cognitive Neurology Group and Behavior (CNGB) of Neurological Clinic of HC-FMUSP were invited to participate in this study. Blood samples were collected for lymphocytic DNA extraction. The APOE gene polymorphisms are being determined through the real time PCR technique. The 1-6 exons of TARDBP gene were amplified by PCR and their products were sequenced in automated sequencer. The TDP-43 gene analysis in patients with FTLD showed the presence of one mutation in the region of exon 6 TARDBP gene in a male patient of 54 years old, with diagnoses of semantic dementia. Regarding DA patients genotyping, the real time methodology has been shown as an efficient approach to detect APOE polymorphisms, presenting data similar to those observed in other Brazilian studies

Atualmente, as demências tornam-se mais prevalentes e constituem-se como um importante problema de saúde pública mundial. A Degeneração Lobar Frontotemporal (DLFT) e a Doença de Alzheimer (DA) são as de maior incidência. A investigação dos fatores de risco para as demências degenerativas inscreve-se entre os temas mais relevantes das neurociências e a avaliação dos fatores de risco de natureza genética tem produzido contribuições importantes. Na DLFT, mutações no gene TARDBP, codificador da proteína nuclear TDP-43, estão entre as ocorrências genéticas mais descritas, enquanto que para a DA, o alelo 4 do gene da apolipoproteína E (APOE) é o principal fator de risco. Pacientes com diagnóstico clínico de DLFT (n=47) e de DA provável (n=30) recebidos do ambulatório do Grupo de Neurologia Cognitiva e do Comportamento (GNCC) da Clínica Neurológica do HC-FMUSP foram convidados a participar do estudo. Amostras de sangue foram coletadas para a realização da extração de DNA linfocitário. Os éxons de 1-6 do gene TARDBP foram amplificados por PCR e seus produtos foram sequenciados em sequenciador automático. Os polimorfismos do gene APOE foram determinados através da técnica de PCR em tempo real. A análise do gene da TDP-43 em pacientes com DLFT mostrou a presença de uma mutação na região do éxon 6 do TARDBP (g.14935A>G) em um paciente do sexo masculino, com idade de 54 anos e diagnóstico de demência semântica. Na genotipagem dos pacientes de DA, foi observado que a metodologia utilizada, através de PCR em tempo real mostrou-se eficiente em detectar os polimorfismos do gene APOE, fornecendo resultados compatíveis quando comparados aos demais estudos brasileiros publicados anteriormente / Brazil is one of the developing countries that are undergoing a process of demographic transition in which the elderly represents a significant proportion of the total population. Neurodegenerative illnesses most commonly appear at such ages. Frontotemporal lobar degeneration (FTLD) and Alzheimers disease (AD) are the most frequent causes for dementia. The investigation of risk factors for degenerative dementia is a relevant subject of neurosciences and the evaluation of the nature of genetic risk factors has produced the most important contributions. Mutations in TARDBP gene, the encoder of the TDP-43 nuclear protein, appear as the most frequent genetic occurrences for FTLD, whereas, in DA, the 4 allele of the apolipoprotein E (APOE) is the major genetic risk factor. Patients with clinical diagnosis of FTLD types of families and sporadic (n=47) and probable AD (n=30) from the ambulatory of Cognitive Neurology Group and Behavior (CNGB) of Neurological Clinic of HC-FMUSP were invited to participate in this study. Blood samples were collected for lymphocytic DNA extraction. The APOE gene polymorphisms are being determined through the real time PCR technique. The 1-6 exons of TARDBP gene were amplified by PCR and their products were sequenced in automated sequencer. The TDP-43 gene analysis in patients with FTLD showed the presence of one mutation in the region of exon 6 TARDBP gene in a male patient of 54 years old, with diagnoses of semantic dementia. Regarding DA patients genotyping, the real time methodology has been shown as an efficient approach to detect APOE polymorphisms, presenting data similar to those observed in other Brazilian studies

Abstract Frontotemporal lobar degeneration (FTLD) is the second most common neurodegenerative disease leading to early-onset dementia (< 65 years), next to Alzheimer’s disease. FTLD is substantially a genetic disorder with up to 50% of cases having a positive family history. Mutations in the genes microtubule-associated protein tau (MAPT) and progranulin (PGRN) account for about 10–20% of all cases of FTLD. Hexanucleotide repeat expansion mutation within the gene C9ORF72 has recently been identified as the major cause of FTLD, FTLD with amyotrophic lateral sclerosis (ALS) and pure ALS. During this study, hexanucleotide repeat expansion within the C9ORF72 gene was shown to explain nearly 50% of familial and 30% of all FTLD cases in the Finnish population. Otherwise, the genetic background of Finnish FTLD is largely unknown. The object of the present work was to disentangle the genetic aetiology of FTLD in the Finnish population. We studied a cohort of patients with a clinical diagnosis of FTLD from the province of Northern Ostrobothnia, Finland. Sequencing analysis of the genes MAPT, charged multi-vesicular body protein 2B (CHMP2B) and TAR DNA binding protein (TARDBP) were performed and the MAPT haplotypes were analysed. Correlations between genotype and phenotype were studied in patients with C9ORF72 repeat expansion mutation. C9ORF72 expansion mutation explained nearly 30% of cases of FTLD in our cohort. Concomitant ALS and positive family history of the disease increased the possibility of carrying expanded C9ORF72. The clinical phenotype of C9ORF72 expansion carriers varied at presentation: both behavioural and language variants were detected with or without ALS. The behavioural presentations included prominent psychotic features, although psychiatric presentations were not overrepresented in expansion carriers. No pathogenic mutations were identified in the MAPT, CHMP2B and TARDBP genes in our series of FTLD patients. The H2 MAPT haplotype was associated with FTLD in the series. Our findings emphasise the importance of C9ORF72 expansion mutation in FTLD. While mutations in MAPT and PGRN cause a significant proportion of cases of FTLD worldwide, they seem to be rare causes of FTLD in the Finnish population. Besides being infrequent in other populations, mutations in CHMP2B and TARDBP are rare causes of FTLD in the Finnish population as well. Our findings have clinical implications for recognising phenotypic features characteristic of expanded C9ORF72 as well as for genetic counselling of Finnish patients with FTLD. Even though a considerable proportion of our cases of familial FTLD is caused by the C9ORF72 expansion, over 50 % of our familial cases are without a molecular genetic diagnosis, suggesting that there are other unidentified causal genes to be found. / Tiivistelmä Otsa-ohimolohkorappeumat on toiseksi yleisin työikäisten dementiaa aiheuttava etenevä aivojen rappeumasairaus. Toisinaan otsa-ohimolohkorappeumat esiintyvät yhdessä liikehermorappeuman, amyotrofisen lateraaliskleroosin (ALS), kanssa. Perinnöllisillä tekijöillä on todennäköisesti keskeinen merkitys taudin taustalla. Mutaatiot microtubule-associated protein tau (MAPT)- ja progranulin (PGRN) geeneissä aiheuttavat yhteensä 10–20 % otsa-ohimolohkorappeumista maailmalla. C9ORF72-geenissä sijaitsevan toistojaksomonistuman on vastikään todettu olevan yleisin otsa-ohimolohkorappeumia ja ALS:a aiheuttava mutaatio. Mutaatio on erityisen yleinen suomalaisessa väestössä selittäen lähes 50 % suvuittaisista ja 30 % kaikista otsa-ohimolohkorappeumista. Oireyhtymän perinnöllisyys on muutoin huonosti tunnettu suomalaisessa väestössä. Tutkimuksen tavoitteena oli selvittää otsa-ohimolohkorappeumien geneettisiä syitä aineistossa, joka koostui vuosina 1999–2010 Oulun yliopistollisessa sairaalassa tutkituista potilaista. Tutkimuksessa selvitettiin MAPT-, charged multi-vesicular body protein 2B (CHMP2B)- ja TAR DNA-binding protein (TARDBP) geenien mutaatioiden esiintyvyyttä ja määritettiin MAPT-geenin haplotyypit. Lisäksi tutkittiin taudin kliinisiä erityispiirteitä C9ORF72-mutaation kantajilla. C9ORF72-mutaatio selitti lähes 30 % otsa-ohimolohkorappeumista aineistossamme. Tutkimuksessa havaittiin, että suvuittain esiintyvä tautimuoto ja ALS yhdistyneenä otsa-ohimolohkorappeumaan liittyivät merkittävästi C9ORF72-mutaatioon. Monistuman kantajien fenotyyppi oli moninainen – ensioireina oli sekä käytösongelmia että kielellisiä vaikeuksia. Vaikka C9ORF72-mutaation kantajilla on kuvattu runsaasti psykoottisia oireita, psykoottiset oireet eivät olleet selvästi yliedustettuna mutaation kantajilla aineistossamme. Tutkimuksessa ei löydetty tautia aiheuttavia mutaatioita MAPT-, CHMP2B- tai TARDBP-geeneistä. Havaitsimme kuitenkin tilastollisesti merkittävän yhteyden MAPT-geenin H2-haplotyypin ja otsa-ohimolohkorappeumien välillä. Tuloksemme antavat uutta tietoa C9ORF72-mutaation kantajien kliinisistä erityispiirteistä. MAPT-geenin mutaatioiden merkitys otsa-ohimolohkorappeumien synnyssä ei näyttäisi olevan suomalaisessa väestössä niin merkittävä kuin muissa väestöissä. CHMP2B- ja TARDBP-mutaatiot ovat harvinainen oireyhtymän syy myös suomalaisessa väestössä. Tuloksiamme voidaan hyödyntää suomalaisten otsa-ohimolohkorappeumapotilaiden perinnöllisessä neuvonnassa. Huomattavista edistysaskelista huolimatta yli puolet suvuittain esiintyvistä tautitapauksistamme on vailla geneettistä diagnoosia, mikä antaa aihetta jatkotutkimuksille.

Les dégénérescences lobaires fronto-temporale (DLFT) sont des démences neurodégénératives rares. 30-50% des DLFT a une cause génétique, la plupart sont des mutations des gènes C9orf72 et progranuline (GRN). L'objectif de la thèse a été d'élargir le spectre mutationnel et phénotypique des mutations GRN. Nous avons identifié les premières délétions partielles du gène GRN chez des patients avec progranulinémie baisse (la progranulinémie est abaissée en cas de mutation), mais sans mutation détectée par séquençage. Nous avons contribué à élargir le spectre clinique de la maladie en décrivant un phénotype d'atrophie corticale postérieure et des lésions de la substance blanche cérébrale chez des patients GRN, caractéristique évocatrice de cette forme génétique. Enfin, nous avons étudié la phase présymptomatique de la maladie, alors que se développent les premiers essais thérapeutiques, par une approche longitudinale avec IRM et TEP-FDG. Le métabolisme cérébral est réduit dans le lobe temporal latéral gauche 20 ans avant l'apparition des symptômes et, après 20 mois, dans les régions frontales et l'épaisseur corticale dans les régions temporales gauche. Le lobe temporal latéral pourrait être donc l'"épicentre " de la maladie, et le processus lésionnel pourrait, secondairement, progresser vers les régions frontales. J'ai également contribué à définir les phénotypes associés aux mutations de gènes plus rares de DLFT/DLFT-SLA. TARDBP est associé à un large spectre phénotypique; TBK1 est caractérisé par une démence sémantique ou aphasie non fluent associés à l'atteinte de la corne antérieure. Cette étude importante souligne le rôle de ces mutations dans le spectre clinique des DLFT. / Frontotemporal lobar degeneration (FTLD) are rare neurodegenerative dementias. 30-50% of FTLD has a genetic cause, most are mutations in C9orf72 and in progranulin gene (GRN). The aim of the thesis was to expand the mutational and phenotypic spectrum of GRN mutations. We identified the first partial deletions of GRN gene in patients with low plasmatic progranulin (the plasmatic progranulin is low in case of mutation), but without mutation detected by sequencing. We contributed to expand the clinical spectrum of the disease by describing a posterior cortical atrophy phenotype and lesions of the cerebral white matter in GRN patients, evocative feature of this genetic form. Finally, we studied the presymptomatic stage of the disease, while the first clinical trials develop, for a longitudinal approach with MRI and FDG-PET. The cerebral metabolism is reduced in the left temporal lobe 20 years before clinical onset and, after 20 months, the metabolism is reduced in the frontal regions and the cortical thickness in the left temporal regions. The lateral temporal lobe could thus be the "epicenter" of the disease, and the lesional process could secondarily progress towards the frontal regions. I also contributed to define the phenotypes associated with rare gene mutations in FTLD/FTLD-ALS. TARDBP is associated with a wide phenotypic spectrum; TBK1 is characterized by semantic dementia or not fluent aphasia associated with involvement of the anterior horn. This important study highlights the role of these mutations in the clinical spectrum of FTLD.

CHMP2B est une sous-unité du complexe ESCRT-III, un complexe cytosolique très conservé, responsable du remodelage des membranes biologique, dans divers processus cellulaires. Des mutations de CHMP2B sont associées à une forme familiale de démence frontotemporale. Une étude précédente a mis en évidence que les mutants pathogènes de CHMP2B altèrent la morphologie des épines dendritiques, un phénomène potentiellement à l'origine de la maladie. Ce travail de recherche a pour objectif de décrire le rôle de CHMP2B, et du complexe ESCRT-III, dans la structure et le fonctionnement des épines dendritiques. Dans des lignées cellulaires, nous avons démontré que CHMP2B a la propriété de s'associer préférentiellement à la membrane plasmique, de se polymériser en filaments hélicoïdaux et de former de longs et fins tubes membranaires. Ce résultat indique que CHMP2B est directement impliqué dans le remodelage de la membrane plasmique. Dans les neurones, CHMP2B se concentre dans des régions sous-membranaires proches de la PSD. Une analyse biochimique a montré que CHMP2B et CHMP4B sont associées à d'autres sous-unités, pour former un complexe ESCRT-III postsynaptique particulièrement stable. Nous avons identifié par spectrométrie de masse que ce complexe interagit également avec des protéines d'échafaudage postsynaptiques et des protéines de remodelage du cytosquelette d'actine. La déplétion de CHMP2B par RNAi, dans des neurones en culture, affecte la complexité de l'arborisation dendritique, la morphologie des épines dendritiques et empêche le gonflement des épines associé à la LTP. Des expériences de récupération, avec des mutants pontuels, indiquent que le rôle de CHMP2B dans le maintien de l'arborisation dendritique est dépendant à la fois de de son association avec ESCRT-III et la bicouche phospholipidique. Nous proposons une nouvelle fonctionnalité pour un complexe ESCRT-III contenant CHMP2B, dans les processus de remodelage de la membrane postsynaptique associés à la maturation et à la plasticité des épines dendritiques. / CHMP2B is a subunit of ESCRT-III, a highly conserved cytosolic protein machinery, responsible for membrane remodeling in diverse cellular mechanisms. Mutations in CHMP2B are responsible for a familial form of frontotemporal dementia. A previous study highlighted that FTD-related mutants of CHMP2B impair the morphological maturation of dendritic spines, a process that may underlie neurodegeneration in this disease. The goal of this research work id directed towards understanding the role of CHMP2B and ESCRT-III in dendritic spines structure and function. In cell lines, we demonstrated that CHMP2B associates preferentially with the plasma membrane, polymerizes in helical filaments and forms long and thin membrane protrusions. This result indicates that CHMP2B is directly involved in plasma membrane remodeling. In neurons, CHMP2B concentrates in specific sub-membrane microdomains close to the PSD. Biochemical analysis revealed that CHMP2B and CHMP4B associate with other subunits to form a remarkably stable postsynaptic ESCRT-III complex. Mass-spectrometry indicated that this complex also interacts with postsynaptic scaffolds and proteins involved in actin cytoskeleton remodelling. RNAi depletion of CHMP2B, in cultured neurons, alters stability of dendrite branching and morphology of dendritic spines, and impairs spine head growth, normally associated with LTP. Rescue experiments, with point mutants, indicated that CHMP2B activity in dendrite branching is dependent on its capacity to both bind phospholipids and oligomerization with ESCRT-III. We propose a novel functionality for an ESCRT-III complex containing CHMP2B, in maturation-dependent and plasticity-dependent processes of dendritic spine morphogenesis.

Abstract Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD) are the two most common neurodegenerative diseases leading to early onset dementia (< 65 years). Mutations in the amyloid precursor protein (APP), presenilin 1 (PSEN1) and presenilin 2 (PSEN2) genes cause a proportion of familial early-onset AD (eoAD), while the microtubule-associated protein tau (MAPT) and progranulin (PGRN) mutations have been identified in FTLD patients. Only a few PSEN1 and APP mutations have previously been found in Finnish AD patients, and one MAPT mutation in a FTLD family, while the role of PGRN in Finnish FTLD patients is unknown. Increasing evidence suggests that mitochondrial dysfunction and oxidative stress also play an important role in neurodegenerative diseases. The aim here was to investigate the genetics of eoAD and FTLD in the population of the province of Northern Ostrobothnia, Finland. Sequencing analysis of the APP, PSEN1 and PSEN2 genes was performed to determine whether mutations in these genes could be detected. The MAPT and PGRN genes were analysed in the FTLD patients by sequencing and MAPT haplotypes were determined. The contributions of mtDNA and its maintenance enzymes to eoAD and FTLD were studied by comparing the frequencies of mtDNA haplogroups and their clusters between the patient groups and controls and by screening for the five common POLG1 mutations (T251I, A467T, P587L, W748S, Y955C), two common mtDNA mutations (m.3243A>G, m.8344A>G) and mutations in the PEO1 and ANT1 genes. This is the first report of a significant association between the mtDNA haplogroup cluster IWX and FTLD. The H2 MAPT haplotype was also associated with FTLD in our cohort. No significant differences in the frequencies of the mtDNA haplogroups were observed between the eoAD patients and controls, nor were there any pathogenic mutations detected in the genes analysed. The findings suggest that possession of the mtDNA haplogroup cluster IWX and the H2 MAPT haplotype may be possible risk factors for FTLD in our cohort. The absence of any pathogenic mutations in the MAPT, PGRN, APP or PSEN genes in our series, together with the previous reports of only a few mutations found in this region, supports a minor role for these genes in the aetiology of eoAD and FTLD in Northern Ostrobothnia and indicates that this population may have its own genetic features. There may be other, still unknown genetic factors to be discovered, that explain familial diseases in the region.