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Using Exome Sequencing to Reveal Mutations in TREM2 Presenting as a Frontotemporal Dementia–like Syndrome Without Bone Involvement
Open accessAbstract
OBJECTIVE: To identify new genes and risk factors associated with frontotemporal dementia (FTD). Several genes and loci have been associated with different forms of FTD, but a large number of families with dementia do not harbor mutations in these genes. DESIGN: Whole-exome sequencing and whole-genome genotyping were performed in all patients. Genetic variants obtained from whole-exome sequencing were integrated with the data obtained from whole-genome genotyping. SETTING: Database of the Behavioral Neurology Outpatient Clinic of the Department of Neurology, Istanbul Faculty of Medicine, Istanbul, Turkey. PATIENTS Forty-four Turkish patients with an FTD-like clinical diagnosis were included in the study. Relatives were screened when appropriate. MAIN OUTCOME MEASURE: Mutations in the triggering receptor expressed on myeloid cells 2 gene (TREM2). RESULTS: In 3 probands with FTD-like disease, we identified different homozygous mutations in TREM2 that had previously been associated with polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy (PLOSL). None of these 3 patients had a typical clinical presentation of PLOSL: they presented with behavioral change and subsequent cognitive impairment and motor features but without any bone cysts or bone-associated phenotypes. Imaging showed white matter abnormalities as well as frontal atrophy in all 3 patients. CONCLUSIONS: Our results show that TREM2 is responsible for an unexpectedly high number of dementia cases in our cohort, suggesting that this gene should be taken into account when mutations in other dementia genes are excluded. Even for complex syndromes such as dementia, exome sequencing has proven to be a rapid and cost-effective tool to identify genetic mutations, allowing for the association of clinical phenotypes with unexpected molecular underpinnings.
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“In particular, there is converging evidence for the role of neuroinflammation in neurodegenerative dementias, including FTD, from genetic associations (Guerreiro et al., 2013; Rayaprolu et al., 2013; Broce et al., 2018), CSF (Sjogren et al., 2004; Woollacott et al., 2018), epidemiology (Miller et al., 2013, 2016), post-mortem tissue (Venneti et al., 2008; Lant et al., 2014) and animal models”
From Neuroinflammation and protein aggregation co-localize across the frontotemporal dementia spectrum (2020) · cites this paper as Guerreiro et al., 2013
In the citing paper
“Nonsense or missense mutations in TREM2 have been identified in several families with FTD.343–345”
From Microglia in neurodegenerative diseases: mechanism and potential therapeutic targets (2023) · cites this paper as [344]
In the citing paper
“Homozygous TREM2 p.T66M mutation has also been identified to cause FTD-like syndrome.344”
From Microglia in neurodegenerative diseases: mechanism and potential therapeutic targets (2023) · cites this paper as [344]
In the citing paper
“In addition to the R47H variant, further TREM2 variants have been revealed to be risk factors of AD or other CNS diseases, such as R62H (8,20), H157Y (25), Q33X, T66M and Y38C (26,27).”
From Trem2 promotes anti-inflammatory responses in microglia and is suppressed under pro-inflammatory conditions (2020) · cites this paper as [27]
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“The same type of mutations in TREM2 were also found to cause frontotemporal dementia (FTD) without the typical bone phenotypes found in PLOSL (Guerreiro et al., 2013a), and heterozygous rare variants have been shown to modulate the risk of Alzheimer's disease (Guerreiro et al., 2013b; Jonsson et al., 2013).”
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“Additional variants including D87N and T96K have been linked to AD development [1] and two other point mutations in TREM-2 (Y38C and T66M) have been linked to the development of frontotemporal dementia (FTD) [8–11].”
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“1, in the TREM gene cluster.([30,31]) The structural components of TREMs include an extracellular immunoglobulin-like domain, a transmembrane domain, and a small cytoplasmic tail.”
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“…genetics studies culminated in the discovery of both rare disease variants and common risk loci, all of which were located within genes expressed exclusively in microglia or other brain-associated myeloid cells (Guerreiro et al. 2013; Hollingworth et al. 2011; Jonsson et al. 2013; Naj et al. 2011).”
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“TREM2 mutations leading to early-onset dementia without bone cyst formation have so far been reported only in a single Lebanese family (Chouery et al., 2008) and three Turkish families (Guerreiro et al., 2013).”
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Haploinsufficiency and Alzheimer’s Disease: The Possible Pathogenic and Protective Genetic Factors
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“Y38C variants, residing in the Ig fold, lead to deficits in TREM2 protein folding, maturation, and expression (145, 146).”
BackgroundBianchin, M. M., Abujamra, A. L., & Izquierdo, I. (2013) · JAMA Neurology · doi:10.1001/jamaneurol.2013.453 · Cited by 9
Pillai, J. P., Sung, K., & Wu, C. (2025) · Computational and Structural Biotechnology Journal · doi:10.1016/j.csbj.2025.01.024 · Cited by 7
“However, two heterozygotes demonstrated these symptoms, consistent with NHD [28].”
Unveiling the impact of TREM-2+ Macrophages in metabolic disorders
Contreras, M., Matos, A. D. O., Dantas, P. H. D. S., Neto, J. R. D. C., Silva‐Sales, M., & Sales‐Campos, H. (2024) · Cellular Immunology · doi:10.1016/j.cellimm.2024.104882 · Cited by 10
Hernández, I., Rosende‐Roca, M., Alegret, M., Mauleón, A., Espinosa, A., Vargas, L., Sotolongo‐Grau, Ó., Tárraga, L., Boada, M., & Ruiz, A. (2014) · Journal of Alzheimer s Disease · doi:10.3233/jad-132432 · Cited by 8
“Interestingly, genetic analysis of familiar cases of FTD has revealed mutations in multiple loci including GRN [13, 14] and MAPT [15] genes, both very close on chromosome 17, but also in CHMP2B [16], UBQLN2 [17], SQSTM1 [18], or TREM2 [19] genes.”
Soluble TREM2 in body fluid in Alzheimer’s disease and Parkinson’s disease
Gu, L., Shu, H., & Wang, Y. (2023) · Neurological Sciences · doi:10.1007/s10072-023-06729-5 · Cited by 7
“The gene encoding the TREM2, a signaling receptor associated with microglial activation, is considered to be related to some neurodegenerative disorders, including AD [5], frontotemporal (FTD)-like dementia [6], and polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy [7].”
BackgroundAtypical findings: Atypical parkinsonian syndromes or Atypical parkinsonian syndromes look-alikes
Çalıkuşu, F. Z., Akkuş, S., Kızılkılıç, E. K., Poyraz, B. Ç., Altunç, A. T., Kızıltan, G., & Gündüz, A. (2023) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2023.107975 · Cited by 8
Ramakrishnan, S., Arshad, F., Bs, K., Pon, A. G., Bosco, S., Kumar, S., Chidambaram, H., Chinnathambi, S. C. B., Kulanthaivelu, K., Arunachal, G., et al. (2024) · Dementia and Geriatric Cognitive Disorders Extra · doi:10.1159/000538145 · Cited by 8
Evaluation of the Clinical Features Accompanied by the Gene Mutations
Eryılmaz, I. E., Bakar, M., Egelí, Ü., Çeçener, G., Yurdacan, B., Çolak, D. K., & Tunca, B. (2021) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0000000000000437 · Cited by 7
Crews, F. T., Qin, L., Coleman, L. G., Vidrascu, E. M., & Vetreno, R. P. (2025) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2025.106156 · Cited by 7
Santamaría‐García, H. A., Ogonowski, N. S., Báez, S., Palacio, N., Reyes, P. A., Schulte, M., López, A., Matallana, D., & Ibáñez, A. M. (2022) · BMC Neurology · doi:10.1186/s12883-022-02954-1 · Cited by 17
Leukodystrophy or genetic leukoencephalopathy? Nature does not make leaps
Salsano, E. (2015) · Molecular Genetics and Metabolism · doi:10.1016/j.ymgme.2015.02.005 · Cited by 6
Tan, C., Wan, Y., Tan, M., Zhang, W., Wang, Z., Sun, F.-R., Miao, D., Tan, L., & Yu, J. (2016) · Journal of Alzheimer s Disease · doi:10.3233/jad-151073 · Cited by 6
“Similarly, using exome sequencing a study has revealed mutations in TREM2 in patients presenting as an FTD-like syndrome [14].”
Method[Splenic cyst. Review of the literature and report of 2 cases].
de Melo, V. A., Júnior, A. A., Andrade, L. C., Aragão, J. F. B., & Rosa, J. E. (1995) · PubMed · Cited by 6
The Role of Genetics in Alzheimer's Disease and Parkinson's Disease
Porter, T., Gozt, A., Mastaglia, F. L., & Laws, S. M. (2019) · Wiley eBooks · doi:10.1002/9781119356752.ch15 · Cited by 6
Soares, I. F. Z., Christofolini, D. M., Silva, L. G., Feder, D., & Carvalho, A. A. D. S. (2020) · Molecular Genetics & Genomic Medicine · doi:10.1002/mgg3.1491 · Cited by 6
“In all patients, homozygous variants in the TREM2 gene were found, and none had a bone phenotype (Chouery et al., 2008; Giraldo et al., 2013; Guerreiro et al., 2013).”
BackgroundInfluentialβ-Catenin Pathway Is Involved in TREM2-Mediated Microglial Survival
Zulfiqar, S., & Tanriöver, G. (2017) · Journal of Neuroscience · doi:10.1523/jneurosci.1087-17.2017 · Cited by 5
Williamson, J. C., & Larner, A. J. (2018) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0000000000000271 · Cited by 5
Ahmad, S. S., Younis, K., Jeandet, P., Aschner, M., & Khan, H. Z. (2021) · CNS & Neurological Disorders - Drug Targets · doi:10.2174/1871527320666210811160007 · Cited by 5
Wauters, E., Sleegers, K., Cruts, M., & Broeckhoven, C. V. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-805120-7.00009-9 · Cited by 6
TREM2 R47H exacerbates immune response in Alzheimer’s disease brainPreprint
Korvatska, O., Kiianitsa, K., Ratushny, A., Matsushita, M., Beeman, N., Chien, W.-M., Satoh, J.-I., Dorschner, M., Keene, C., Bammler, T., et al. (2018) · bioRxiv · doi:10.1101/499319 · Cited by 4
“In PLOSL, homozygous inactivating mutations include premature stop codons (33, 34), splice site mutations (35, 36) and missense mutations D134G, K186N (4), Y38C, T66M, and V126G (37),(38),(5).”
BackgroundWhite matter hyperintensities and neurodegenerative dementias
Sassi, C. (2019) · Aging · doi:10.18632/aging.101967 · Cited by 4
Monoallelic TYROBP deletion is a novel risk factor for Alzheimer’s diseasePreprint
Martiskainen, H., Willman, R.-M., Heikkinen, S., Müller, S. A., Sinisalo, R., Takalo, M., Mäkinen, P. M., Kuulasmaa, T., Pekkala, V., del Rey, A. G., et al. (2024) · medRxiv · doi:10.1101/2024.05.09.24307099 · Cited by 4
Alterations in the brain lipidome of Alzheimer's disease donors with rare TREM2 risk variants
Proitsi, P., Ebshiana, A., Wretlind, A., Xu, J., Hodges, A., & Legido‐Quigley, C. (2026) · Brain Communications · doi:10.1093/braincomms/fcaf452 · Cited by 3
Gilani, N., Bitarafan, F., Özaslan, M., Åsheim, S., Heidari, M., & Garshasbi, M. (2024) · Molecular Genetics & Genomic Medicine · doi:10.1002/mgg3.2476 · Cited by 3
Familial cerebral amyloid disorders with prominent white matter involvement
Banerjee, G., Schott, J. M., & Ryan, N. S. (2024) · Handbook of clinical neurology · doi:10.1016/b978-0-323-99209-1.00010-7 · Cited by 3
Origin and Development of Microglia
Patro, N., & Patro, I. K. (2022) · Springer eBooks · doi:10.1007/978-981-16-8313-8_7 · Cited by 3
Yuan, Q., Liu, X., Zhang, Y., Xian, Y., Zou, J., Zhang, X., Huang, P., Song, Y., & Lin, Z. (2021) · Molecules · doi:10.3390/molecules26092685 · Cited by 3
Network-Based Analysis for Uncovering Mechanisms Underlying Alzheimer’s Disease
Kikuchi, M., Ogishima, S., Mizuno, S., Miyashita, A., Kuwano, R., Nakaya, J., & Tanaka, H. (2015) · Methods in molecular biology · doi:10.1007/978-1-4939-2627-5_29 · Cited by 3
Gorenjak, V., Arguinano, A.-A. A., Dadé, S., Stathopoulou, M., Vance, D. R., Masson, C., & Visvikis-Siest, S. (2018) · Scientific Reports · doi:10.1038/s41598-018-25553-y · Cited by 3
Cell autonomous microglia defects in a stem cell model of frontotemporal dementiaPreprint
Iyer, A. K., Vermunt, L., Mirfakhar, F. S., Minaya, M., Acquarone, M., Koppisetti, R. K., Renganathan, A., You, S., Danhash, E., Verbeck, A. C., et al. (2024) · medRxiv · doi:10.1101/2024.05.15.24307444 · Cited by 3
Biophysical characterization of TREM2 missense variants implicated in neurodegenerative disease
Pillai, J. P., Sung, K., Shi, L. Z., & Wu, C. (2025) · Computational and Structural Biotechnology Journal · doi:10.1016/j.csbj.2025.07.003 · Cited by 2
“Finally, the D86V caused significant damage to TREM2 as a charged residue was replaced with an uncharged and removal of hydrogen bond interactions [45].”
Microglial heterogeneity in neurological disorders: From dynamic states to druggable targets
Ou, Q., Dai, Z., Zhou, Y., Li, G., Liu, H., Li, J., He, C., Qin, S., & Su, Z. (2026) · Biochemical Pharmacology · doi:10.1016/j.bcp.2026.117994 · Cited by 3
Innate immune crosstalk in ALS/FTD pathogenesis
Shu, X., Yu, X., Xu, P., & Wang, A. (2026) · Cell Insight · doi:10.1016/j.cellin.2026.100340 · Cited by 2
“Moreover, TREM2 is a recognized risk gene in ALS/FTD (Cady et al., 2014; Guerreiro et al., 2013a); the TREM2 protein drives microglial survival, metabolic adaptation, and phagocytic activity, enabling the clearance of toxic aggregates such as poly-GA and TDP-43 (Shu et al., 2023; Xie et al., 2022).”
Revisiting TREM2: from multi-omics signaling networks to clinical translation
Yang, J., Wan, D., Ren, L., Lv, Y., & Zhao, H. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1782384 · Cited by 2
Genetics and Epigenetics in the Neurodegenerative Disorders of the Central Nervous System
Fenoglio, C. (2018) · Springer eBooks · doi:10.1007/978-3-319-72938-1_1 · Cited by 2
Reitz, C., & Tosto, G. (2013) · Journal of Molecular and Genetic Medicine · doi:10.4172/1747-0862.1000060 · Cited by 2
“Other homozygous TREM2 mutations have been described in patients presenting with frontotemporal-like dementia [53].”
BackgroundPosterior cortical atrophy: a single case cognitive and radiological follow-up
Esteves, S., Romero, D. A. R., Torralva, T., Cuitiño, M. M., Herndon, S., Couto, B., Ibáñez, A. M., Manes, F. F., & Roca, M. (2018) · Neurocase · doi:10.1080/13554794.2017.1421667 · Cited by 2
Metadata
- Authors
- Guerreiro, R. J., Lohmann, E., Brás, J. M., Gibbs, J. R., Rohrer, J. D., Gurunlian, N., Dursun, B., Bilgic, B., Hanagasi, H., Gurvit, H., Emre, M., Singleton, A., & Hardy, J.
- Affiliations
- National Institutes of Health (US)
- ORCID
- Venue
- JAMA Neurology
- Publisher
- American Medical Association (AMA)
- Published
- 2013-01-01
- Volume
- 70
- Issue
- 1
- Pages
- 78
- ISSN
- 2168-6149 (ISSN-L)
- PMC
- PMC4001789
- OpenAlex
- W1984557585
- Cited by
- 374
- References
- 27
- Citations by year
- 2026: 18 · 2025: 23 · 2024: 20 · 2023: 17 · 2022: 12 · 2021: 39 · 2020: 34 · 2019: 22 · 2018: 32 · 2017: 37 · 2016: 29 · 2015: 40 · 2014: 26 · 2013: 21
- FWCI
- 27.37
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- JAMA Neurology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Wellcome Trust (089698)
- National Institutes of Health
- National Institute on Aging (Z01AG000950)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genomics and Rare Diseases
- Keywords
- TREM2, frontotemporal dementia, homozygous mutation, genetic diagnosis, white matter abnormalities, behavior change, cognitive impairment, exome sequencing, Turkish patients
- MeSH terms
- Adult, Humans, Male, Membrane Glycoproteins, Mutation, Receptors, Immunologic, Risk Factors, Syndrome, Frontotemporal Dementia, Exome
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