Disease survival and progression in TARDBP ALS patients from Sardinia, Italy

Background Common genes implicated in amyotrophic lateral sclerosis (ALS) development may also influence its progression rate. The C9orf72 mutations featured a faster progression rate while the European SOD1 mutations were associated with a slower progression. In this study, we assessed the relationship between TARDBP and ALS progression/survival. Methods ALS incident patients (2010–2019) were diagnosed by El Escorial revised criteria and staged over the disease course by the King’s staging system. Disease progression was analysed by Kaplan–Meier survival curves and Cox regression models, with survival measured from symptom onset to death/tracheostomy or censor date. Results The study population included 76 patients carrying TARDBP mutations (A382T/G295S), 28 patients carrying the C9orf72 GGGGCC expansion, and 158 patients who had no evidence of causative genetic mutations (nmALS group). TARDBP patients reached death/tracheostomy later than C9orf72 and nmALS patients, independently of possible prognostic indicators (sex, age at ALS onset, diagnostic delay, phenotype at onset, and family history of ALS). On King’s staging, the time elapsed between disease onset (King’s stage 1) and involvement of the second body region (King’s stage 2B) was similar in TARDBP and nmALS patients but longer in TARDBP than in C9orf72 patients. TARDBP patients reached King’s stages 3 and 4 later than C9orf72 and nmALS patients. Conclusions TARDBP patients have a better survival/prognosis than C9orf72-positive and nmALS patients. King’s staging also suggested that the higher survival rate and the slower progression associated with the TARDBP mutation could mainly be attributed to the longer time elapsed between King’s stages 2B to 3.