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Debette S, Paré G. Stroke Genetics, Genomics, and Precision Medicine. Stroke 2024; 55:2163-2168. [PMID: 38511336 DOI: 10.1161/strokeaha.123.044212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Stéphanie Debette
- University of Bordeaux, INSERM, Bordeaux Population Health, France (S.D.)
- Department of Neurology, Institute for Neurodegenerative Diseases, Bordeaux University Hospital, France (S.D.)
| | - Guillaume Paré
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (G.P.)
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Boston G, Jobson D, Mizuno T, Ihara M, Kalaria RN. Most common NOTCH3 mutations causing CADASIL or CADASIL-like cerebral small vessel disease: A systematic review. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100227. [PMID: 38966425 PMCID: PMC11223087 DOI: 10.1016/j.cccb.2024.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 05/09/2024] [Accepted: 05/30/2024] [Indexed: 07/06/2024]
Abstract
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a monogenic disorder caused by mutations in the NOTCH3 gene. The main aim of our survey was to determine if there is an association between phenotypes and genotypes across the most common NOTCH3 mutations found in CADASIL patients. We systematically searched clinical studies and genomic databases from 1996 to 2023 to first identify the most common mutations responsible for CADASIL. We found the six most common NOTCH3 missense mutations globally were the p.R75P, p.R133C, p.R141C, p.R169C, p.R182C, and p.R544C, of which p.R133C was described to occur most often. Focusing on studies with comprehensive clinical records, our analysis further suggested that the p.R75P, p.R141C, p.R182C and p.R544C genotypes were highly congruent with the presence of white matter hyperintensities on magnetic resonance imaging (MRI), which was the most common phenotypic characteristic across all four mutations. We found the p.R141C mutation was associated with increased severity of disease. We also found the average age of onset in p.R544C carriers was more than a decade later compared to the p.R141C carriers. However, statistical analysis showed there were no overall differences between the phenotypic characteristics of the two common mutations, p.R141C and p.R544C. Geographically, China and Japan were the only two countries to report all the four common mutations vis a vis p.R75P, p.R141C, p.R182C and p.R544C. There is a possibility that this is due to a combination of a founder effect, but there also could be sampling biases.
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Affiliation(s)
- Georgina Boston
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dan Jobson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Toshiki Mizuno
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Centre, Osaka, Japan
| | - Raj N Kalaria
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Mnaili MA. First intravenous thrombolysis for pCys194Arg Notch 3 mutation in a Moroccan CADASIL patient with stroke. Radiol Case Rep 2024; 19:2549-2551. [PMID: 38596173 PMCID: PMC11001636 DOI: 10.1016/j.radcr.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) is caused by mutations in the NOTCH3 gene. Clinical manifestations of CADASIL include lacunar infarcts, transient ischemic attacks, dementia, migraine, and psychiatric disorders. Cerebral MRI can show signal abnormalities in the basal ganglia and white matter, especially characteristic when located in the anterior part of the temporal lobe and external capsules. We report CADASIL patient treated with intravenous tenectelase for acute ischemic stroke, and we present a review of literature aimed to report effectiveness and safety of intravenous thrombolysis in CADASIL patients.
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Affiliation(s)
- Mohamed Amine Mnaili
- Neurology Department, Agadir Military Hospital, Agadir, Morocco
- University of Hassan II, Casablanca, Morocco
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Cerfontaine MN, Hack RJ, Gesierich B, Duering M, Witjes-Ané MNW, Rodríguez-Girondo M, Gravesteijn G, Rutten J, Lesnik Oberstein SAJ. Association of NOTCH3 Variant Risk Category With 2-Year Clinical and Radiologic Small Vessel Disease Progression in Patients With CADASIL. Neurology 2024; 102:e209310. [PMID: 38713890 PMCID: PMC11177591 DOI: 10.1212/wnl.0000000000209310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/01/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Pathogenic variants in NOTCH3 are the main cause of hereditary cerebral small vessel disease (SVD). SVD-associated NOTCH3 variants have recently been categorized into high risk (HR), moderate risk (MR), or low risk (LR) for developing early-onset severe SVD. The most severe NOTCH3-associated SVD phenotype is also known as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). We aimed to investigate whether NOTCH3 variant risk category is associated with 2-year progression rate of SVD clinical and neuroimaging outcomes in CADASIL. METHODS A single-center prospective 2-year follow-up study was performed of patients with CADASIL. Clinical outcomes were incident stroke, disability (modified Rankin Scale), and executive function (Trail Making Test B given A t-scores). Neuroimaging outcomes were mean skeletonized mean diffusivity (MSMD), normalized white matter hyperintensity volume (nWMHv), normalized lacune volume (nLV), and brain parenchymal fraction (BPF). Cox regression and mixed-effect models, adjusted for age, sex, and cardiovascular risk factors, were used to study 2-year changes in outcomes and differences in disease progression between patients with HR-NOTCH3 and MR-NOTCH3 variants. RESULTS One hundred sixty-two patients with HR (n = 90), MR (n = 67), and LR (n = 5) NOTCH3 variants were included. For the entire cohort, there was 2-year mean progression for MSMD (β = 0.20, 95% CI 0.17-0.23, p = 7.0 × 10-24), nLV (β = 0.13, 95% CI 0.080-0.19, p = 2.1 × 10-6), nWMHv (β = 0.092, 95% CI 0.075-0.11, p = 8.8 × 10-20), and BPF (β = -0.22, 95% CI -0.26 to -0.19, p = 3.2 × 10-22), as well as an increase in disability (p = 0.002) and decline of executive function (β = -0.15, 95% CI -0.30 to -3.4 × 10-5, p = 0.05). The HR-NOTCH3 group had a higher probability of 2-year incident stroke (hazard ratio 4.3, 95% CI 1.4-13.5, p = 0.011), and a higher increase in MSMD (β = 0.074, 95% CI 0.013-0.14, p = 0.017) and nLV (β = 0.14, 95% CI 0.034-0.24, p = 0.0089) than the MR-NOTCH3 group. Subgroup analyses showed significant 2-year progression of MSMD in young (n = 17, β = 0.014, 95% CI 0.0093-0.019, p = 1.4 × 10-5) and premanifest (n = 24, β = 0.012, 95% CI 0.0082-0.016, p = 1.1 × 10-6) individuals. DISCUSSION In a trial-sensitive time span of 2 years, we found that patients with HR-NOTCH3 variants have a significantly faster progression of major clinical and neuroimaging outcomes, compared with patients with MR-NOTCH3 variants. This has important implications for clinical trial design and disease prediction and monitoring in the clinic. Moreover, we show that MSMD is a promising outcome measure for trials enrolling premanifest individuals.
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Affiliation(s)
- Minne N Cerfontaine
- From the Departments of Clinical Genetics (M.N.C., R.J.H., G.G., J.R., S.A.J.L.O.), Geriatrics and Psychiatrics (M.-N.W.W.-A.), and Medical Statistics (M.R.-G.), Leiden University Medical Center, the Netherlands; and Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering (B.G., M.D.), University of Basel, Switzerland
| | - Remco J Hack
- From the Departments of Clinical Genetics (M.N.C., R.J.H., G.G., J.R., S.A.J.L.O.), Geriatrics and Psychiatrics (M.-N.W.W.-A.), and Medical Statistics (M.R.-G.), Leiden University Medical Center, the Netherlands; and Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering (B.G., M.D.), University of Basel, Switzerland
| | - Benno Gesierich
- From the Departments of Clinical Genetics (M.N.C., R.J.H., G.G., J.R., S.A.J.L.O.), Geriatrics and Psychiatrics (M.-N.W.W.-A.), and Medical Statistics (M.R.-G.), Leiden University Medical Center, the Netherlands; and Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering (B.G., M.D.), University of Basel, Switzerland
| | - Marco Duering
- From the Departments of Clinical Genetics (M.N.C., R.J.H., G.G., J.R., S.A.J.L.O.), Geriatrics and Psychiatrics (M.-N.W.W.-A.), and Medical Statistics (M.R.-G.), Leiden University Medical Center, the Netherlands; and Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering (B.G., M.D.), University of Basel, Switzerland
| | - Marie-Noëlle W Witjes-Ané
- From the Departments of Clinical Genetics (M.N.C., R.J.H., G.G., J.R., S.A.J.L.O.), Geriatrics and Psychiatrics (M.-N.W.W.-A.), and Medical Statistics (M.R.-G.), Leiden University Medical Center, the Netherlands; and Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering (B.G., M.D.), University of Basel, Switzerland
| | - Mar Rodríguez-Girondo
- From the Departments of Clinical Genetics (M.N.C., R.J.H., G.G., J.R., S.A.J.L.O.), Geriatrics and Psychiatrics (M.-N.W.W.-A.), and Medical Statistics (M.R.-G.), Leiden University Medical Center, the Netherlands; and Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering (B.G., M.D.), University of Basel, Switzerland
| | - Gido Gravesteijn
- From the Departments of Clinical Genetics (M.N.C., R.J.H., G.G., J.R., S.A.J.L.O.), Geriatrics and Psychiatrics (M.-N.W.W.-A.), and Medical Statistics (M.R.-G.), Leiden University Medical Center, the Netherlands; and Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering (B.G., M.D.), University of Basel, Switzerland
| | - Julie Rutten
- From the Departments of Clinical Genetics (M.N.C., R.J.H., G.G., J.R., S.A.J.L.O.), Geriatrics and Psychiatrics (M.-N.W.W.-A.), and Medical Statistics (M.R.-G.), Leiden University Medical Center, the Netherlands; and Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering (B.G., M.D.), University of Basel, Switzerland
| | - Saskia A J Lesnik Oberstein
- From the Departments of Clinical Genetics (M.N.C., R.J.H., G.G., J.R., S.A.J.L.O.), Geriatrics and Psychiatrics (M.-N.W.W.-A.), and Medical Statistics (M.R.-G.), Leiden University Medical Center, the Netherlands; and Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering (B.G., M.D.), University of Basel, Switzerland
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Saks DG, Bajorek B, Catts VS, Bentvelzen AC, Jiang J, Wen W, Mather KA, Thalamuthu A, Huang-Lung J, Nivison-Smith L, Griffiths LR, Smith RA, Sexton A, James P, Jayasena T, Poljak A, Hansra GK, Hosoki S, Park A, Hillenbrand CM, van Wijngaarden P, Chander RJ, Humphrey S, Chen R, Kochan NA, Helman TJ, Levi C, Brodtmann A, O'Sullivan MJ, Markus R, Butcher K, Parsons M, Kovacic JC, Sachdev PS. The protocol for an observational Australian cohort study of CADASIL: The AusCADASIL study. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100225. [PMID: 38841148 PMCID: PMC11152887 DOI: 10.1016/j.cccb.2024.100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024]
Abstract
Introduction Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a rare genetic condition with a broad phenotypic presentation. This study aims to establish the first Australian cohort of individuals affected by CADASIL (AusCADASIL) and examine its clinical features and longitudinal course, and to investigate neuroimaging and blood biomarkers to assist in early diagnosis and identify disease progression. Methods Participants will be recruited from six study centres across Australia for an observational study of CADASIL. We aim to recruit 150 participants with diagnosed CADASIL, family history of CADASIL or suspected CADASIL symptoms, and 150 cognitively normal NOTCH3 negative individuals as controls. Participants will complete: 1) online questionnaires on medical and family history, mental health, and wellbeing; 2) neuropsychological evaluation; 3) neurological examination and brain MRI; 4) ocular examination and 5) blood sample donation. Participants will have annual follow-up for 4 years to assess their progression and will be asked to invite a study partner to corroborate their self-reported cognitive and functional abilities.Primary outcomes include cognitive function and neuroimaging abnormalities. Secondary outcomes include investigation of genetics and blood and ocular biomarkers. Data from the cohort will contribute to an international consortium, and cohort participants will be invited to access future treatment/health intervention trials. Discussion AusCADASIL will be the first study of an Australian cohort of individuals with CADASIL. The study will identify common pathogenic variants in this cohort, and characterise the pattern of clinical presentation and longitudinal progression, including imaging features, blood and ocular biomarkers and cognitive profile.
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Affiliation(s)
- Danit G. Saks
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Beata Bajorek
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, 2305, Australia
- Pharmacy Department, John Hunter Hospital, Newcastle, 2305, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, 2308, Australia
| | - Vibeke S. Catts
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Adam C. Bentvelzen
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Wei Wen
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Karen A. Mather
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Anbupalam Thalamuthu
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Jessie Huang-Lung
- School of Optometry and Vision Science, University of New South Wales, Sydney, 2052, Australia
| | - Lisa Nivison-Smith
- School of Optometry and Vision Science, University of New South Wales, Sydney, 2052, Australia
| | - Lyn R. Griffiths
- Genomics Research Centre, Centre for Genomics and Personalised Health, Queensland University of Technology, Brisbane, 4059, Australia
| | - Robert A. Smith
- Genomics Research Centre, Centre for Genomics and Personalised Health, Queensland University of Technology, Brisbane, 4059, Australia
| | - Adrienne Sexton
- Genomic Medicine, Royal Melbourne Hospital, Melbourne, 3052, Australia
| | - Paul James
- Genomic Medicine, Royal Melbourne Hospital, Melbourne, 3052, Australia
| | - Tharusha Jayasena
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Anne Poljak
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
- Bioanalytical Mass Spectrometry Facility, University of New South Wales, Sydney, 2052, Australia
| | - Gurpreet K. Hansra
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Satoshi Hosoki
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Ashley Park
- Department of Neurology, Royal Melbourne Hospital, Melbourne, 3052, Australia
| | | | - Peter van Wijngaarden
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, 3002, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, 3052, Australia
| | - Russell J. Chander
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Sam Humphrey
- Department of Neurology, Royal Melbourne Hospital, Melbourne, 3052, Australia
| | - Rory Chen
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Nicole A. Kochan
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Tessa J. Helman
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Christopher Levi
- School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia
- John Hunter Health and Innovation Precinct (JHHIP), Newcastle, 2305, Australia
- Neurology Department, John Hunter Hospital, Newcastle, 2305, Australia
| | - Amy Brodtmann
- Department of Neurology, Royal Melbourne Hospital, Melbourne, 3052, Australia
| | - Michael J. O'Sullivan
- Institute for Molecular Bioscience, University of Queensland, Brisbane, 4067, Australia
| | - Romesh Markus
- Department of Neurology, St Vincent's Hospital, Sydney, 2010, Australia
| | - Ken Butcher
- Department of Neurology, Prince of Wales Hospital, Sydney, 2031, Australia
| | - Mark Parsons
- School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Jason C. Kovacic
- School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
- Victor Chang Cardiac Research Institute, Sydney, 2010, Australia
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, 2031, Australia
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Dupré N, Drieu A, Joutel A. Pathophysiology of cerebral small vessel disease: a journey through recent discoveries. J Clin Invest 2024; 134:e172841. [PMID: 38747292 PMCID: PMC11093606 DOI: 10.1172/jci172841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Abstract
Cerebral small vessel disease (cSVD) encompasses a heterogeneous group of age-related small vessel pathologies that affect multiple regions. Disease manifestations range from lesions incidentally detected on neuroimaging (white matter hyperintensities, small deep infarcts, microbleeds, or enlarged perivascular spaces) to severe disability and cognitive impairment. cSVD accounts for approximately 25% of ischemic strokes and the vast majority of spontaneous intracerebral hemorrhage and is also the most important vascular contributor to dementia. Despite its high prevalence and potentially long therapeutic window, there are still no mechanism-based treatments. Here, we provide an overview of the recent advances in this field. We summarize recent data highlighting the remarkable continuum between monogenic and multifactorial cSVDs involving NOTCH3, HTRA1, and COL4A1/A2 genes. Taking a vessel-centric view, we discuss possible cause-and-effect relationships between risk factors, structural and functional vessel changes, and disease manifestations, underscoring some major knowledge gaps. Although endothelial dysfunction is rightly considered a central feature of cSVD, the contributions of smooth muscle cells, pericytes, and other perivascular cells warrant continued investigation.
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Affiliation(s)
- Nicolas Dupré
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
| | - Antoine Drieu
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
| | - Anne Joutel
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
- GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
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Valančienė J, Melaika K, Šliachtenko A, Šiaurytė-Jurgelėnė K, Ekkert A, Jatužis D. Stroke genetics and how it Informs novel drug discovery. Expert Opin Drug Discov 2024; 19:553-564. [PMID: 38494780 DOI: 10.1080/17460441.2024.2324916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/26/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Stroke is one of the main causes of death and disability worldwide. Nevertheless, despite the global burden of this disease, our understanding is limited and there is still a lack of highly efficient etiopathology-based treatment. It is partly due to the complexity and heterogenicity of the disease. It is estimated that around one-third of ischemic stroke is heritable, emphasizing the importance of genetic factors identification and targeting for therapeutic purposes. AREAS COVERED In this review, the authors provide an overview of the current knowledge of stroke genetics and its value in diagnostics, personalized treatment, and prognostication. EXPERT OPINION As the scale of genetic testing increases and the cost decreases, integration of genetic data into clinical practice is inevitable, enabling assessing individual risk, providing personalized prognostic models and identifying new therapeutic targets and biomarkers. Although expanding stroke genetics data provides different diagnostics and treatment perspectives, there are some limitations and challenges to face. One of them is the threat of health disparities as non-European populations are underrepresented in genetic datasets. Finally, a deeper understanding of underlying mechanisms of potential targets is still lacking, delaying the application of novel therapies into routine clinical practice.
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Affiliation(s)
| | | | | | - Kamilė Šiaurytė-Jurgelėnė
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Dalius Jatužis
- Center of Neurology, Vilnius University, Vilnius, Lithuania
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De Kort AM, Verbeek MM, Schreuder FH, Klijn CJ, Jäkel L. Prevalence of Cerebral Amyloid Angiopathy Pathology and Strictly Lobar Microbleeds in East-Asian Versus Western Populations: A Systematic Review and Meta-Analysis. J Stroke 2024; 26:179-189. [PMID: 38836267 PMCID: PMC11164577 DOI: 10.5853/jos.2023.04287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND PURPOSE Possible differences in the prevalence of cerebral amyloid angiopathy (CAA) in East-Asian compared to Western populations have received little attention, and results so far have been ambiguous. Our aim is to compare the prevalence of CAA neuropathology and magnetic resonance imaging markers of CAA in East-Asian and Western cohorts reflecting the general population, cognitively normal elderly, patients with Alzheimer's disease (AD), and patients with (lobar) intracerebral hemorrhage (ICH). METHODS We performed a systematic literature search in PubMed and Embase for original research papers on the prevalence of CAA and imaging markers of CAA published up until February 17th 2022. Records were screened by two independent reviewers. Pooled estimates were determined using random-effects models. We compared studies from Japan, China, Taiwan, South Korea (East-Asian cohorts) to studies from Europe or North America (Western cohorts) by meta-regression models. RESULTS We identified 12,257 unique records, and we included 143 studies on Western study populations and 53 studies on East-Asian study populations. Prevalence of CAA neuropathology did not differ between East-Asian and Western cohorts in any of the investigated patient domains. The prevalence of strictly lobar microbleeds was lower in East-Asian cohorts of population-based individuals (5.6% vs. 11.4%, P=0.020), cognitively normal elderly (2.6% vs. 11.4%, P=0.001), and patients with ICH (10.2% vs. 24.6%, P<0.0001). However, age was in general lower in the East-Asian cohorts. CONCLUSION The prevalence of CAA neuropathology in the general population, cognitively normal elderly, patients with AD, and patients with (lobar) ICH is similar in East-Asian and Western countries. In East-Asian cohorts reflecting the general population, cognitively normal elderly, and patients with ICH, strictly lobar microbleeds were less prevalent, likely due to their younger age. Consideration of potential presence of CAA is warranted in decisions regarding antithrombotic treatment and potential new anti-amyloid-β immunotherapy as treatment for AD in East-Asian and Western countries alike.
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Affiliation(s)
- Anna M. De Kort
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel M. Verbeek
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Floris H.B.M. Schreuder
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Catharina J.M. Klijn
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Lieke Jäkel
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands
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Liu W, Zhang J, Li J, Jia S, Wang Y, Geng J, Wang Y. First report of a p.Cys484Tyr Notch3 mutation in a CADASIL patient with acute bilateral multiple subcortical infarcts-case report and brief review. BMC Neurol 2024; 24:77. [PMID: 38408980 PMCID: PMC10895806 DOI: 10.1186/s12883-024-03573-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/16/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND CADASIL(Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)is an inherited small vessel disease caused by mutations in NOTCH3 gene. Although NOTCH3 has numerous hotspots of gene mutations, mutations in exons 9 are rare. The p.C484T gene mutation type associated with it has not been reported in any relevant cases yet. Furthermore, CADASIL patients rarely present with acute bilateral multiple subcortical infarcts. CASE PRESENTATION We report the case of a Chinese female patient with CADASIL who experienced "an acute bilateral subcortical infarction" because of"hemodynamic changes and hypercoagulability". In genetic testing, we discovered a new Cys484Tyr mutation in exon 9, which has also been found in the patient's two daughters. CONCLUSIONS It is important to note that this discovery not only expands the mutation spectrum of Notch3 mutations in CADASIL patients, but also examines the mechanism behind acute bilateral subcortical infarction in CADASIL patients via case reviews and literature reviews, in order to provide some clinical recommendations for early intervention, diagnosis, and treatment in similar cases in the future.
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Affiliation(s)
- Weili Liu
- Department of Neurology II, Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Jie Zhang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Jian Li
- Department of Neurology II, Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Shuai Jia
- Department of Neurology II, Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Yanqiang Wang
- Department of Neurology II, Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Jianhong Geng
- Department of Neurology II, Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Yaozhen Wang
- Department of Neurology II, Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China.
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10
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Wang J, Zhang L, Wu G, Wu J, Zhou X, Chen X, Niu Y, Jiao Y, Liu Q, Liang P, Shi G, Wu X, Huang J. Correction of a CADASIL point mutation using adenine base editors in hiPSCs and blood vessel organoids. J Genet Genomics 2024; 51:197-207. [PMID: 37164272 DOI: 10.1016/j.jgg.2023.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/12/2023]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a monogenic small vessel disease caused by mutations in the NOTCH3 gene. However, the pathogenesis of CADASIL remains unclear, and patients have limited treatment options. Here, we use human induced pluripotent stem cells (hiPSCs) generated from the peripheral blood mononuclear cells of a patient with CADASIL carrying a heterozygous NOTCH3 mutation (c.1261C>T, p.R421C) to develop a disease model. The correction efficiency of different adenine base editors (ABEs) is tested using the HEK293T-NOTCH3 reporter cell line. ABEmax is selected based on its higher efficiency and minimization of predicted off-target effects. Vascular smooth muscle cells (VSMCs) differentiated from CADASIL hiPSCs show NOTCH3 deposition and abnormal actin cytoskeleton structure, and the abnormalities are recovered in corrected hiPSC-derived VSMCs. Furthermore, CADASIL blood vessel organoids generated for in vivo modeling show altered expression of genes related to disease phenotypes, including the downregulation of cell adhesion, extracellular matrix organization, and vessel development. The dual adeno-associated virus (AAV) split-ABEmax system is applied to the genome editing of vascular organoids with an average editing efficiency of 8.82%. Collectively, we present potential genetic therapeutic strategies for patients with CADASIL using blood vessel organoids and the dual AAV split-ABEmax system.
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Affiliation(s)
- Jingwen Wang
- MOE Key Laboratory of Gene Function and Regulation, State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, Guangdong 510275, China; Key Laboratory of Reproductive Medicine of Guangdong Province, The First Affiliated Hospital and School of Life Sciences, Sun Yat-sen University, Guangzhou, Guangdong 510275, China
| | - Lei Zhang
- Center of Reproductive Medicine, Children's Hospital of Shanxi and Women Health Center of Shanxi, Taiyuan, Shanxi 030013, China
| | - Guanglan Wu
- MOE Key Laboratory of Gene Function and Regulation, State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, Guangdong 510275, China
| | - Jinni Wu
- MOE Key Laboratory of Gene Function and Regulation, State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, Guangdong 510275, China
| | - Xinyao Zhou
- MOE Key Laboratory of Gene Function and Regulation, State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, Guangdong 510275, China
| | - Xiaolin Chen
- MOE Key Laboratory of Gene Function and Regulation, State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, Guangdong 510275, China
| | - Yongxia Niu
- MOE Key Laboratory of Gene Function and Regulation, State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, Guangdong 510275, China
| | - Yiren Jiao
- MOE Key Laboratory of Gene Function and Regulation, State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, Guangdong 510275, China
| | - Qianyi Liu
- MOE Key Laboratory of Gene Function and Regulation, State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, Guangdong 510275, China
| | - Puping Liang
- MOE Key Laboratory of Gene Function and Regulation, State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, Guangdong 510275, China
| | - Guang Shi
- MOE Key Laboratory of Gene Function and Regulation, State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, Guangdong 510275, China
| | - Xueqing Wu
- Center of Reproductive Medicine, Children's Hospital of Shanxi and Women Health Center of Shanxi, Taiyuan, Shanxi 030013, China.
| | - Junjiu Huang
- MOE Key Laboratory of Gene Function and Regulation, State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, Guangdong 510275, China; Key Laboratory of Reproductive Medicine of Guangdong Province, The First Affiliated Hospital and School of Life Sciences, Sun Yat-sen University, Guangzhou, Guangdong 510275, China.
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11
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Mizuta I, Nakao-Azuma Y, Yoshida H, Yamaguchi M, Mizuno T. Progress to Clarify How NOTCH3 Mutations Lead to CADASIL, a Hereditary Cerebral Small Vessel Disease. Biomolecules 2024; 14:127. [PMID: 38254727 PMCID: PMC10813265 DOI: 10.3390/biom14010127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Notch signaling is conserved in C. elegans, Drosophila, and mammals. Among the four NOTCH genes in humans, NOTCH1, NOTCH2, and NOTCH3 are known to cause monogenic hereditary disorders. Most NOTCH-related disorders are congenital and caused by a gain or loss of Notch signaling activity. In contrast, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) caused by NOTCH3 is adult-onset and considered to be caused by accumulation of the mutant NOTCH3 extracellular domain (N3ECD) and, possibly, by an impairment in Notch signaling. Pathophysiological processes following mutant N3ECD accumulation have been intensively investigated; however, the process leading to N3ECD accumulation and its association with canonical NOTCH3 signaling remain unknown. We reviewed the progress in clarifying the pathophysiological process involving mutant NOTCH3.
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Affiliation(s)
- Ikuko Mizuta
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan; (I.M.)
| | - Yumiko Nakao-Azuma
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan; (I.M.)
- Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Hideki Yoshida
- Department of Applied Biology, Kyoto Institute of Technology, Matsugasaki, Sakyo-ku, Kyoto 606-8585, Japan
| | - Masamitsu Yamaguchi
- Department of Applied Biology, Kyoto Institute of Technology, Matsugasaki, Sakyo-ku, Kyoto 606-8585, Japan
- Kansai Gakken Laboratory, Kankyo Eisei Yakuhin Co., Ltd., 3-6-2 Hikaridai, Seika-cho, Kyoto 619-0237, Japan
| | - Toshiki Mizuno
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan; (I.M.)
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12
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Markus HS. How genetics is impacting on stroke, thrombolysis for central retinal artery occlusion, and cerebral microinfarcts. Int J Stroke 2024; 19:4-6. [PMID: 38161293 DOI: 10.1177/17474930231217911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
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13
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Lin HJ, Chen CH, Su MW, Lin CW, Cheng YW, Tang SC, Jeng JS. Modifiable vascular risk factors contribute to stroke in 1080 NOTCH3 R544C carriers in Taiwan Biobank. Int J Stroke 2024; 19:105-113. [PMID: 37485895 DOI: 10.1177/17474930231191991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND AND AIM Previous studies have suggested cardiovascular risk factors increase the risk of not only common sporadic stroke but also of stroke in patients with monogenic stroke disorders including CADASIL. We investigated the effects of the NOTCH3 Arg544Cys (R544C) variant and associated vascular risk factors on stroke in the Taiwanese population. METHODS This study was conducted using data from the Taiwan Biobank, consisting of at least 130,000 Han Chinese participants. The genotype was derived from customized genome-wide arrays for 650,000 to 750,000 single-nucleotide polymorphisms (SNPs). Individuals with NOTCH3 R544C were subsequently matched with noncarriers based on the propensity score at a 1:10 ratio by demographic and cardiovascular risk factors. The odds ratio (OR) for stroke or other phenotypes in NOTCH3 R544C carriers and matched noncarriers was then calculated. Univariate and multivariate regression analyses were performed on cardiovascular risk factors in NOTCH3 R544C carriers with and without stroke. The polygenic risk score (PRS) model, adopted from the UK Biobank, was then applied to evaluate the role of NOTCH3 R544C in stroke. RESULTS From the 114,282 participants with both genotype and questionnaire results, 1080 (0.95%) harbored the pathogenic NOTCH3 R544C variant. When compared to the matched controls (n = 10,800), the carriers presented with a history of stroke (OR: 2.52, 95% confidence interval (CI) (1.45, 4.37)), dementia (OR: 30.1, 95% CI (3.13, 289.43)), and sibling history of stroke (OR: 2.48, 95% CI (1.85, 3.34)) phenotypes. The risk of stroke increased with every 10-year increase in age (p = 0.006, Cochran-Mantel-Haenszel test). Among NOTCH3 R544C carriers, 16 (1.3%) of the 1080 carriers with a stroke history were older, male, and more likely to have hypertension, diabetes, dyslipidemia, and a family history of stroke. In the stepwise multivariate analysis, hypertension (OR: 11.28, 95% CI (3.54, 43.3)) and diabetes mellitus (OR: 4.10, 95% CI (1.31, 12.4)) were independently associated with stroke. Harboring the NOTCH3 R544C variant in the Taiwan Biobank is comparable with a 6.74 standard deviations increase in individual's polygenic risk score for stroke. CONCLUSION While the NOTCH3 R544C variant alone increased the risk of stroke, modifiable vascular risk factors also played a role in the occurrence of stroke in Taiwanese community-dwelling individuals carrying the NOTCH3 variant.
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Affiliation(s)
- Hung-Jen Lin
- Department of Medical Education, National Taiwan University Hospital, Taipei
| | - Chih-Hao Chen
- Department of Neurology, National Taiwan University Hospital, Taipei
| | - Ming-Wei Su
- Institute of Biomedical Sciences, Academia Sinica, Taipei
| | - Chien-Wei Lin
- Institute of Biomedical Sciences, Academia Sinica, Taipei
| | - Yu-Wen Cheng
- Department of Neurology, National Taiwan University Hospital, Taipei
| | - Sung-Chun Tang
- Department of Neurology, National Taiwan University Hospital, Taipei
| | - Jiann-Shing Jeng
- Department of Neurology, National Taiwan University Hospital, Taipei
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14
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Chhoa H, Chabriat H, Chevret S, Biard L. Comparison of models for stroke-free survival prediction in patients with CADASIL. Sci Rep 2023; 13:22443. [PMID: 38105268 PMCID: PMC10725863 DOI: 10.1038/s41598-023-49552-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, which is caused by mutations of the NOTCH3 gene, has a large heterogeneous progression, presenting with declines of various clinical scores and occurrences of various clinical event. To help assess disease progression, this work focused on predicting the composite endpoint of stroke-free survival time by comparing the performance of Cox proportional hazards regression to that of machine learning models using one of four feature selection approaches applied to demographic, clinical and magnetic resonance imaging observational data collected from a study cohort of 482 patients. The quality of the modeling process and the predictive performance were evaluated in a nested cross-validation procedure using the time-dependent Brier Score and AUC at 5 years from baseline, the former measuring the overall performance including calibration and the latter highlighting the discrimination ability, with both metrics taking into account the presence of right-censoring. The best model for each metric was the componentwise gradient boosting model with a mean Brier score of 0.165 and the random survival forest model with a mean AUC of 0.773, both combined with the LASSO feature selection method.
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Affiliation(s)
- Henri Chhoa
- ECSTRRA Team, Université Paris Cité, UMR1153, INSERM, Paris, France
| | - Hugues Chabriat
- Centre NeuroVasculaire Translationnel - Centre de Référence CERVCO, DMU NeuroSciences, Hôpital Lariboisière, GHU APHP-Nord, Université Paris Cité, Paris, France
- INSERM NeuroDiderot UMR 1141, GenMedStroke Team, Paris, France
| | - Sylvie Chevret
- ECSTRRA Team, Université Paris Cité, UMR1153, INSERM, Paris, France
| | - Lucie Biard
- ECSTRRA Team, Université Paris Cité, UMR1153, INSERM, Paris, France.
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15
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Cheng Y, Liao Y, Chen C, Chung C, Fann CSJ, Chang C, Lee Y, Tang S. Contribution of the APOE Genotype to Cognitive Impairment in Individuals With NOTCH3 Cysteine-Altering Variants. J Am Heart Assoc 2023; 12:e032689. [PMID: 37982214 PMCID: PMC10727295 DOI: 10.1161/jaha.123.032689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/23/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most prevalent monogenic cerebral small-vessel disease. Phenotype variability in CADASIL suggests the possible role of genetic modifiers. We aimed to investigate the contributions of the APOE genotype and Neurogenic locus notch homolog protein 3 (NOTCH3) variant position to cognitive impairment associated with CADASIL. METHODS AND RESULTS Patients with the cysteine-altering NOTCH3 variant were enrolled in a cross-sectional study, including the Mini-Mental State Examination (MMSE), brain magnetic resonance imaging, and APOE genotyping. Cognitive impairment was defined as an MMSE score <24. The associations between the MMSE score and genetic factors were assessed using linear regression models. Bayesian adjustment for confounding was used to identify clinical confounders. A total of 246 individuals were enrolled, among whom 210 (85%) harbored the p.R544C variant, 96 (39%) had cognitive impairment, and 150 (61%) had a history of stroke. The APOE ɛ2 allele was associated with a lower MMSE score (adjusted B, -4.090 [95% CI, -6.708 to -1.473]; P=0.023), whereas the NOTCH3 p.R544C variant was associated with a higher MMSE score (adjusted B, 2.854 [95% CI, 0.603-5.105]; P=0.0132) after adjustment for age, education, and history of ischemic stroke. Mediation analysis suggests that the associations between the APOE ɛ2 allele and MMSE score and between the NOTCH3 p.R544C variant and MMSE score are mediated by mesial temporal atrophy and white matter hyperintensity, respectively. CONCLUSIONS APOE genotype may modify cognitive impairment in CADASIL, whereby individuals carrying the APOE ɛ2 allele may present a more severe cognitive impairment.
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Affiliation(s)
- Yu‐Wen Cheng
- Department of NeurologyNational Taiwan University HospitalTaipeiTaiwan
| | - Yi‐Chu Liao
- Department of NeurologyTaipei Veterans General HospitalTaipeiTaiwan
- Faculty of Medicine, School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Chih‐Hao Chen
- Department of NeurologyNational Taiwan University HospitalTaipeiTaiwan
| | - Chih‐Ping Chung
- Department of NeurologyTaipei Veterans General HospitalTaipeiTaiwan
| | | | | | - Yi‐Chung Lee
- Department of NeurologyTaipei Veterans General HospitalTaipeiTaiwan
- Faculty of Medicine, School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Sung‐Chun Tang
- Department of NeurologyNational Taiwan University HospitalTaipeiTaiwan
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16
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Liu ZY, Zhai FF, Liu JY, Zhou YJ, Shu MJ, Huang XH, Han F, Li ML, Zhou LX, Ni J, Yao M, Zhang SY, Cui LY, Jin ZY, Zhu YC. Pattern of Brain Parenchymal Damage Related to Cerebral Small Vessel Disease in Carriers of Rare NOTCH3 Variants. Neurology 2023; 101:e1979-e1991. [PMID: 37775315 PMCID: PMC10662991 DOI: 10.1212/wnl.0000000000207882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/10/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Previous studies reported that carriers of rare NOTCH3 variants comprised more than 10% of the general population and are susceptible to a heavy overall burden of cerebral small vessel disease while the injury patterns remain uncovered. This study aimed to investigate the imaging features in relation to rare NOTCH3 variants and the interaction between cortical atrophy and white matter lesions from a longitudinal view, with respect to spatial and dynamic patterns. METHODS As part of a community-based cohort, we included participants with complete whole-exome sequencing and brain MRI in the baseline analysis. All participants were invited for a 5-year follow-up MRI, and those who did not complete the follow-up were excluded from the longitudinal analysis. NOTCH3 variants with minor allele frequency <1% in all 4 public population databases were defined as rare variants. We used general linear models to compare the volume of white matter hyperintensity (WMH) volume and brain parenchymal fraction between rare NOTCH3 variant carriers and noncarriers. In addition, we compared the WMH probability map and vertex-wise cortex maps at a voxel/vertex-wise level. RESULTS A total of 1,054 participants were included in baseline analysis (13.56% carried rare NOTCH3 variants), among whom 661 had a follow-up brain MRI (13.76% carried rare NOTCH3 variants). Rare NOTCH3 variant carriers had a heavier white matter hyperintensity burden (1.65 vs 0.85 mL, p = 0.025) and had more extensive WMH distributed in the periventricular areas. We also found that rare NOTCH3 variant carriers were susceptible to worse cortical atrophy (β = -0.004, SE = 0.002, p = 0.057, adjusted for age and sex). Cortical atrophy of multiple regions in the frontal and parietal lobes was related to white matter hyperintensity progression. DISCUSSION Individuals with rare NOTCH3 variants have a distinct pattern of brain parenchymal damage related to CSVD. Our findings uncover the important genetic predisposition in age-related cerebral small vessel disease in the general population.
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Affiliation(s)
- Zi-Yue Liu
- From the Department of Neurology (Z.-Y.L., F.-F.Z., M.-J.S., X.-H.H., F.H., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.); Department of Radiology (J.-Y.L., Y.-J.Z., M.-L.L., Z.-Y.J.); and Department of Cardiology (S.-Y.Z.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei-Fei Zhai
- From the Department of Neurology (Z.-Y.L., F.-F.Z., M.-J.S., X.-H.H., F.H., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.); Department of Radiology (J.-Y.L., Y.-J.Z., M.-L.L., Z.-Y.J.); and Department of Cardiology (S.-Y.Z.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing-Yi Liu
- From the Department of Neurology (Z.-Y.L., F.-F.Z., M.-J.S., X.-H.H., F.H., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.); Department of Radiology (J.-Y.L., Y.-J.Z., M.-L.L., Z.-Y.J.); and Department of Cardiology (S.-Y.Z.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Jun Zhou
- From the Department of Neurology (Z.-Y.L., F.-F.Z., M.-J.S., X.-H.H., F.H., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.); Department of Radiology (J.-Y.L., Y.-J.Z., M.-L.L., Z.-Y.J.); and Department of Cardiology (S.-Y.Z.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mei-Jun Shu
- From the Department of Neurology (Z.-Y.L., F.-F.Z., M.-J.S., X.-H.H., F.H., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.); Department of Radiology (J.-Y.L., Y.-J.Z., M.-L.L., Z.-Y.J.); and Department of Cardiology (S.-Y.Z.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Hong Huang
- From the Department of Neurology (Z.-Y.L., F.-F.Z., M.-J.S., X.-H.H., F.H., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.); Department of Radiology (J.-Y.L., Y.-J.Z., M.-L.L., Z.-Y.J.); and Department of Cardiology (S.-Y.Z.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Han
- From the Department of Neurology (Z.-Y.L., F.-F.Z., M.-J.S., X.-H.H., F.H., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.); Department of Radiology (J.-Y.L., Y.-J.Z., M.-L.L., Z.-Y.J.); and Department of Cardiology (S.-Y.Z.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming-Li Li
- From the Department of Neurology (Z.-Y.L., F.-F.Z., M.-J.S., X.-H.H., F.H., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.); Department of Radiology (J.-Y.L., Y.-J.Z., M.-L.L., Z.-Y.J.); and Department of Cardiology (S.-Y.Z.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Xin Zhou
- From the Department of Neurology (Z.-Y.L., F.-F.Z., M.-J.S., X.-H.H., F.H., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.); Department of Radiology (J.-Y.L., Y.-J.Z., M.-L.L., Z.-Y.J.); and Department of Cardiology (S.-Y.Z.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Ni
- From the Department of Neurology (Z.-Y.L., F.-F.Z., M.-J.S., X.-H.H., F.H., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.); Department of Radiology (J.-Y.L., Y.-J.Z., M.-L.L., Z.-Y.J.); and Department of Cardiology (S.-Y.Z.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Yao
- From the Department of Neurology (Z.-Y.L., F.-F.Z., M.-J.S., X.-H.H., F.H., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.); Department of Radiology (J.-Y.L., Y.-J.Z., M.-L.L., Z.-Y.J.); and Department of Cardiology (S.-Y.Z.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Yang Zhang
- From the Department of Neurology (Z.-Y.L., F.-F.Z., M.-J.S., X.-H.H., F.H., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.); Department of Radiology (J.-Y.L., Y.-J.Z., M.-L.L., Z.-Y.J.); and Department of Cardiology (S.-Y.Z.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Ying Cui
- From the Department of Neurology (Z.-Y.L., F.-F.Z., M.-J.S., X.-H.H., F.H., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.); Department of Radiology (J.-Y.L., Y.-J.Z., M.-L.L., Z.-Y.J.); and Department of Cardiology (S.-Y.Z.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng-Yu Jin
- From the Department of Neurology (Z.-Y.L., F.-F.Z., M.-J.S., X.-H.H., F.H., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.); Department of Radiology (J.-Y.L., Y.-J.Z., M.-L.L., Z.-Y.J.); and Department of Cardiology (S.-Y.Z.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Cheng Zhu
- From the Department of Neurology (Z.-Y.L., F.-F.Z., M.-J.S., X.-H.H., F.H., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.); Department of Radiology (J.-Y.L., Y.-J.Z., M.-L.L., Z.-Y.J.); and Department of Cardiology (S.-Y.Z.), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Szymanowicz O, Korczowska-Łącka I, Słowikowski B, Wiszniewska M, Piotrowska A, Goutor U, Jagodziński PP, Kozubski W, Dorszewska J. Headache and NOTCH3 Gene Variants in Patients with CADASIL. Neurol Int 2023; 15:1238-1252. [PMID: 37873835 PMCID: PMC10594416 DOI: 10.3390/neurolint15040078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/25/2023] Open
Abstract
Autosomal dominant cerebral arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited vascular disease characterized by recurrent strokes, cognitive impairment, psychiatric symptoms, apathy, and migraine. Approximately 40% of patients with CADASIL experience migraine with aura (MA). In addition to MA, CADASIL patients are described in the literature as having migraine without aura (MO) and other types of headaches. Mutations in the NOTCH3 gene cause CADASIL. This study investigated NOTCH3 genetic variants in CADASIL patients and their potential association with headache types. Genetic tests were performed on 30 patients with CADASIL (20 women aged 43.6 ± 11.5 and 10 men aged 39.6 ± 15.8). PCR-HRM and sequencing methods were used in the genetic study. We described three variants as pathogenic/likely pathogenic (p.Tyr189Cys, p.Arg153Cys, p.Cys144Arg) and two benign variants (p.Ala202=, p.Thr101=) in the NOTCH3 gene and also presented the NOTCH3 gene variant (chr19:15192258 G>T), which has not been previously described in the literature. Patients with pathogenic/likely pathogenic variants had similar headache courses. People with benign variants showed a more diverse clinical picture. It seems that different NOTCH3 variants may contribute to the differential presentation of a CADASIL headache, highlighting the diagnostic and prognostic value of headache characteristics in this disease.
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Affiliation(s)
- Oliwia Szymanowicz
- Laboratory of Neurobiology, Department of Neurology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (O.S.); (I.K.-Ł.); (U.G.)
| | - Izabela Korczowska-Łącka
- Laboratory of Neurobiology, Department of Neurology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (O.S.); (I.K.-Ł.); (U.G.)
| | - Bartosz Słowikowski
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (B.S.); (P.P.J.)
| | - Małgorzata Wiszniewska
- Faculty of Health Care, Stanislaw Staszic University of Applied Sciences in Pila, 64-920 Pila, Poland;
- Department of Neurology, Specialistic Hospital in Pila, 64-920 Pila, Poland
| | - Ada Piotrowska
- Chair and Department of Neurology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.P.); (W.K.)
| | - Ulyana Goutor
- Laboratory of Neurobiology, Department of Neurology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (O.S.); (I.K.-Ł.); (U.G.)
| | - Paweł P. Jagodziński
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (B.S.); (P.P.J.)
| | - Wojciech Kozubski
- Chair and Department of Neurology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.P.); (W.K.)
| | - Jolanta Dorszewska
- Laboratory of Neurobiology, Department of Neurology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (O.S.); (I.K.-Ł.); (U.G.)
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18
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Chhoa H, Chabriat H, Anato AJ, Bamba M, Zittoun F, Chevret S, Biard L. Improvement of an External Predictive Model Based on New Information Using a Synthetic Data Approach: Application to CADASIL. Neurol Genet 2023; 9:e200091. [PMID: 38235365 PMCID: PMC10691224 DOI: 10.1212/nxg.0000000000200091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/07/2023] [Indexed: 01/19/2024]
Abstract
Background and Objectives Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most frequent hereditary cerebral small vessel disease. It is caused by mutations of the NOTCH3 gene. The disease evolves progressively over decades leading to stroke, disability, cognitive decline, and functional dependency. The course and clinical severity of CADASIL seem heterogeneous. Predictive models are thus needed to improve prognostic evaluation and inform future clinical trials. A predictive model of the 3-year variation in the Mattis Dementia Rating Scale (MDRS), which reflects the global cognitive performance of patients with CADASIL, was previously proposed. This model made predictions based on demographic, clinical, and MRI data. We aimed to improve this existing predictive model by integrating a new potential factor, the location of the genetic mutation in the different epidermal growth factor (EGFr) domains of the NOTCH3 gene, dichotomized into EGFr domains 1 to 6 or 7 to 34. Methods We used a new synthetic data approach to improve the initial predictive model by incorporating additional genetic information. This method combined the predicted outcomes from the previous model and 5 "synthetic" data sets with the observed outcome in a new data set. We then applied a multiple imputation method for missing data on the mutation location. Results The new data set included 367 patients who were followed up for 30 to 42 months. In the multivariable model with synthetic data, patients with NOTCH3 mutations in EGFr domains 7 to 34 had an additional average decrease of -1.4 points (standard error 0.67, p = 0.035) in their MDRS score variation over 3 years compared with patients with mutations located in EGFr domains 1 to 6. Cross-validation results highlighted the improved predictive performance of the enhanced model. Moreover, the model estimation was found to be more robust than fitting a model without synthetic data. Discussion The use of synthetic data improved the predictive model of MDRS change over 3 years in CADASIL. The predictive performance and estimation robustness of the predictive model were enhanced using this approach, whether genetic information was used. A statistically significant association between the location of the mutation in the NOTCH3 gene and the 3-year MDRS score variation was detected.
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Affiliation(s)
- Henri Chhoa
- From the ECSTRRA Team (H. Chhoa, S.C., L.B.), Université Paris-Cité, UMR1153, INSERM; Translational Neurovascular Centre (H. Chabriat), GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris-Cité and DHU NeuroVasc Sorbonne Paris-Cité; UMR 1161 (H. Chabriat), INSERM; and ENSAI (A.J.A., M.B., F.Z.), Ecole d'ingénieur statistique, data science et big data, Bruz, France
| | - Hugues Chabriat
- From the ECSTRRA Team (H. Chhoa, S.C., L.B.), Université Paris-Cité, UMR1153, INSERM; Translational Neurovascular Centre (H. Chabriat), GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris-Cité and DHU NeuroVasc Sorbonne Paris-Cité; UMR 1161 (H. Chabriat), INSERM; and ENSAI (A.J.A., M.B., F.Z.), Ecole d'ingénieur statistique, data science et big data, Bruz, France
| | - Adelina Joanita Anato
- From the ECSTRRA Team (H. Chhoa, S.C., L.B.), Université Paris-Cité, UMR1153, INSERM; Translational Neurovascular Centre (H. Chabriat), GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris-Cité and DHU NeuroVasc Sorbonne Paris-Cité; UMR 1161 (H. Chabriat), INSERM; and ENSAI (A.J.A., M.B., F.Z.), Ecole d'ingénieur statistique, data science et big data, Bruz, France
| | - Mamadou Bamba
- From the ECSTRRA Team (H. Chhoa, S.C., L.B.), Université Paris-Cité, UMR1153, INSERM; Translational Neurovascular Centre (H. Chabriat), GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris-Cité and DHU NeuroVasc Sorbonne Paris-Cité; UMR 1161 (H. Chabriat), INSERM; and ENSAI (A.J.A., M.B., F.Z.), Ecole d'ingénieur statistique, data science et big data, Bruz, France
| | - Florent Zittoun
- From the ECSTRRA Team (H. Chhoa, S.C., L.B.), Université Paris-Cité, UMR1153, INSERM; Translational Neurovascular Centre (H. Chabriat), GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris-Cité and DHU NeuroVasc Sorbonne Paris-Cité; UMR 1161 (H. Chabriat), INSERM; and ENSAI (A.J.A., M.B., F.Z.), Ecole d'ingénieur statistique, data science et big data, Bruz, France
| | - Sylvie Chevret
- From the ECSTRRA Team (H. Chhoa, S.C., L.B.), Université Paris-Cité, UMR1153, INSERM; Translational Neurovascular Centre (H. Chabriat), GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris-Cité and DHU NeuroVasc Sorbonne Paris-Cité; UMR 1161 (H. Chabriat), INSERM; and ENSAI (A.J.A., M.B., F.Z.), Ecole d'ingénieur statistique, data science et big data, Bruz, France
| | - Lucie Biard
- From the ECSTRRA Team (H. Chhoa, S.C., L.B.), Université Paris-Cité, UMR1153, INSERM; Translational Neurovascular Centre (H. Chabriat), GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris-Cité and DHU NeuroVasc Sorbonne Paris-Cité; UMR 1161 (H. Chabriat), INSERM; and ENSAI (A.J.A., M.B., F.Z.), Ecole d'ingénieur statistique, data science et big data, Bruz, France
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Korvatska O, Bucks SA, Yoda RA, Nolan A, Dorschner MO, Tsuang D, Jayadev S, Raskind WH, Bird TD. NOTCH3 C201R variant causes cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) that can be confused with early-onset Alzheimer's disease. J Neurol Sci 2023; 452:120763. [PMID: 37598468 PMCID: PMC10863424 DOI: 10.1016/j.jns.2023.120763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/08/2023] [Accepted: 08/05/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND NOTCH3 is the causative gene for autosomal dominant cerebral arteriopathy with subcortical infarctions and leukoencephalopathy (CADASIL) which is associated with both stroke and dementia. When CADASIL presents primarily as dementia it can be difficult to distinguish from Alzheimer's disease (AD) at both the clinical and neuropathological levels. METHODS We performed exome sequencing of several affected individuals from a large family affected with AD. PCR amplification and direct Sanger sequencing were used to verify variants detected by exome analysis and to screen family members at-risk to carry those variants. Neuropathologic brain evaluation by immunohistochemistry and MRI were performed for the carriers of the NOTCH3 variant. RESULTS In a three-generation family with AD, we found a c.601 T > C p.Cys201Arg variant in the NOTCH3 gene that caused clinical and neuropathological manifestations of CADASIL. These features included earlier onset of dementia accompanied by behavioral abnormalities in the father and son and white matter abnormalities in the asymptomatic grandson. The family is one branch of a large pedigree studied by the Alzheimer's Disease Sequencing Project (ADSP). As part of the ADSP linkage analysis and whole genome sequencing endeavor, an ABCA1 variant, p.Ala937Val, was previously found associated with AD in this pedigree. CONCLUSIONS Our findings, together with other reported pathogenic missense variants of the C201 codon in NOTCH3, support the role of cysteine 201 as a mutation hotspot for CADASIL and highlight the genetic complexity both clinically and pathologically of AD and related dementia.
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Affiliation(s)
- Olena Korvatska
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA.
| | - Stephanie A Bucks
- Department of Neurology, University of Washington, Seattle, USA; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, USA
| | - Rebecca A Yoda
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, USA
| | - Amber Nolan
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, USA
| | - Michael O Dorschner
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, USA; Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, USA
| | - Debby Tsuang
- Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Medical Center, Seattle, USA
| | - Suman Jayadev
- Department of Neurology, University of Washington, Seattle, USA
| | - Wendy H Raskind
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, USA; Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Medical Center, Seattle, USA; Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Medical Center, Seattle, USA
| | - Thomas D Bird
- Department of Neurology, University of Washington, Seattle, USA; Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Medical Center, Seattle, USA
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20
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Liu S, Men X, Guo Y, Cai W, Wu R, Gao R, Zhong W, Guo H, Ruan H, Chou S, Mai J, Ping S, Jiang C, Zhou H, Mou X, Zhao W, Lu Z. Gut microbes exacerbate systemic inflammation and behavior disorders in neurologic disease CADASIL. MICROBIOME 2023; 11:202. [PMID: 37684694 PMCID: PMC10486110 DOI: 10.1186/s40168-023-01638-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/01/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a cerebral small vessel disease that carries mutations in NOTCH3. The clinical manifestations are influenced by genetic and environmental factors that may include gut microbiome. RESULTS We investigated the fecal metagenome, fecal metabolome, serum metabolome, neurotransmitters, and cytokines in a cohort of 24 CADASIL patients with 28 healthy household controls. The integrated-omics study showed CADASIL patients harbored an altered microbiota composition and functions. The abundance of bacterial coenzyme A, thiamin, and flavin-synthesizing pathways was depleted in patients. Neurotransmitter balance, represented by the glutamate/GABA (4-aminobutanoate) ratio, was disrupted in patients, which was consistent with the increased abundance of two major GABA-consuming bacteria, Megasphaera elsdenii and Eubacterium siraeum. Essential inflammatory cytokines were significantly elevated in patients, accompanied by an increased abundance of bacterial virulence gene homologs. The abundance of patient-enriched Fusobacterium varium positively correlated with the levels of IL-1β and IL-6. Random forest classification based on gut microbial species, serum cytokines, and neurotransmitters showed high predictivity for CADASIL with AUC = 0.89. Targeted culturomics and mechanisms study further showed that patient-derived F. varium infection caused systemic inflammation and behavior disorder in Notch3R170C/+ mice potentially via induction of caspase-8-dependent noncanonical inflammasome activation in macrophages. CONCLUSION These findings suggested the potential linkage among the brain-gut-microbe axis in CADASIL. Video Abstract.
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Affiliation(s)
- Sheng Liu
- Shenzhen Key Laboratory for Systems Medicine in Inflammatory Diseases, School of Medicine, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, 518107, Guangdong, China
| | - Xuejiao Men
- Department of Neurology, Center for the Study of Mental and Neurological Disorders, the Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Yang Guo
- Shenzhen Key Laboratory for Systems Medicine in Inflammatory Diseases, School of Medicine, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, 518107, Guangdong, China
| | - Wei Cai
- Department of Neurology, Center for the Study of Mental and Neurological Disorders, the Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Ruizhen Wu
- Department of Neurology, Center for the Study of Mental and Neurological Disorders, the Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Rongsui Gao
- Shenzhen Key Laboratory for Systems Medicine in Inflammatory Diseases, School of Medicine, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, 518107, Guangdong, China
| | - Weicong Zhong
- Shenzhen Key Laboratory for Systems Medicine in Inflammatory Diseases, School of Medicine, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, 518107, Guangdong, China
| | - Huating Guo
- Shenzhen Key Laboratory for Systems Medicine in Inflammatory Diseases, School of Medicine, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, 518107, Guangdong, China
| | - Hengfang Ruan
- Department of Neurology, Center for the Study of Mental and Neurological Disorders, the Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Shuli Chou
- Shenzhen Key Laboratory for Systems Medicine in Inflammatory Diseases, School of Medicine, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, 518107, Guangdong, China
| | - Junrui Mai
- Shenzhen Key Laboratory for Systems Medicine in Inflammatory Diseases, School of Medicine, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, 518107, Guangdong, China
| | - Suning Ping
- Shenzhen Key Laboratory for Systems Medicine in Inflammatory Diseases, School of Medicine, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, 518107, Guangdong, China
| | - Chao Jiang
- Life Sciences Institute, Zhejiang University, Hangzhou, 310012, Zhejiang, China
| | - Hongwei Zhou
- Department of Laboratory Medicine, Microbiome Medicine Center, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, Guangdong, China
| | - Xiangyu Mou
- Shenzhen Key Laboratory for Systems Medicine in Inflammatory Diseases, School of Medicine, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, 518107, Guangdong, China.
| | - Wenjing Zhao
- Shenzhen Key Laboratory for Systems Medicine in Inflammatory Diseases, School of Medicine, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, 518107, Guangdong, China.
| | - Zhengqi Lu
- Department of Neurology, Center for the Study of Mental and Neurological Disorders, the Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China.
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21
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Cheng S, Xu Z, Bian S, Chen X, Shi Y, Li Y, Duan Y, Liu Y, Lin J, Jiang Y, Jing J, Li Z, Wang Y, Meng X, Liu Y, Fang M, Jin X, Xu X, Wang J, Wang C, Li H, Liu S, Wang Y. The STROMICS genome study: deep whole-genome sequencing and analysis of 10K Chinese patients with ischemic stroke reveal complex genetic and phenotypic interplay. Cell Discov 2023; 9:75. [PMID: 37479695 PMCID: PMC10362040 DOI: 10.1038/s41421-023-00582-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/21/2023] [Indexed: 07/23/2023] Open
Abstract
Ischemic stroke is a leading cause of global mortality and long-term disability. However, there is a paucity of whole-genome sequencing studies on ischemic stroke, resulting in limited knowledge of the interplay between genomic and phenotypic variations among affected patients. Here, we outline the STROMICS design and present the first whole-genome analysis on ischemic stroke by deeply sequencing and analyzing 10,241 stroke patients from China. We identified 135.59 million variants, > 42% of which were novel. Notable disparities in allele frequency were observed between Chinese and other populations for 89 variants associated with stroke risk and 10 variants linked to response to stroke medications. We investigated the population structure of the participants, generating a map of genetic selection consisting of 31 adaptive signals. The adaption of the MTHFR rs1801133-G allele, which links to genetically evaluated VB9 (folate acid) in southern Chinese patients, suggests a gene-specific folate supplement strategy. Through genome-wide association analysis of 18 stroke-related traits, we discovered 10 novel genetic-phenotypic associations and extensive cross-trait pleiotropy at 6 lipid-trait loci of therapeutic relevance. Additionally, we found that the set of loss-of-function and cysteine-altering variants present in the causal gene NOTCH3 for the autosomal dominant stroke disorder CADASIL displayed a broad neuro-imaging spectrum. These findings deepen our understanding of the relationship between the population and individual genetic layout and clinical phenotype among stroke patients, and provide a foundation for future efforts to utilize human genetic knowledge to investigate mechanisms underlying ischemic stroke outcomes, discover novel therapeutic targets, and advance precision medicine.
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Affiliation(s)
- Si Cheng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Changping Laboratory, Beijing, China
- Clinical Center for Precision Medicine in Stroke, Capital Medical University, Beijing, China
- Center of excellence for Omics Research (CORe), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhe Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of excellence for Omics Research (CORe), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shengzhe Bian
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Xi Chen
- BGI-Tianjin, BGI-Shenzhen, Tianjin, China
| | - Yanfeng Shi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of excellence for Omics Research (CORe), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanran Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of excellence for Omics Research (CORe), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of excellence for Omics Research (CORe), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jinxi Lin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Tiantan Neuroimaging Center of Excellence, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | - Xin Jin
- BGI-Shenzhen, Shenzhen, Guangdong, China
| | - Xun Xu
- BGI-Shenzhen, Shenzhen, Guangdong, China
- Guangdong Provincial Key Laboratory of Genome Read and Write, BGI-Shenzhen, Shenzhen, Guangdong, China
| | - Jian Wang
- BGI-Shenzhen, Shenzhen, Guangdong, China
- James D. Watson Institute of Genome Sciences, Hangzhou, Zhejiang, China
| | - Chaolong Wang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of excellence for Omics Research (CORe), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Siyang Liu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China.
- BGI-Shenzhen, Shenzhen, Guangdong, China.
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
- Changping Laboratory, Beijing, China.
- Clinical Center for Precision Medicine in Stroke, Capital Medical University, Beijing, China.
- Center of excellence for Omics Research (CORe), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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22
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Hack RJ, Gravesteijn G, Cerfontaine MN, Santcroos MA, Gatti L, Kopczak A, Bersano A, Duering M, Rutten JW, Lesnik Oberstein SAJ. Three-tiered EGFr domain risk stratification for individualized NOTCH3-small vessel disease prediction. Brain 2023; 146:2913-2927. [PMID: 36535904 PMCID: PMC10316769 DOI: 10.1093/brain/awac486] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/23/2022] [Accepted: 11/27/2022] [Indexed: 02/10/2024] Open
Abstract
Cysteine-altering missense variants (NOTCH3cys) in one of the 34 epidermal growth-factor-like repeat (EGFr) domains of the NOTCH3 protein are the cause of NOTCH3-associated small vessel disease (NOTCH3-SVD). NOTCH3-SVD is highly variable, ranging from cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) at the severe end of the spectrum to non-penetrance. The strongest known NOTCH3-SVD modifier is NOTCH3cys variant position: NOTCH3cys variants located in EGFr domains 1-6 are associated with a more severe phenotype than NOTCH3cys variants located in EGFr domains 7-34. The objective of this study was to further improve NOTCH3-SVD genotype-based risk prediction by using relative differences in NOTCH3cys variant frequencies between large CADASIL and population cohorts as a starting point. Scientific CADASIL literature, cohorts and population databases were queried for NOTCH3cys variants. For each EGFr domain, the relative difference in NOTCH3cys variant frequency (NVFOR) was calculated using genotypes of 2574 CADASIL patients and 1647 individuals from population databases. Based on NVFOR cut-off values, EGFr domains were classified as either low (LR-EGFr), medium (MR-EGFr) or high risk (HR-EGFr). The clinical relevance of this new three-tiered EGFr risk classification was cross-sectionally validated by comparing SVD imaging markers and clinical outcomes between EGFr risk categories using a genotype-phenotype data set of 434 CADASIL patients and 1003 NOTCH3cys positive community-dwelling individuals. CADASIL patients and community-dwelling individuals harboured 379 unique NOTCH3cys variants. Nine EGFr domains were classified as an HR-EGFr, which included EGFr domains 1-6, but additionally also EGFr domains 8, 11 and 26. Ten EGFr domains were classified as MR-EGFr and 11 as LR-EGFr. In the population genotype-phenotype data set, HR-EGFr individuals had the highest risk of stroke [odds ratio (OR) = 10.81, 95% confidence interval (CI): 5.46-21.37], followed by MR-EGFr individuals (OR = 1.81, 95% CI: 0.84-3.88) and LR-EGFr individuals (OR = 1 [reference]). MR-EGFr individuals had a significantly higher normalized white matter hyperintensity volume (nWMHv; P = 0.005) and peak width of skeletonized mean diffusivity (PSMD; P = 0.035) than LR-EGFr individuals. In the CADASIL genotype-phenotype data set, HR-EGFr domains 8, 11 and 26 patients had a significantly higher risk of stroke (P = 0.002), disability (P = 0.041), nWMHv (P = 1.8 × 10-8), PSMD (P = 2.6 × 10-8) and lacune volume (P = 0.006) than MR-EGFr patients. SVD imaging marker load and clinical outcomes were similar between HR-EGFr 1-6 patients and HR-EGFr 8, 11 and 26 patients. NVFOR was significantly associated with vascular NOTCH3 aggregation load (P = 0.006), but not with NOTCH3 signalling activity (P = 0.88). In conclusion, we identified three clinically distinct NOTCH3-SVD EGFr risk categories based on NFVOR cut-off values, and identified three additional HR-EGFr domains located outside of EGFr domains 1-6. This EGFr risk classification will provide an important key to individualized NOTCH3-SVD disease prediction.
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Affiliation(s)
- Remco J Hack
- Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Gido Gravesteijn
- Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Minne N Cerfontaine
- Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Mark A Santcroos
- Department of Human Genetics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Laura Gatti
- Laboratory of Neurobiology, Fondazione IRCSS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Anna Kopczak
- Institute for Stroke and Dementia Research, LMU University Hospital Munich, 81377 Munich, Germany
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Marco Duering
- Institute for Stroke and Dementia Research, LMU University Hospital Munich, 81377 Munich, Germany
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, 4051 Basel, Switzerland
| | - Julie W Rutten
- Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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23
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Zhang W, Zhao X, Qi X, Kimber SJ, Hooper NM, Wang T. Induced pluripotent stem cell model revealed impaired neurovascular interaction in genetic small vessel disease Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy. Front Cell Neurosci 2023; 17:1195470. [PMID: 37361999 PMCID: PMC10285224 DOI: 10.3389/fncel.2023.1195470] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is the most common genetic small vessel disease caused by variants in the NOTCH3 gene. Patients with CADASIL experience recurrent strokes, developing into cognitive defect and vascular dementia. CADASIL is a late-onset vascular condition, but migraine and brain MRI lesions appear in CADASIL patients as early as their teens and twenties, suggesting an abnormal neurovascular interaction at the neurovascular unit (NVU) where microvessels meet the brain parenchyma. Methods To understand the molecular mechanisms of CADASIL, we established induced pluripotent stem cell (iPSC) models from CADASIL patients and differentiated the iPSCs into the major NVU cell types including brain microvascular endothelial-like cells (BMECs), vascular mural cells (MCs), astrocytes and cortical projection neurons. We then built an in vitro NVU model by co-culturing different neurovascular cell types in Transwells and evaluated the blood brain barrier (BBB) function by measuring transendothelial electrical resistance (TEER). Results Results showed that, while the wild-type MCs, astrocytes and neurons could all independently and significantly enhance TEER of the iPSC-BMECs, such capability of MCs from iPSCs of CADASIL patients was significantly impaired. Additionally, the barrier function of the BMECs from CADASIL iPSCs was significantly decreased, accompanied with disorganized tight junctions in iPSC-BMECs, which could not be rescued by the wild-type MCs or sufficiently rescued by the wild-type astrocytes and neurons. Discussion Our findings provide new insight into early disease pathologies on the neurovascular interaction and BBB function at the molecular and cellular levels for CADASIL, which helps inform future therapeutic development.
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Affiliation(s)
- Wenjun Zhang
- Division of Evolution, Infection and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
| | - Xiangjun Zhao
- Division of Evolution, Infection and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
| | - Xuewei Qi
- Division of Evolution, Infection and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
| | - Susan J. Kimber
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
| | - Nigel M. Hooper
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Group, The University of Manchester, Manchester, United Kingdom
| | - Tao Wang
- Division of Evolution, Infection and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Group, The University of Manchester, Manchester, United Kingdom
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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24
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Lee SJ, Zhang X, Wu E, Sukpraphrute R, Sukpraphrute C, Ye A, Wang MM. Structural changes in NOTCH3 induced by CADASIL mutations: role of cysteine and non-cysteine alterations. J Biol Chem 2023:104838. [PMID: 37209821 PMCID: PMC10318516 DOI: 10.1016/j.jbc.2023.104838] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/22/2023] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a cerebral small vessel disease that results from mutations in NOTCH3. How mutations in NOTCH3 ultimately result in disease is not clear, though there is a predilection for mutations to alter the number of cysteines of the gene product, supporting a model in which alterations of conserved disulfide bonds of NOTCH3 drives the disease process. We have found that recombinant proteins with CADASIL NOTCH3 EGF-domains 1-3 fused to the C-terminus of Fc are distinguished from wildtype proteins by slowed mobility in non-reducing gels. We use this gel mobility shift assay to define the effects of mutations in the first three EGF-like domains of NOTCH3 in 167 unique recombinant protein constructs. This assay permits a readout on NOTCH3 protein mobility that indicates that: 1) Any loss of cysteine mutation in the first three EGF motifs results in structural abnormalities; 2) For loss of cysteine mutants, the mutant amino acid residue plays a minimal role; 3) The majority of changes that result in a new cysteine are poorly tolerated; 4) At residue 75, cysteine, proline, and glycine, but no other amino acids, induce structural shifts; 5) Specific second mutations in conserved cysteines suppress the impact of loss of cysteine CADASIL mutations. In sum, these studies support the importance of NOTCH3 cysteines and disulfide bonds in maintaining normal protein structure. Moreover, double mutant analysis suggests that suppression of protein abnormalities can be achieved through modification of cysteine reactivity, a potential therapeutic strategy.
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Affiliation(s)
- Soo Jung Lee
- Departments of Neurology, University of Michigan, Ann Arbor, MI 48109; Neurology Service, VA Ann Arbor Healthcare System, Department of Veterans Affairs, Ann Arbor, MI 48105
| | - Xiaojie Zhang
- Departments of Neurology, University of Michigan, Ann Arbor, MI 48109; Neurology Service, VA Ann Arbor Healthcare System, Department of Veterans Affairs, Ann Arbor, MI 48105
| | - Emily Wu
- Departments of Neurology, University of Michigan, Ann Arbor, MI 48109; Neurology Service, VA Ann Arbor Healthcare System, Department of Veterans Affairs, Ann Arbor, MI 48105
| | - Richard Sukpraphrute
- Departments of Neurology, University of Michigan, Ann Arbor, MI 48109; Neurology Service, VA Ann Arbor Healthcare System, Department of Veterans Affairs, Ann Arbor, MI 48105
| | - Catherine Sukpraphrute
- Departments of Neurology, University of Michigan, Ann Arbor, MI 48109; Neurology Service, VA Ann Arbor Healthcare System, Department of Veterans Affairs, Ann Arbor, MI 48105
| | - Andrew Ye
- Departments of Neurology, University of Michigan, Ann Arbor, MI 48109; Neurology Service, VA Ann Arbor Healthcare System, Department of Veterans Affairs, Ann Arbor, MI 48105
| | - Michael M Wang
- Departments of Neurology, University of Michigan, Ann Arbor, MI 48109; Departments of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI 48109; Neurology Service, VA Ann Arbor Healthcare System, Department of Veterans Affairs, Ann Arbor, MI 48105.
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25
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Markus HS. Diagnostic challenges in CADASIL. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:415-416. [PMID: 37257461 DOI: 10.1055/s-0043-1769618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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26
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Abstract
Cerebral small vessel disease (CSVD) has emerged as a common factor driving age-dependent diseases, including stroke and dementia. CSVD-related dementia will affect a growing fraction of the aging population, requiring improved recognition, understanding, and treatments. This review describes evolving criteria and imaging biomarkers for the diagnosis of CSVD-related dementia. We describe diagnostic challenges, particularly in the context of mixed pathologies and the absence of highly effective biomarkers for CSVD-related dementia. We review evidence regarding CSVD as a risk factor for developing neurodegenerative disease and potential mechanisms by which CSVD leads to progressive brain injury. Finally, we summarize recent studies on the effects of major classes of cardiovascular medicines relevant to CSVD-related cognitive impairment. Although many key questions remain, the increased attention to CSVD has resulted in a sharper vision for what will be needed to meet the upcoming challenges imposed by this disease.
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Affiliation(s)
- Fanny M. Elahi
- Departments of Neurology and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY
- Neurology Service, VA Bronx Healthcare System, Bronx, NY
| | - Michael M. Wang
- Departments of Neurology and Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI
- Neurology Service, VA Ann Arbor Healthcare System, Ann Arbor, MI
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27
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Kim C, Park JS. Double-troubled brothers with GNE myopathy and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy: a case report. Acta Neurol Belg 2023:10.1007/s13760-023-02221-1. [PMID: 36829089 DOI: 10.1007/s13760-023-02221-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/16/2023] [Indexed: 02/26/2023]
Affiliation(s)
- Changho Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea
| | - Jin-Sung Park
- Department of Neurology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, 41404, Daegu, South Korea.
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28
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Yamamoto Y, Liao YC, Lee YC, Ihara M, Choi JC. Update on the Epidemiology, Pathogenesis, and Biomarkers of Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy. J Clin Neurol 2023; 19:12-27. [PMID: 36606642 PMCID: PMC9833879 DOI: 10.3988/jcn.2023.19.1.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 01/04/2023] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common monogenic disorder of the cerebral small blood vessels. It is caused by mutations in the NOTCH3 gene on chromosome 19, and more than 280 distinct pathogenic mutations have been reported to date. CADASIL was once considered a very rare disease with an estimated prevalence of 1.3-4.1 per 100,000 adults. However, recent large-scale genomic studies have revealed a high prevalence of pathogenic NOTCH3 variants among the general population, with the highest risk being among Asians. The disease severity and age at onset vary significantly even among individuals who carry the same NOTCH3 mutations. It is still unclear whether a significant genotype-phenotype correlation is present in CADASIL. The accumulation of granular osmiophilic material in the vasculature is a characteristic feature of CADASIL. However, the exact pathogenesis of CADASIL remains largely unclear despite various laboratory and clinical observations being made. Major hypotheses proposed so far have included aberrant NOTCH3 signaling, toxic aggregation, and abnormal matrisomes. Several characteristic features have been observed in the brain magnetic resonance images of patients with CADASIL, including subcortical lacunar lesions and white matter hyperintensities in the anterior temporal lobe or external capsule, which were useful in differentiating CADASIL from sporadic stroke in patients. The number of lacunes and the degree of brain atrophy were useful in predicting the clinical outcomes of patients with CADASIL. Several promising blood biomarkers have also recently been discovered for CADASIL, which require further research for validation.
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Affiliation(s)
- Yumi Yamamoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yi-Chu Liao
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chung Lee
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju, Korea.,Institute for Medical Science, Jeju National University, Jeju, Korea
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29
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Yongsheng Z, Chong S, Bingyou L, Jianian H, Haofeng C, Chongbo Z, Zhang VW, Jie L. Prevalence estimation of ATTRv in China based on genetic databases. Front Genet 2023; 14:1126836. [PMID: 37124609 PMCID: PMC10133693 DOI: 10.3389/fgene.2023.1126836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction: Amyloid transthyretin (ATTR) is divided into either hereditary (ATTRv) or sporadic (ATTRwt) and ATTRv is a rare hereditary disease transmitted as an autosomal dominant manner. Its global prevalence is traditionally estimated as 5,000 to 10,000 persons. However, it may be underestimated and the exact prevalence of ATTRv in China mainland remains unknown. Methods: The Genome Aggregation database (gnomAD) database (containing 125,748 exomes) and two genomic sequencing databases--China Metabolic Analytics Project (ChinaMAP) (containing 10588 individuals) and Amcarelab gene database (containing 45392 exomes), were integrated to estimate the prevalence of ATTRv in the world and mainland Chinese populations. Pathogenic variants allele frequency and the prevalence of ATTRv was calculated. Results: Six variants, counting 470 alleles, were defined as pathogenic variants in gnomAD. The prevalence of ATTRv in the world population was 57.4/100,000. Two variants (2 allele counts) and 15 variants (34 individuals) were defined as pathogenic variants in the ChinaMAP database and the Amcarelab exome database, respectively. Thus, the estimated prevalence interval of ATTRv in mainland China was 18.9/100,000-74,9/100,000. Conclusion: The present study demonstrated that the previous prevalence was greatly underestimated using traditional methods. Therefore, raising awareness of the disease is essential for recognizing ATTRv in its early stage.
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Affiliation(s)
- Zheng Yongsheng
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Sun Chong
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Liu Bingyou
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Hu Jianian
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Chen Haofeng
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Zhao Chongbo
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | | | - Lin Jie
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- *Correspondence: Lin Jie,
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30
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Juhosová M, Chandoga J, Cisárik F, Dallemule S, Ďurina P, Jarásková D, Jungová P, Kantarská D, Kvasnicová M, Mistrík M, Pastoráková A, Petrovič R, Valachová A, Zelinková H, Barošová J, Böhmer D, Štofko J. Influence of different spectra of NOTCH3 variants on the clinical phenotype of CADASIL - experience from Slovakia. Neurogenetics 2023; 24:1-16. [PMID: 36401683 DOI: 10.1007/s10048-022-00704-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common hereditary vascular disorder causing ischaemic attacks and strokes in middle-aged adults. Though the clinical spectrum includes some typical symptoms, recognition of the disease, especially at an earlier stage, is very difficult because of the highly variable manifestation and incomplete clinical picture. Characteristic brain MRI findings and the presence of pathogenic variants in the NOTCH3 gene are fundamental for CADASIL diagnosis. In this paper, we provide the first comprehensive report on CADASIL patients from Slovakia. Altogether, we identified 23 different pathogenic variants in 35 unrelated families. In our cohort of patients with clinical suspicion of CADASIL, we found a causal genetic defect and confirmed the diagnosis in 10.2% of cases. We present the case reports with up-to-date unpublished NOTCH3 variants and describe their phenotype-genotype correlation: p.(Cys65Phe), p.(Pro86Leu/Ser502Phe), p.(Arg156*), p.(Cys408Arg), p.(Tyr423Cys), p.(Asp1720His), and p.(Asp1893Thrfs*13). The most frequently described location for pathogenic variants was in exon 4, whereas the most common single variant was p.Arg1076Cys in exon 20. Based on the results of our study, we propose a re-evaluation of the criteria for the selection of patients suitable for NOTCH3 gene analysis. We hereby state that the currently used protocol of a high score requirement is not ideal for assessing molecular analysis, and it will be desirable to be less strict in criteria for genetic testing.
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Affiliation(s)
- M Juhosová
- Department of Molecular and Biochemical Genetics, Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine of Comenius University, University Hospital, Mickiewiczova 13, 813 69, Bratislava, Slovakia.
| | - J Chandoga
- Department of Molecular and Biochemical Genetics, Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine of Comenius University, University Hospital, Mickiewiczova 13, 813 69, Bratislava, Slovakia
| | - F Cisárik
- Department of Medical Genetics, University Hospital, Žilina, Slovakia
| | - S Dallemule
- Department of Molecular and Biochemical Genetics, Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine of Comenius University, University Hospital, Mickiewiczova 13, 813 69, Bratislava, Slovakia
| | - P Ďurina
- Department of Molecular and Biochemical Genetics, Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine of Comenius University, University Hospital, Mickiewiczova 13, 813 69, Bratislava, Slovakia
| | - D Jarásková
- Department of Molecular and Biochemical Genetics, Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine of Comenius University, University Hospital, Mickiewiczova 13, 813 69, Bratislava, Slovakia
| | - P Jungová
- Department of Molecular and Biochemical Genetics, Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine of Comenius University, University Hospital, Mickiewiczova 13, 813 69, Bratislava, Slovakia
| | - D Kantarská
- Department of Medical Genetics, University Hospital F.D. Roosvelta, Námestie Ludvíka Svobodu 1, 975 17, Banská Bystrica, Slovakia
| | - M Kvasnicová
- Unilabs Slovensko, s. r. o., Ltd., Bratislava, Slovakia
| | - M Mistrík
- Unilabs Slovensko, s. r. o., Ltd., Bratislava, Slovakia
| | - A Pastoráková
- Department of Molecular and Biochemical Genetics, Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine of Comenius University, University Hospital, Mickiewiczova 13, 813 69, Bratislava, Slovakia
| | - R Petrovič
- Department of Molecular and Biochemical Genetics, Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine of Comenius University, University Hospital, Mickiewiczova 13, 813 69, Bratislava, Slovakia
| | - A Valachová
- Department of Clinical Genetics, University Hospital Trenčín, Trenčín, Slovakia
| | - H Zelinková
- Unilabs Slovensko, s. r. o., Ltd., Bratislava, Slovakia
| | - J Barošová
- Genet, s. r. o., Razusova 16, 949 01, Nitra, Slovakia
| | - D Böhmer
- Department of Molecular and Biochemical Genetics, Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine of Comenius University, University Hospital, Mickiewiczova 13, 813 69, Bratislava, Slovakia
| | - J Štofko
- 1st Department of Neurology, Faculty of Medicine of Comenius University, University Hospital, Bratislava, Slovakia
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31
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Dupé C, Guey S, Biard L, Dieng S, Lebenberg J, Grosset L, Alili N, Hervé D, Tournier-Lasserve E, Jouvent E, Chevret S, Chabriat H. Phenotypic variability in 446 CADASIL patients: Impact of NOTCH3 gene mutation location in addition to the effects of age, sex and vascular risk factors. J Cereb Blood Flow Metab 2023; 43:153-166. [PMID: 36254369 PMCID: PMC9875352 DOI: 10.1177/0271678x221126280] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The recent discovery that the prevalence of cysteine mutations in the NOTCH3 gene responsible for CADASIL was more than 100 times higher in the general population than that estimated in patients highlighted that the mutation location in EGFr-like-domains of the NOTCH3 receptor could have a major effect on the phenotype of the disease. The exact impact of such mutations locations on the multiple facets of the disease has not been fully evaluated. We aimed to describe the phenotypic spectrum of a large population of CADASIL patients and to investigate how this mutation location influenced various clinical and imaging features of the disease. Both a supervised and a non-supervised approach were used for analysis. The results confirmed that the mutation location is strongly related to clinical severity and showed that this effect is mainly driven by a different development of the most damaging ischemic tissue lesions at cerebral level. These effects were detected in addition to those of aging, male sex, hypertension and hypercholesterolemia. The exact mechanisms relating the location of mutations along the NOTCH3 receptor, the amount or properties of the resulting NOTCH3 products accumulating in the vessel wall, and their final consequences at cerebral level remain to be determined.
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Affiliation(s)
- Charlotte Dupé
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France.,UMR 1141 NeuroDiderot, INSERM and Université Paris Cité, Paris, France
| | - Stéphanie Guey
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France.,UMR 1141 NeuroDiderot, INSERM and Université Paris Cité, Paris, France
| | - Lucie Biard
- ECSTRRA Team, UMR-S 1153, Université Paris Cité, INSERM, Paris, France
| | - Sokhna Dieng
- ECSTRRA Team, UMR-S 1153, Université Paris Cité, INSERM, Paris, France
| | - Jessica Lebenberg
- UMR 1141 NeuroDiderot, INSERM and Université Paris Cité, Paris, France
| | - Lina Grosset
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France
| | - Nassira Alili
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France
| | - Dominique Hervé
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France
| | | | - Eric Jouvent
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France.,UMR 1141 NeuroDiderot, INSERM and Université Paris Cité, Paris, France
| | - Sylvie Chevret
- ECSTRRA Team, UMR-S 1153, Université Paris Cité, INSERM, Paris, France
| | - Hugues Chabriat
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France.,UMR 1141 NeuroDiderot, INSERM and Université Paris Cité, Paris, France
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32
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Oliveira DV, Coupland KG, Shao W, Jin S, Del Gaudio F, Wang S, Fox R, Rutten JW, Sandin J, Zetterberg H, Lundkvist J, Lesnik Oberstein SAJ, Lendahl U, Karlström H. Active immunotherapy reduces NOTCH3 deposition in brain capillaries in a CADASIL mouse model. EMBO Mol Med 2022; 15:e16556. [PMID: 36524456 PMCID: PMC9906330 DOI: 10.15252/emmm.202216556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/14/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common monogenic form of familial small vessel disease; no preventive or curative therapy is available. CADASIL is caused by mutations in the NOTCH3 gene, resulting in a mutated NOTCH3 receptor, with aggregation of the NOTCH3 extracellular domain (ECD) around vascular smooth muscle cells. In this study, we have developed a novel active immunization therapy specifically targeting CADASIL-like aggregated NOTCH3 ECD. Immunizing CADASIL TgN3R182C150 mice with aggregates composed of CADASIL-R133C mutated and wild-type EGF1-5 repeats for a total of 4 months resulted in a marked reduction (38-48%) in NOTCH3 deposition around brain capillaries, increased microglia activation and lowered serum levels of NOTCH3 ECD. Active immunization did not impact body weight, general behavior, the number and integrity of vascular smooth muscle cells in the retina, neuronal survival, or inflammation or the renal system, suggesting that the therapy is tolerable. This is the first therapeutic study reporting a successful reduction of NOTCH3 accumulation in a CADASIL mouse model supporting further development towards clinical application for the benefit of CADASIL patients.
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Affiliation(s)
- Daniel V Oliveira
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden,Department of Cell Biology, Faculty of ScienceCharles UniversityPragueCzech Republic
| | - Kirsten G Coupland
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Wenchao Shao
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Shaobo Jin
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden,Department of Cell and Molecular BiologyKarolinska InstitutetStockholmSweden
| | | | - Sailan Wang
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Rhys Fox
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden,Department of Cell and Molecular BiologyKarolinska InstitutetStockholmSweden
| | - Julie W Rutten
- Department of Clinical GeneticsLeiden University Medical CenterLeidenThe Netherlands
| | - Johan Sandin
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden,Alzecure FoundationHuddingeSweden,Alzecure PharmaHuddingeSweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and PhysiologyThe Sahlgrenska Academy at the University of GothenburgMölndalSweden,Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden,Department of Neurodegenerative DiseaseUCL Institute of Neurology, Queen SquareLondonUK,UK Dementia Research Institute at UCLLondonUK,Hong Kong Center for Neurodegenerative Diseases, Clear Water BayHong KongChina
| | - Johan Lundkvist
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden,Alzecure FoundationHuddingeSweden,Sinfonia BiotherapeuticsHuddingeSweden
| | | | - Urban Lendahl
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden,Department of Cell and Molecular BiologyKarolinska InstitutetStockholmSweden
| | - Helena Karlström
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
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33
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Dunn PJ, Lea RA, Maksemous N, Smith RA, Sutherland HG, Haupt LM, Griffiths LR. Investigating a Genetic Link Between Alzheimer's Disease and CADASIL-Related Cerebral Small Vessel Disease. Mol Neurobiol 2022; 59:7293-7302. [PMID: 36175824 PMCID: PMC9616771 DOI: 10.1007/s12035-022-03039-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/19/2022] [Indexed: 10/14/2022]
Abstract
Monogenic forms of Alzheimer's disease (AD) have been identified through mutations in genes such as APP, PSEN1, and PSEN2, whilst other genetic markers such as the APOE ε carrier allele status have been shown to increase the likelihood of having the disease. Mutations in these genes are not limited to AD, as APP mutations can also cause an amyloid form of cerebral small vessel disease (CSVD) known as cerebral amyloid angiopathy, whilst PSEN1 and PSEN2 are involved in NOTCH3 signalling, a process known to be dysregulated in the monogenic CSVD, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The overlap between AD genes and causes of CSVD led to the hypothesis that mutations in other genes within the PANTHER AD-presenilin pathway may be novel causes of CSVD in a cohort of clinically suspicious CADASIL patients without a pathogenic NOTCH3 mutation. To investigate this, whole exome sequencing was performed on 50 suspected CADASIL patients with no NOTCH3 mutations, and a targeted gene analysis was completed on the PANTHER. ERN1 was identified as a novel candidate CSVD gene following predicted pathogenic gene mutation analysis. Rare variant burden testing failed to identify an association with any gene; however, it did show a nominally significant link with ERN1 and TRPC3. This study provides evidence to support a genetic overlap between CSVD and Alzheimer's disease.
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Affiliation(s)
- Paul J Dunn
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia.,Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, QLD, 4226, Australia
| | - Rodney A Lea
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
| | - Neven Maksemous
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
| | - Robert A Smith
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
| | - Heidi G Sutherland
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
| | - Larisa M Haupt
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
| | - Lyn R Griffiths
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia.
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34
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Mönkäre S, Kuuluvainen L, Schleutker J, Myllykangas L, Pöyhönen M. Clinical features and spectrum of NOTCH3 variants in Finnish patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Acta Neurol Scand 2022; 146:643-651. [PMID: 36086804 PMCID: PMC9825900 DOI: 10.1111/ane.13703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/10/2022] [Accepted: 08/31/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a cerebral small vessel disease caused by pathogenic variants in the NOTCH3 gene. In Finland, the majority of CADASIL patients carry the pathogenic founder variant c.397C>T, (p.Arg133Cys), but the spectrum of other NOTCH3 variants has not been investigated previously. The aim of the study was to investigate the spectrum and prevalence of NOTCH3 variants Finnish CADASIL patients and to examine the clinical features associated with them. MATERIALS AND METHODS The spectrum of NOTCH3 variants and the clinical features associated with them were retrospectively examined in 294 Finnish CADASIL patients tested during January 1996 to October 2021 in the Medical Genetics laboratory of Department of Genomics of Turku University Hospital, where practically all samples of patients with suspected CADASIL in Finland are investigated. RESULTS The most common NOTCH3 variants in the study cohort were c.397C>T, (p.Arg133Cys) (68%) and c.3206A>G p.(Tyr1069Cys) (18%), but other less common NOTCH3 variants were detected in as many as 14% of the patients. Eight of the detected NOTCH3 variants were novel: c.520T>A,p.(Cys174Ser), c.836A>G,p.(Gln279Arg), c.1369T>G,p.(Cys457Gly), c.1338C>G,p.(Cys446Trp), c.1564T>G,p.(Cys522Gly), c.2848T>G,p.(Cys950Gly), c.6102dup,p.(Gly2035Argfs*60), and c.2410+6C>G. Other NOTCH3 variants than p.Arg133Cys and p.Tyr1069Cys were more often associated with more severe clinical features. CONCLUSION This study revealed the genetic and clinical spectrum of CADASIL in the Finnish population. Sequencing of the whole NOTCH3 gene performing a gene-panel or exome sequencing is recommended when suspecting CADASIL.
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Affiliation(s)
- Saana Mönkäre
- University of HelsinkiDepartment of Medical and Clinical GeneticsHelsinkiFinland
- Medical Genetics, Department of Genomics, Laboratory DivisionTurku University HospitalTurkuFinland
- HUS Diagnostic CenterHelsinki University HospitalHelsinkiFinland
| | - Liina Kuuluvainen
- HUS Diagnostic CenterHelsinki University HospitalHelsinkiFinland
- Department of Medical and Clinical GeneticsUniversity of HelsinkiHelsinkiFinland
| | - Johanna Schleutker
- Medical Genetics, Department of Genomics, Laboratory DivisionTurku University HospitalTurkuFinland
- Institute of BiomedicineUniversity of TurkuTurkuFinland
| | - Liisa Myllykangas
- HUS Diagnostic CenterHelsinki University HospitalHelsinkiFinland
- Department of PathologyUniversity of HelsinkiHelsinkiFinland
| | - Minna Pöyhönen
- HUS Diagnostic CenterHelsinki University HospitalHelsinkiFinland
- Department of Medical and Clinical GeneticsUniversity of HelsinkiHelsinkiFinland
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35
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Ashraf S, Allena N, Shrestha E, Dhallu M, Khaja M. Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy (CADASIL): A Rare Cause of Transient Ischemic Attack. Cureus 2022; 14:e30940. [DOI: 10.7759/cureus.30940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
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36
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Hamid M, Adraoui YE, Satte A, Bourazza A. Persistent aura and status migrainosus in CADASIL syndrome: A case report. Radiol Case Rep 2022; 17:3863-3866. [PMID: 35982717 PMCID: PMC9379942 DOI: 10.1016/j.radcr.2022.07.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 12/01/2022] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary microangiopathy characterized by a genetic predisposition to small arteries of the brain. It is produced by a mutation in the NOTCH3 gene and concerns adults. The symptomatology is diversified including migraines with or without aura, subcortical ischemic events, and cognitive impairment. The diagnosis of CADASIL is suspected by neuroimaging and confirmed by genetic testing. Treatment of the disease remains preventive. We report a case of CADASIL manifesting as status migrainosus with persistent aura.
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37
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Hack R, Rutten J, Lesnik Oberstein SAJ. What's in a Domain? The Role of NOTCH3 EGFr Domains in CADASIL Disease Severity. Neurology 2022; 99:179-180. [PMID: 35914942 DOI: 10.1212/wnl.0000000000200755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/01/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Remco Hack
- From the Expert Center for Genetic Cerebral Small Vessel Disease, Department of Clinical Genetics, Leiden University Medical Center, the Netherlands
| | - Julie Rutten
- From the Expert Center for Genetic Cerebral Small Vessel Disease, Department of Clinical Genetics, Leiden University Medical Center, the Netherlands
| | - Saskia A J Lesnik Oberstein
- From the Expert Center for Genetic Cerebral Small Vessel Disease, Department of Clinical Genetics, Leiden University Medical Center, the Netherlands.
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38
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Mishra A, Duplaà C, Vojinovic D, Suzuki H, Sargurupremraj M, Zilhão NR, Li S, Bartz TM, Jian X, Zhao W, Hofer E, Wittfeld K, Harris SE, van der Auwera-Palitschka S, Luciano M, Bis JC, Adams HHH, Satizabal CL, Gottesman RF, Gampawar PG, Bülow R, Weiss S, Yu M, Bastin ME, Lopez OL, Vernooij MW, Beiser AS, Völker U, Kacprowski T, Soumare A, Smith JA, Knopman DS, Morris Z, Zhu Y, Rotter JI, Dufouil C, Valdés Hernández M, Muñoz Maniega S, Lathrop M, Boerwinkle E, Schmidt R, Ihara M, Mazoyer B, Yang Q, Joutel A, Tournier-Lasserve E, Launer LJ, Deary IJ, Mosley TH, Amouyel P, DeCarli CS, Psaty BM, Tzourio C, Kardia SLR, Grabe HJ, Teumer A, van Duijn CM, Schmidt H, Wardlaw JM, Ikram MA, Fornage M, Gudnason V, Seshadri S, Matthews PM, Longstreth WT, Couffinhal T, Debette S. Gene-mapping study of extremes of cerebral small vessel disease reveals TRIM47 as a strong candidate. Brain 2022; 145:1992-2007. [PMID: 35511193 PMCID: PMC9255380 DOI: 10.1093/brain/awab432] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/11/2021] [Accepted: 10/28/2021] [Indexed: 12/11/2022] Open
Abstract
Cerebral small vessel disease is a leading cause of stroke and a major contributor to cognitive decline and dementia, but our understanding of specific genes underlying the cause of sporadic cerebral small vessel disease is limited. We report a genome-wide association study and a whole-exome association study on a composite extreme phenotype of cerebral small vessel disease derived from its most common MRI features: white matter hyperintensities and lacunes. Seventeen population-based cohorts of older persons with MRI measurements and genome-wide genotyping (n = 41 326), whole-exome sequencing (n = 15 965), or exome chip (n = 5249) data contributed 13 776 and 7079 extreme small vessel disease samples for the genome-wide association study and whole-exome association study, respectively. The genome-wide association study identified significant association of common variants in 11 loci with extreme small vessel disease, of which the chr12q24.11 locus was not previously reported to be associated with any MRI marker of cerebral small vessel disease. The whole-exome association study identified significant associations of extreme small vessel disease with common variants in the 5' UTR region of EFEMP1 (chr2p16.1) and one probably damaging common missense variant in TRIM47 (chr17q25.1). Mendelian randomization supports the causal association of extensive small vessel disease severity with increased risk of stroke and Alzheimer's disease. Combined evidence from summary-based Mendelian randomization studies and profiling of human loss-of-function allele carriers showed an inverse relation between TRIM47 expression in the brain and blood vessels and extensive small vessel disease severity. We observed significant enrichment of Trim47 in isolated brain vessel preparations compared to total brain fraction in mice, in line with the literature showing Trim47 enrichment in brain endothelial cells at single cell level. Functional evaluation of TRIM47 by small interfering RNAs-mediated knockdown in human brain endothelial cells showed increased endothelial permeability, an important hallmark of cerebral small vessel disease pathology. Overall, our comprehensive gene-mapping study and preliminary functional evaluation suggests a putative role of TRIM47 in the pathophysiology of cerebral small vessel disease, making it an important candidate for extensive in vivo explorations and future translational work.
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Affiliation(s)
- Aniket Mishra
- University of Bordeaux, INSERM, Bordeaux Population Health Research Centre, Team ELEANOR, UMR 1219, F-33000 Bordeaux, France
| | - Cécile Duplaà
- University of Bordeaux, INSERM, Biologie des Maladies Cardiovasculaires, U1034, F-33600 Pessac, France
| | - Dina Vojinovic
- Department of Epidemiology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Hideaki Suzuki
- Department of Cardiovascular Medicine, Tohoku University Hospital, 1-1, Seiryo, Aoba, Sendai 980-8574, Japan
- Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryo, Aoba, Sendai 980-8573, Japan
- Department of Brain Sciences and UK Dementia Research Institute Centre, Imperial College, London, W12 0NN, UK
| | - Muralidharan Sargurupremraj
- University of Bordeaux, INSERM, Bordeaux Population Health Research Centre, Team ELEANOR, UMR 1219, F-33000 Bordeaux, France
| | | | - Shuo Li
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02115, USA
| | - Traci M Bartz
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Xueqiu Jian
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Wei Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Michigan, MI 48104, USA
| | - Edith Hofer
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, 8036 Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria
| | - Katharina Wittfeld
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, 17489 Greifswald, Germany
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, 17489 Greifswald, Germany
| | - Sarah E Harris
- Department of Psychology, University of Edinburgh, EH8 9JZ Edinburgh, UK
| | - Sandra van der Auwera-Palitschka
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, 17489 Greifswald, Germany
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, 17489 Greifswald, Germany
| | - Michelle Luciano
- Department of Psychology, University of Edinburgh, EH8 9JZ Edinburgh, UK
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Hieab H H Adams
- Department of Epidemiology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands
- Department of Clinical Genetics, Erasmus University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Claudia L Satizabal
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
- The Framingham Heart Study, Framingham, MA 01701, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA 2115, USA
| | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD 20814, USA
| | - Piyush G Gampawar
- Institute of Molecular Biology & Biochemistry, Gottfried Schatz Research Centre (for Cell Signalling, Metabolism and Aging), Medical University of Graz, 8036 Graz, Austria
| | - Robin Bülow
- Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17489 Greifswald, Germany
| | - Stefan Weiss
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, 17489 Greifswald, Germany
| | - Miao Yu
- Department of Epidemiology, School of Public Health, University of Michigan, Michigan, MI 48104, USA
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH8 9AB, UK
- Division of Neuroimaging Sciences, Brain Research Imaging Centre, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK
| | - Oscar L Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands
| | - Alexa S Beiser
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02115, USA
- The Framingham Heart Study, Framingham, MA 01701, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA 2115, USA
| | - Uwe Völker
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, 17489 Greifswald, Germany
| | - Tim Kacprowski
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, 17489 Greifswald, Germany
- TUM School of Life Sciences Weihenstephan (WZW), Technical University of Munich (TUM), 85354 Freising-Weihenstephan, Germany
| | - Aicha Soumare
- University of Bordeaux, INSERM, Bordeaux Population Health Research Centre, Team ELEANOR, UMR 1219, F-33000 Bordeaux, France
| | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Michigan, MI 48104, USA
| | | | - Zoe Morris
- Neuroradiology Department, Department of Clinical Neurosciences, Western General Hospital, Edinburgh EH4 2XU, UK
| | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Carole Dufouil
- University of Bordeaux, INSERM, Bordeaux Population Health Research Centre, Team ELEANOR, UMR 1219, F-33000 Bordeaux, France
| | - Maria Valdés Hernández
- Division of Neuroimaging Sciences, Brain Research Imaging Centre, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK
| | - Susana Muñoz Maniega
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH8 9AB, UK
| | - Mark Lathrop
- University of McGill Genome Center, Montreal, Quebec H3A 0G1, Canada
| | - Erik Boerwinkle
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Reinhold Schmidt
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, 8036 Graz, Austria
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka 564-8565, Japan
| | - Bernard Mazoyer
- University of Bordeaux, Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293, 33000 Bordeaux, France
| | - Qiong Yang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02115, USA
- The Framingham Heart Study, Framingham, MA 01701, USA
| | - Anne Joutel
- Institute of Psychiatry and Neurosciences of Paris, INSERM UMR1266, Université de Paris, France
| | | | - Lenore J Launer
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ian J Deary
- Department of Psychology, University of Edinburgh, EH8 9JZ Edinburgh, UK
| | - Thomas H Mosley
- Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Philippe Amouyel
- University of Lille, INSERM, Institut Pasteur de Lille, UMR1167-RID-AGE—Risk Factors and Molecular Determinants of Aging-Related Diseases, F-59000 Lille, France
- LabEx DISTALZ, Institut Pasteur de Lille, 59000 Lille, France
- Department of Epidemiology and Public Health, Centre Hospital University of Lille, F-59000 Lille, France
| | - Charles S DeCarli
- Department of Neurology and Center for Neuroscience, University of California at Davis, Sacramento, CA 95816, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Christophe Tzourio
- University of Bordeaux, INSERM, Bordeaux Population Health Research Centre, Team ELEANOR, UMR 1219, F-33000 Bordeaux, France
- CHU de Bordeaux, Pole de santé publique, Service d’information médicale, F-33000 Bordeaux, France
| | - Sharon L R Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Michigan, MI 48104, USA
| | - Hans J Grabe
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, 17489 Greifswald, Germany
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, 17489 Greifswald, Germany
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, D-17475 Greifswald, Germany
| | - Cornelia M van Duijn
- Department of Biomedical Data Sciences, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Helena Schmidt
- Institute of Molecular Biology & Biochemistry, Gottfried Schatz Research Centre (for Cell Signalling, Metabolism and Aging), Medical University of Graz, 8036 Graz, Austria
| | - Joanna M Wardlaw
- Division of Neuroimaging Sciences, Brain Research Imaging Centre, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK
| | - M Arfan Ikram
- Department of Biomedical Data Sciences, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, 200 Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, 101 Reykjavik, Iceland
| | - Sudha Seshadri
- Department of Epidemiology, School of Public Health, University of Michigan, Michigan, MI 48104, USA
- The Framingham Heart Study, Framingham, MA 01701, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA 2115, USA
| | - Paul M Matthews
- Department of Brain Sciences and UK Dementia Research Institute Centre, Imperial College, London, W12 0NN, UK
| | - William T Longstreth
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA 98104-2420, USA
| | - Thierry Couffinhal
- University of Bordeaux, INSERM, Biologie des Maladies Cardiovasculaires, U1034, F-33600 Pessac, France
| | - Stephanie Debette
- University of Bordeaux, INSERM, Bordeaux Population Health Research Centre, Team ELEANOR, UMR 1219, F-33000 Bordeaux, France
- Department of Neurology, Boston University School of Medicine, Boston, MA 2115, USA
- CHU de Bordeaux, Department of Neurology, F-33000 Bordeaux, France
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Abstract
Stroke is the second leading cause of death worldwide and a complex, heterogeneous condition. In this review, we provide an overview of the current knowledge on monogenic and multifactorial forms of stroke, highlighting recent insight into the continuum between these. We describe how, in recent years, large-scale genome-wide association studies have enabled major progress in deciphering the genetic basis for stroke and its subtypes, although more research is needed to interpret these findings. We cover the potential of stroke genetics to reveal novel pathophysiological processes underlying stroke, to accelerate the discovery of new therapeutic approaches, and to identify individuals in the population who are at high risk of stroke and could be targeted for tailored preventative interventions.
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Affiliation(s)
- Stéphanie Debette
- Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, France (S.D.).,Department of Neurology, Bordeaux University Hospital, Institute for Neurodegenerative Diseases, France (S.D.)
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M.)
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40
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Abstract
Notch signalling is an evolutionarily highly conserved signalling mechanism governing differentiation and regulating homeostasis in many tissues. In this review, we discuss recent advances in our understanding of the roles that Notch signalling plays in the vasculature. We describe how Notch signalling regulates different steps during the genesis and remodelling of blood vessels (vasculogenesis and angiogenesis), including critical roles in assigning arterial and venous identities to the emerging blood vessels and regulation of their branching. We then proceed to discuss how experimental perturbation of Notch signalling in the vasculature later in development affects vascular homeostasis. In this review, we also describe how dysregulated Notch signalling, as a consequence of direct mutations of genes in the Notch pathway or aberrant Notch signalling output, contributes to various types of vascular disease, including CADASIL, Snedden syndrome and pulmonary arterial hypertension. Finally, we point out some of the current knowledge gaps and identify remaining challenges in understanding the role of Notch in the vasculature, which need to be addressed to pave the way for Notch-based therapies to cure or ameliorate vascular disease.
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Affiliation(s)
- Francesca Del Gaudio
- Department of Cell and Molecular Biology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Dongli Liu
- Department of Cell and Molecular Biology, Karolinska Institutet, 171 77 Stockholm, Sweden,Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, People's Republic of China
| | - Urban Lendahl
- Department of Cell and Molecular Biology, Karolinska Institutet, 171 77 Stockholm, Sweden
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Wang YF, Liao YC, Tzeng YS, Chen SP, Lirng JF, Fuh JL, Chen WT, Lai KL, Lee YC, Wang SJ. Mutation screening and association analysis of NOTCH3 p.R544C in patients with migraine with or without aura. Cephalalgia 2022; 42:888-898. [PMID: 35302383 DOI: 10.1177/03331024221080891] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The role of the NOTCH3 p.R544C variant, the predominant variant of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy in multiple East Asian regions, in migraine is unknown. METHODS Migraine patients (n = 2,884) (2,279F/605M, mean age 38.8 ± 11.7 years), including 324 (11.2%) with migraine with aura, were prospectively enrolled by headache specialists according to the International Classification of Headache Disorders criteria. These patients and 3,502 population controls free of stroke, dementia, and headache were genotyped for NOTCH3 p.R544C by TaqMan genotyping assay or Axiom Genome-Wide TWB 2.0 Array. Clinical manifestations and brain magnetic resonance images were examined and compared between migraine patients with and without NOTCH3 p.R544C. RESULTS Thirty-two migraine patients (1.1%) and 36 controls (1.0%) harbored the p.R544C variant, and the percentages were comparable among migraine patients without and with aura, and controls (1.2%, vs. 0.6% vs. 1.0%, p = 0.625). Overall, migraine patients with and without the p.R544C variant had similar percentages of migraine with aura, headache characteristics, frequencies and disabilities. However, those with p.R544C were less likely to have pulsatile headaches (50.0% vs. 68.2%, p = 0.028), and more likely to have moderate to severe white matter hyperintensities in the external capsule (18.8% vs. 1.2%, p = 0.006) and anterior temporal lobe (12.5% vs. 0%, p = 0.008). CONCLUSIONS Our findings suggest that NOTCH3 p.R544C does not increase the risk of migraine with aura, or migraine as a whole, and generally does not alter clinical manifestations of migraine. The role of NOTCH3 variants, as well as potential influences from ethnicity or modifier genes, in migraine needs to be further clarified.
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Affiliation(s)
- Yen-Feng Wang
- Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chu Liao
- Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Shiang Tzeng
- Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Pin Chen
- Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiing-Feng Lirng
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jong-Ling Fuh
- Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Ta Chen
- Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuan-Lin Lai
- Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chung Lee
- Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, 46615Taipei Veterans General Hospital, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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42
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Padhye AA, Sahay S. An Adult Case of NOTCH3 Mutation in Pulmonary Artery Hypertension. Pulm Circ 2022; 12:e12050. [PMID: 35506080 PMCID: PMC9052997 DOI: 10.1002/pul2.12050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/04/2021] [Accepted: 02/07/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
| | - Sandeep Sahay
- Houston Methodist Lung Center, Division of Pulmonary, Critical Care and Sleep Medicine, Houston Methodist Hospital Houston Texas
- Assistant Professor, Weill Cornell Medical College New York NY
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43
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Oliveira DV, Svensson J, Zhong X, Biverstål H, Chen G, Karlström H. Molecular Chaperone BRICHOS Inhibits CADASIL-Mutated NOTCH3 Aggregation In Vitro. Front Mol Biosci 2022; 9:812808. [PMID: 35223989 PMCID: PMC8864064 DOI: 10.3389/fmolb.2022.812808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/11/2022] [Indexed: 11/20/2022] Open
Abstract
CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is the most common familial form of stroke, which is caused by mutations located in the epidermal growth factor (EGF)-like repeats of the NOTCH3 gene. Mutations cause the NOTCH3 (N3) protein to misfold and aggregate. These aggregates will be a component of granular osmiophilic material, which when accumulated around the arteries and arterioles is believed to cause the degradation of vascular smooth muscle cells (VSMC). VSMC degradation affects blood flow regulation and leads to white matter and neuronal death. Currently, there is no treatment for CADASIL. The dementia-relevant BRICHOS domain is a small multitalented protein with functions that include ATP-independent chaperone-like properties. BRICHOS has been shown to prevent the aggregation of both fibrillar and non-fibrillar structures. Therefore, the objective of this study is to investigate whether BRICHOS exhibits anti-aggregating properties on a recombinant CADASIL-mutated N3 protein consisting of the first five repeats of EGF (EGF1–5), harboring a cysteine instead of an arginine in the position 133, (R133C). We found that the N3 EGF1–5 R133C mutant is more prone to aggregate, while the wildtype is more stable. Recombinant human Bri2 BRICHOS is able to interact and stabilize the R133C-mutated N3 protein in a dose-dependent manner. These results suggest an anti-aggregating impact of BRICHOS on the N3 EGF1–5 R133C protein, which could be a potential treatment for CADASIL.
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Affiliation(s)
- Daniel V. Oliveira
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Julia Svensson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Xueying Zhong
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Huddinge, Sweden
| | - Henrik Biverstål
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Gefei Chen
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
- *Correspondence: Gefei Chen, ; Helena Karlström,
| | - Helena Karlström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Gefei Chen, ; Helena Karlström,
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44
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Jacobs HI, Schoemaker D, Torrico-Teave H, Zuluaga Y, Velilla-Jimenez L, Ospina-Villegas C, Lopera F, Arboleda-Velasquez JF, Quiroz YT. Specific Abnormalities in White Matter Pathways as Interface to Small Vessels Disease and Cognition in Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy Individuals. Brain Connect 2022; 12:52-60. [PMID: 33980027 PMCID: PMC8867102 DOI: 10.1089/brain.2020.0980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is characterized by leukoencephalopathy leading to cognitive impairment. Subtle cognitive deficits can be observed early in the course of the disease, before the occurrence of the first stroke. Therefore, markers that can predict disease progression at this early stage, when interventions are likely to alter disease course, are needed. We aimed to examine the biological cascade of microstructural and macrostructural white matter (WM) abnormalities underlying cognitive deficits in CADASIL. Methods: We examined 20 nondemented CADASIL mutation carriers and 23 noncarriers who underwent neuropsychological evaluation and magnetic resonance imaging. Using probabilistic tractography of key WM tracts, we examined group differences in diffusivity measures and WM hyperintensity volume. Successive mediation models examined whether tract-specific WM abnormalities mediated subtle cognitive differences between CADASIL mutation carriers and noncarriers. Results: The largest effect size differentiating the two groups was observed for left superior longitudinal fasciculus-temporal (SLFt) diffusivity (Cohen's f = 0.49). No group differences were observed with a global diffusion measure. These specific microstructural differences in the SLFt were associated with higher WM hyperintensities burden, and subtle executive deficits in CADASIL mutation carriers. Discussion: Worse diffusivity in the left SLFt is related to greater severity of small vessel disease and worse executive functioning in the asymptomatic stage of the disease. Worse diffusivity of the left SLFt may potentially hold promise as an indicator of disease progression. Impact statement Diffusion tensor imaging outperforms conventional imaging of subcortical small vessel disease as a potential marker of future disease progression. Here we identified the left superior longitudinal temporal fasciculus as a critical white matter fiber bundle, of which worse diffusivity can link presence of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy mutations to greater severity of small vessel disease and worse executive functioning in asymptomatic stages of the disease. This tract may hold promise and deserves further examination as an early indicator of disease progression.
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Affiliation(s)
- Heidi I.L. Jacobs
- Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Gordon Center for Medical Imaging, Boston, Massachusetts, USA.,Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Dorothee Schoemaker
- Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hei Torrico-Teave
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yesica Zuluaga
- Grupo Neurociencias de Antioquia, Universidad de Antioquia, Medellín, Colombia
| | | | | | - Francisco Lopera
- Grupo Neurociencias de Antioquia, Universidad de Antioquia, Medellín, Colombia
| | - Joseph F. Arboleda-Velasquez
- Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Yakeel T. Quiroz
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Address correspondence to: Yakeel T. Quiroz, Department of Psychiatry and Neurology, Harvard Medical School, Massachusetts General Hospital, 100 1st Avenue, Building 39, Suite 101, Charlestown, MA 02129, USA
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45
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Abstract
Cerebral small vessel disease (cSVD) is a leading cause of ischaemic and haemorrhagic stroke and a major contributor to dementia. Covert cSVD, which is detectable with brain MRI but does not manifest as clinical stroke, is highly prevalent in the general population, particularly with increasing age. Advances in technologies and collaborative work have led to substantial progress in the identification of common genetic variants that are associated with cSVD-related stroke (ischaemic and haemorrhagic) and MRI-defined covert cSVD. In this Review, we provide an overview of collaborative studies - mostly genome-wide association studies (GWAS) - that have identified >50 independent genetic loci associated with the risk of cSVD. We describe how these associations have provided novel insights into the biological mechanisms involved in cSVD, revealed patterns of shared genetic variation across cSVD traits, and shed new light on the continuum between rare, monogenic and common, multifactorial cSVD. We consider how GWAS summary statistics have been leveraged for Mendelian randomization studies to explore causal pathways in cSVD and provide genetic evidence for drug effects, and how the combination of findings from GWAS with gene expression resources and drug target databases has enabled identification of putative causal genes and provided proof-of-concept for drug repositioning potential. We also discuss opportunities for polygenic risk prediction, multi-ancestry approaches and integration with other omics data.
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46
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Chabriat H, Joutel A, Tournier-Lasserve E, Bousser MG. Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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47
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Cognition, mood and behavior in CADASIL. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2022; 3:100043. [PMID: 36324403 PMCID: PMC9616390 DOI: 10.1016/j.cccb.2022.100043] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/06/2022] [Accepted: 02/06/2022] [Indexed: 01/02/2023]
Abstract
CADASIL is responsible for cognitive, mood or behavior disturbances. Cognitive disturbances range from moderate cognitive slowing to impairment of executive functions and may progress to a global decrease of cognitive efficiency up to severe dementia. Mood disturbances are extremely variable in intensity, depression is the most frequent symptom. Behavioral changes may occur at all stage of the disease, but are often associated with the onset of cognitive alterations. Apathy is the most prominent behavior alteration.
CADASIL is the most common familial cerebral small vessel disease (cSVD). Stereotyped mutations of the NOTCH3 gene are responsible for this archetypal ischemic cSVD that can lead, at the very end stage, to severe dementia. Variable cognitive alterations, mood, or behavior disturbances are frequently observed during the course of the disease. In this review, these clinical manifestations, their occurrence, severity and duration are analyzed in relation to the disease progression. Also, the potential relationships with cerebral lesions and treatment options are discussed.
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48
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Ruchoux MM, Kalaria RN, Román GC. The pericyte: A critical cell in the pathogenesis of CADASIL. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2021; 2:100031. [PMID: 34950895 PMCID: PMC8661128 DOI: 10.1016/j.cccb.2021.100031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 12/22/2022]
Abstract
CADASIL is the most common hereditary small vessel disease presenting with strokes and subcortical vascular dementia caused by mutations in the NOTCH3 gene. CADASIL is a vasculopathy primarily involving vascular smooth-muscle cells. Arteriolar and capillary pericyte damage or deficiency is a key feature in disease pathogenesis. Pericyte-mediated cerebral venous insufficiency may explain white matter lesions and increased perivascular spaces. Central role of the pericyte offers novel approaches to the treatment of CADASIL.
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary small vessel disease presenting with migraine, mood and cognitive disorders, focal neurological deficits, recurrent ischemic attacks, lacunar infarcts and brain white matter changes. As they age, CADASIL patients invariably develop cognitive impairment and subcortical dementia. CADASIL is caused by missense mutations in the NOTCH3 gene resulting in a profound cerebral vasculopathy affecting primarily arterial vascular smooth muscle cells, which target the microcirculation and perfusion. Based on a thorough review of morphological lesions in arteries, veins, and capillaries in CADASIL, we surmise that arteriolar and capillary pericyte damage or deficiency appears a key feature in the pathogenesis of the disease. This may affect critical pericyte-endothelial interactions causing stroke injury and vasomotor disturbances. Changes in microvascular permeability due to perhaps localized blood-brain barrier alterations and pericyte secretory dysfunction likely contribute to delayed neuronal as well as glial cell death. Moreover, pericyte-mediated cerebral venous insufficiency may explain white matter lesions and the dilatation of Virchow-Robin perivascular spaces typical of CADASIL. The postulated central role of the pericyte offers some novel approaches to the study and treatment of CADASIL and enable elucidation of other forms of cerebral small vessel diseases and subcortical vascular dementia.
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Affiliation(s)
- Marie-Magdeleine Ruchoux
- Former researcher, Université d'Artois, Blood-Brain-Barrier Laboratory Lens France, Former advisor, Alzheimer's Clinic Methodist Neurological Institute, Houston TX, USA
| | - Raj N Kalaria
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Gustavo C Román
- Methodist Neurological Institute, Department of Neurology, Houston Methodist Hospital Houston TX 77030, USA, Weill Cornell Medical College, New York NY, USA and Texas A&M Medical School, Bryan TX, USA
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49
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Kang CH, Kim YM, Kim YJ, Hong SJ, Kim DY, Woo HG, Kim YR, Kim JG, Lee JS, Kong MH, Kim HJ, Choi JC. Pathogenic NOTCH3 Variants Are Frequent Among the Korean General Population. Neurol Genet 2021; 7:e639. [PMID: 34881353 PMCID: PMC8650050 DOI: 10.1212/nxg.0000000000000639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/05/2021] [Indexed: 01/22/2023]
Abstract
Objective This study aimed to determine the frequency of pathogenic NOTCH3 variants among Koreans. Methods In this cross-sectional study, we queried for pathogenic NOTCH3 variants in 2 Korean public genome databases: the Korean Reference Genome Database (KRGDB) and the Korean Genome Project (Korea1K). In addition, we screened the 3 most common pathogenic NOTCH3 variants (p.Arg75Pro, p.Arg544Cys, and p.Arg578Cys) for 1,000 individuals on Jeju Island, where the largest number of patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) have been reported in Korea. Results The pathogenic NOTCH3 variant (p.Arg544Cys) was found in 0.12% of sequences in the KRGDB, and 3 pathogenic variants (p.Arg75Pro, p.Arg182Cys, and p.Arg544Cys) were present in 0.44% of the Korea1K database. Of the 1,000 individuals on Jeju Island, we found 2 cysteine-altering NOTCH3 variants (p.Arg544Cys variant in 9 and p.Arg578Cys in 1 individual) in 1.00% of the participants (95% confidence interval: 0.48%–1.83%). The presence of cysteine-altering NOTCH3 variants was significantly associated with a history of stroke (p < 0.001). Discussion Pathogenic NOTCH3 variants are frequently found in the general Korean population. Such a high prevalence of pathogenic variants could threaten the brain health of tens of thousands to hundreds of thousands of older adults in Korea.
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Affiliation(s)
- Chul-Hoo Kang
- Department of Neurology (C.-H.K., J.-G.K., J.S.L., J.C.C.), Jeju National University Hospital, Jeju National University School of Medicine; Department of Biochemistry (Y.M.K.), School of Medicine; Institute of Medical Science (Y.-J.K., S.-J.H., J.C.C.), Jeju National University, Korea; Department of Physiology (D.Y.K., H.G.W.), School of Medicine; Department of Biomedical Science (D.Y.K., H.G.W.), Graduate School, Ajou University, Suwon, Republic of Korea; Department of Laboratory Medicine (Y.R.K.), School of Medicine, Jeju National University; Department of Family Medicine (M.H.K., H.J.K.), Jeju National University Hospital; and Department of Family Medicine (M.H.K., H.J.K.), School of Medicine, Jeju National University, Korea
| | - Young Mee Kim
- Department of Neurology (C.-H.K., J.-G.K., J.S.L., J.C.C.), Jeju National University Hospital, Jeju National University School of Medicine; Department of Biochemistry (Y.M.K.), School of Medicine; Institute of Medical Science (Y.-J.K., S.-J.H., J.C.C.), Jeju National University, Korea; Department of Physiology (D.Y.K., H.G.W.), School of Medicine; Department of Biomedical Science (D.Y.K., H.G.W.), Graduate School, Ajou University, Suwon, Republic of Korea; Department of Laboratory Medicine (Y.R.K.), School of Medicine, Jeju National University; Department of Family Medicine (M.H.K., H.J.K.), Jeju National University Hospital; and Department of Family Medicine (M.H.K., H.J.K.), School of Medicine, Jeju National University, Korea
| | - Yang-Ji Kim
- Department of Neurology (C.-H.K., J.-G.K., J.S.L., J.C.C.), Jeju National University Hospital, Jeju National University School of Medicine; Department of Biochemistry (Y.M.K.), School of Medicine; Institute of Medical Science (Y.-J.K., S.-J.H., J.C.C.), Jeju National University, Korea; Department of Physiology (D.Y.K., H.G.W.), School of Medicine; Department of Biomedical Science (D.Y.K., H.G.W.), Graduate School, Ajou University, Suwon, Republic of Korea; Department of Laboratory Medicine (Y.R.K.), School of Medicine, Jeju National University; Department of Family Medicine (M.H.K., H.J.K.), Jeju National University Hospital; and Department of Family Medicine (M.H.K., H.J.K.), School of Medicine, Jeju National University, Korea
| | - Su-Jeong Hong
- Department of Neurology (C.-H.K., J.-G.K., J.S.L., J.C.C.), Jeju National University Hospital, Jeju National University School of Medicine; Department of Biochemistry (Y.M.K.), School of Medicine; Institute of Medical Science (Y.-J.K., S.-J.H., J.C.C.), Jeju National University, Korea; Department of Physiology (D.Y.K., H.G.W.), School of Medicine; Department of Biomedical Science (D.Y.K., H.G.W.), Graduate School, Ajou University, Suwon, Republic of Korea; Department of Laboratory Medicine (Y.R.K.), School of Medicine, Jeju National University; Department of Family Medicine (M.H.K., H.J.K.), Jeju National University Hospital; and Department of Family Medicine (M.H.K., H.J.K.), School of Medicine, Jeju National University, Korea
| | - Do Yoon Kim
- Department of Neurology (C.-H.K., J.-G.K., J.S.L., J.C.C.), Jeju National University Hospital, Jeju National University School of Medicine; Department of Biochemistry (Y.M.K.), School of Medicine; Institute of Medical Science (Y.-J.K., S.-J.H., J.C.C.), Jeju National University, Korea; Department of Physiology (D.Y.K., H.G.W.), School of Medicine; Department of Biomedical Science (D.Y.K., H.G.W.), Graduate School, Ajou University, Suwon, Republic of Korea; Department of Laboratory Medicine (Y.R.K.), School of Medicine, Jeju National University; Department of Family Medicine (M.H.K., H.J.K.), Jeju National University Hospital; and Department of Family Medicine (M.H.K., H.J.K.), School of Medicine, Jeju National University, Korea
| | - Hyun Goo Woo
- Department of Neurology (C.-H.K., J.-G.K., J.S.L., J.C.C.), Jeju National University Hospital, Jeju National University School of Medicine; Department of Biochemistry (Y.M.K.), School of Medicine; Institute of Medical Science (Y.-J.K., S.-J.H., J.C.C.), Jeju National University, Korea; Department of Physiology (D.Y.K., H.G.W.), School of Medicine; Department of Biomedical Science (D.Y.K., H.G.W.), Graduate School, Ajou University, Suwon, Republic of Korea; Department of Laboratory Medicine (Y.R.K.), School of Medicine, Jeju National University; Department of Family Medicine (M.H.K., H.J.K.), Jeju National University Hospital; and Department of Family Medicine (M.H.K., H.J.K.), School of Medicine, Jeju National University, Korea
| | - Young Ree Kim
- Department of Neurology (C.-H.K., J.-G.K., J.S.L., J.C.C.), Jeju National University Hospital, Jeju National University School of Medicine; Department of Biochemistry (Y.M.K.), School of Medicine; Institute of Medical Science (Y.-J.K., S.-J.H., J.C.C.), Jeju National University, Korea; Department of Physiology (D.Y.K., H.G.W.), School of Medicine; Department of Biomedical Science (D.Y.K., H.G.W.), Graduate School, Ajou University, Suwon, Republic of Korea; Department of Laboratory Medicine (Y.R.K.), School of Medicine, Jeju National University; Department of Family Medicine (M.H.K., H.J.K.), Jeju National University Hospital; and Department of Family Medicine (M.H.K., H.J.K.), School of Medicine, Jeju National University, Korea
| | - Joong-Goo Kim
- Department of Neurology (C.-H.K., J.-G.K., J.S.L., J.C.C.), Jeju National University Hospital, Jeju National University School of Medicine; Department of Biochemistry (Y.M.K.), School of Medicine; Institute of Medical Science (Y.-J.K., S.-J.H., J.C.C.), Jeju National University, Korea; Department of Physiology (D.Y.K., H.G.W.), School of Medicine; Department of Biomedical Science (D.Y.K., H.G.W.), Graduate School, Ajou University, Suwon, Republic of Korea; Department of Laboratory Medicine (Y.R.K.), School of Medicine, Jeju National University; Department of Family Medicine (M.H.K., H.J.K.), Jeju National University Hospital; and Department of Family Medicine (M.H.K., H.J.K.), School of Medicine, Jeju National University, Korea
| | - Jung Seok Lee
- Department of Neurology (C.-H.K., J.-G.K., J.S.L., J.C.C.), Jeju National University Hospital, Jeju National University School of Medicine; Department of Biochemistry (Y.M.K.), School of Medicine; Institute of Medical Science (Y.-J.K., S.-J.H., J.C.C.), Jeju National University, Korea; Department of Physiology (D.Y.K., H.G.W.), School of Medicine; Department of Biomedical Science (D.Y.K., H.G.W.), Graduate School, Ajou University, Suwon, Republic of Korea; Department of Laboratory Medicine (Y.R.K.), School of Medicine, Jeju National University; Department of Family Medicine (M.H.K., H.J.K.), Jeju National University Hospital; and Department of Family Medicine (M.H.K., H.J.K.), School of Medicine, Jeju National University, Korea
| | - Mi Hee Kong
- Department of Neurology (C.-H.K., J.-G.K., J.S.L., J.C.C.), Jeju National University Hospital, Jeju National University School of Medicine; Department of Biochemistry (Y.M.K.), School of Medicine; Institute of Medical Science (Y.-J.K., S.-J.H., J.C.C.), Jeju National University, Korea; Department of Physiology (D.Y.K., H.G.W.), School of Medicine; Department of Biomedical Science (D.Y.K., H.G.W.), Graduate School, Ajou University, Suwon, Republic of Korea; Department of Laboratory Medicine (Y.R.K.), School of Medicine, Jeju National University; Department of Family Medicine (M.H.K., H.J.K.), Jeju National University Hospital; and Department of Family Medicine (M.H.K., H.J.K.), School of Medicine, Jeju National University, Korea
| | - Hyeon Ju Kim
- Department of Neurology (C.-H.K., J.-G.K., J.S.L., J.C.C.), Jeju National University Hospital, Jeju National University School of Medicine; Department of Biochemistry (Y.M.K.), School of Medicine; Institute of Medical Science (Y.-J.K., S.-J.H., J.C.C.), Jeju National University, Korea; Department of Physiology (D.Y.K., H.G.W.), School of Medicine; Department of Biomedical Science (D.Y.K., H.G.W.), Graduate School, Ajou University, Suwon, Republic of Korea; Department of Laboratory Medicine (Y.R.K.), School of Medicine, Jeju National University; Department of Family Medicine (M.H.K., H.J.K.), Jeju National University Hospital; and Department of Family Medicine (M.H.K., H.J.K.), School of Medicine, Jeju National University, Korea
| | - Jay Chol Choi
- Department of Neurology (C.-H.K., J.-G.K., J.S.L., J.C.C.), Jeju National University Hospital, Jeju National University School of Medicine; Department of Biochemistry (Y.M.K.), School of Medicine; Institute of Medical Science (Y.-J.K., S.-J.H., J.C.C.), Jeju National University, Korea; Department of Physiology (D.Y.K., H.G.W.), School of Medicine; Department of Biomedical Science (D.Y.K., H.G.W.), Graduate School, Ajou University, Suwon, Republic of Korea; Department of Laboratory Medicine (Y.R.K.), School of Medicine, Jeju National University; Department of Family Medicine (M.H.K., H.J.K.), Jeju National University Hospital; and Department of Family Medicine (M.H.K., H.J.K.), School of Medicine, Jeju National University, Korea
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NOTCH3 mutations in a cohort of Portuguese patients within CADASIL spectrum phenotype. Neurogenetics 2021; 23:1-9. [PMID: 34851492 DOI: 10.1007/s10048-021-00679-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common inherited cerebral small vessel disease. It is caused by mutations in the NOTCH3 gene, which encodes a membranebound receptor protein with three main distinct functional domains. Thus far, several different NOTCH3 mutations, most of them cysteine altering variants, have been described and although they tend to cluster in certain exons, their distribution varies in different geographically populations. Therefore, in this study, we describe the mutation analysis of NOTCH3 gene in 24 Portuguese families with small vessel disease suspected to have CADASIL from the central region of Portugal. The genetic analysis revealed 15 different heterozygous variants, eight pathogenic cysteine altering variants, six cysteine sparing variants and one nonsense variant, located mainly in the exons 4, 8 and 11. Thus, in our population, the genetic testing should initially be focused on these exons. In addition, the genetic findings broaden the mutational and clinical spectrum of CADASIL related phenotype and provide additional evidences for genetic counseling and clinical management.
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