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Ter Telgte A, Duering M. Cerebral Small Vessel Disease: Advancing Knowledge With Neuroimaging. Stroke 2024; 55:1686-1688. [PMID: 38328947 DOI: 10.1161/strokeaha.123.044294] [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: 02/09/2024]
Affiliation(s)
- Annemieke Ter Telgte
- VASCage-Center on Clinical Stroke Research, Innsbruck, Austria (A.t.T.)
- Department of Neurology, Medical University of Innsbruck, Austria (A.t.T.)
| | - Marco Duering
- Institute for Stroke and Dementia Research, LMU University Hospital, Munich, Germany (M.D.)
- Medical Image Analysis Center and Department of Biomedical Engineering, University of Basel, Switzerland (M.D.)
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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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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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Van Den Brink H, Pham S, Siero JC, Arts T, Onkenhout L, Kuijf H, Hendrikse J, Wardlaw JM, Dichgans M, Zwanenburg JJ, Biessels GJ. Assessment of Small Vessel Function Using 7T MRI in Patients With Sporadic Cerebral Small Vessel Disease: The ZOOM@SVDs Study. Neurology 2024; 102:e209136. [PMID: 38497722 PMCID: PMC11067699 DOI: 10.1212/wnl.0000000000209136] [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: 05/05/2023] [Accepted: 12/07/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cerebral small vessel disease (cSVD) is a major cause of stroke and dementia, but little is known about disease mechanisms at the level of the small vessels. 7T-MRI allows assessing small vessel function in vivo in different vessel populations. We hypothesized that multiple aspects of small vessel function are altered in patients with cSVD and that these abnormalities relate to disease burden. METHODS Patients and controls participated in a prospective observational cohort study, the ZOOM@SVDs study. Small vessel function measures on 7T-MRI included perforating artery blood flow velocity and pulsatility index in the basal ganglia and centrum semiovale, vascular reactivity to visual stimulation in the occipital cortex, and reactivity to hypercapnia in the gray and white matter. Lesion load on 3T-MRI and cognitive function were used to assess disease burden. RESULTS Forty-six patients with sporadic cSVD (mean age ± SD 65 ± 9 years) and 22 matched controls (64 ± 7 years) participated in the ZOOM@SVDs study. Compared with controls, patients had increased pulsatility index (mean difference 0.09, p = 0.01) but similar blood flow velocity in basal ganglia perforating arteries and similar flow velocity and pulsatility index in centrum semiovale perforating arteries. The duration of the vascular response to brief visual stimulation in the occipital cortex was shorter in patients than in controls (mean difference -0.63 seconds, p = 0.02), whereas reactivity to hypercapnia was not significantly affected in the gray and total white matter. Among patients, reactivity to hypercapnia was lower in white matter hyperintensities compared with normal-appearing white matter (blood-oxygen-level dependent mean difference 0.35%, p = 0.001). Blood flow velocity and pulsatility index in basal ganglia perforating arteries and reactivity to brief visual stimulation correlated with disease burden. DISCUSSION We observed abnormalities in several aspects of small vessel function in patients with cSVD indicative of regionally increased arteriolar stiffness and decreased reactivity. Worse small vessel function also correlated with increased disease burden. These functional measures provide new mechanistic markers of sporadic cSVD.
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Affiliation(s)
- Hilde Van Den Brink
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Stanley Pham
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Jeroen C Siero
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Tine Arts
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Laurien Onkenhout
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Hugo Kuijf
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Jeroen Hendrikse
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Joanna M Wardlaw
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Martin Dichgans
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Jaco J Zwanenburg
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Geert Jan Biessels
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
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Reeve EH, Barnes JN, Moir ME, Walker AE. Impact of arterial stiffness on cerebrovascular function: a review of evidence from humans and preclincal models. Am J Physiol Heart Circ Physiol 2024; 326:H689-H704. [PMID: 38214904 PMCID: PMC11221809 DOI: 10.1152/ajpheart.00592.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/08/2023] [Accepted: 01/08/2024] [Indexed: 01/13/2024]
Abstract
With advancing age, the cerebral vasculature becomes dysfunctional, and this dysfunction is associated with cognitive decline. However, the initiating cause of these age-related cerebrovascular impairments remains incompletely understood. A characteristic feature of the aging vasculature is the increase in stiffness of the large elastic arteries. This increase in arterial stiffness is associated with elevated pulse pressure and blood flow pulsatility in the cerebral vasculature. Evidence from both humans and rodents supports that increases in large elastic artery stiffness are associated with cerebrovascular impairments. These impacts on cerebrovascular function are wide-ranging and include reductions in global and regional cerebral blood flow, cerebral small vessel disease, endothelial cell dysfunction, and impaired perivascular clearance. Furthermore, recent findings suggest that the relationship between arterial stiffness and cerebrovascular function may be influenced by genetics, specifically APOE and NOTCH genotypes. Given the strength of the evidence that age-related increases in arterial stiffness have deleterious impacts on the brain, interventions that target arterial stiffness are needed. The purpose of this review is to summarize the evidence from human and rodent studies, supporting the role of increased arterial stiffness in age-related cerebrovascular impairments.
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Affiliation(s)
- Emily H Reeve
- Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Jill N Barnes
- Department of Kinesiology University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - M Erin Moir
- Department of Kinesiology University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Ashley E Walker
- Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
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Hu X, Xiao Z, Shen Y, Yang W, Wang P, Li P, Wang Z, Pu M, Zhao L, Xie P, Li Q. SERPINA3: A novel inflammatory biomarker associated with cerebral small vessel disease burden in ischemic stroke. CNS Neurosci Ther 2024; 30:e14472. [PMID: 37721405 PMCID: PMC10916418 DOI: 10.1111/cns.14472] [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: 07/08/2023] [Revised: 08/16/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Inflammation has emerged as a prominent risk factor for cerebral small vessel disease (CSVD). However, the specific association between various inflammatory biomarkers and the development of CSVD remains unclear. Serine proteinase inhibitor A3 (SERPINA3), Matrix metalloproteinase-9 (MMP-9), Tissue inhibitor metalloproteinase-1 (TIMP-1), Monocyte Chemoattractant Protein-1 (MCP-1) are several inflammatory biomarkers that are potentially involved in the development of CSVD. In this present study, we aimed to investigate the relationship between candidate molecules and CSVD features. METHOD The concentration of each biomarker was measured in 79 acute ischemic stroke patients admitted within 72 h after symptom onset. The associations between blood levels of inflammatory markers and CSVD score were investigated, as well as each CSVD feature, including white matter hyperintensities (WMH), lacunes, and enlarged perivascular spaces (EPVS). RESULTS The mean age was 69.0 ± 11.8 years, and 65.8% of participants were male. Higher SERPINA3 level (>78.90 ng/mL) was significantly associated with larger WMH volume and higher scores on Fazekas's scale in all three models. Multiple regression analyses revealed the linear association between absolute WMH burden and SERPINA3 level, especially in model 3 (β = 0.14; 95% confidence interval [CI], 0.04-0.24; p = 0.008 ). Restricted cubic spline regression demonstrated a dose-response relationship between SERPINA3 level and larger WMH volume (p nonlineariy = 0.0366 and 0.0378 in model 2 and mode 3, respectively). Using a receiving operating characteristic (ROC) curve, plasma SERPINA3 level of 64.15 ng/mL distinguished WMH >7.8 mL with the highest sensitivity and specificity (75.92% and 60%, respectively, area under curve [AUC] = 0.668, p = 0.0102). No statistically significant relationship has been found between other candidate biomarkers and CSVD features. CONCLUSION In summary, among four inflammatory biomarkers that we investigated, SERPINA3 level at baseline was associated with WMH severity, which revealed a novel biomarker for CSVD and validated its relationship with inflammation and endothelial dysfunction.
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Affiliation(s)
- Xiao Hu
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Zhong‐Song Xiao
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Yi‐Qing Shen
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Wen‐Song Yang
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Peng Wang
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Pei‐Zheng Li
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Zi‐Jie Wang
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Department of NeurologyThe Second Hospital of Anhui Medical UniversityHefeiChina
| | - Ming‐Jun Pu
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Li‐Bo Zhao
- Department of NeurologyYongchuan Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of Cerebrovascular Disease ResearchChongqingChina
| | - Peng Xie
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Qi Li
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Department of NeurologyThe Second Hospital of Anhui Medical UniversityHefeiChina
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Yuan L, Chen X, Jankovic J, Deng H. CADASIL: A NOTCH3-associated cerebral small vessel disease. J Adv Res 2024:S2090-1232(24)00001-8. [PMID: 38176524 DOI: 10.1016/j.jare.2024.01.001] [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: 10/18/2023] [Revised: 12/16/2023] [Accepted: 01/01/2024] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common hereditary cerebral small vessel disease (CSVD), pathologically characterized by a non-atherosclerotic and non-amyloid diffuse angiopathy primarily involving small to medium-sized penetrating arteries and leptomeningeal arteries. In 1996, mutation in the notch receptor 3 gene (NOTCH3) was identified as the cause of CADASIL. However, since that time other genetic CSVDs have been described, including the HtrA serine peptidase 1 gene-associated CSVD and the cathepsin A gene-associated CSVD, that clinically mimic the original phenotype. Though NOTCH3-associated CSVD is now a well-recognized hereditary disorder and the number of studies investigating this disease is increasing, the role of NOTCH3 in the pathogenesis of CADASIL remains elusive. AIM OF REVIEW This review aims to provide insights into the pathogenesis and the diagnosis of hereditary CSVDs, as well as personalized therapy, predictive approach, and targeted prevention. In this review, we summarize the current progress in CADASIL, including the clinical, neuroimaging, pathological, genetic, diagnostic, and therapeutic aspects, as well as differential diagnosis, in which the role of NOTCH3 mutations is highlighted. KEY SCIENTIFIC CONCEPTS OF REVIEW In this review, CADASIL is revisited as a NOTCH3-associated CSVD along with other hereditary CSVDs.
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Affiliation(s)
- Lamei Yuan
- Health Management Center, the Third Xiangya Hospital, Central South University, Changsha, China; Center for Experimental Medicine, the Third Xiangya Hospital, Central South University, Changsha, China; Disease Genome Research Center, Central South University, Changsha, China; Department of Neurology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiangyu Chen
- Center for Experimental Medicine, the Third Xiangya Hospital, Central South University, Changsha, China; Disease Genome Research Center, Central South University, Changsha, China; Department of Pathology, Changsha Maternal and Child Health Care Hospital, Changsha, China
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Hao Deng
- Health Management Center, the Third Xiangya Hospital, Central South University, Changsha, China; Center for Experimental Medicine, the Third Xiangya Hospital, Central South University, Changsha, China; Disease Genome Research Center, Central South University, Changsha, China; Department of Neurology, the Third Xiangya Hospital, Central South University, Changsha, China.
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Saks DG, Smith EE, Sachdev PS. National and international collaborations to advance research into vascular contributions to cognitive decline. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 6:100195. [PMID: 38226362 PMCID: PMC10788430 DOI: 10.1016/j.cccb.2023.100195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 01/17/2024]
Abstract
Cerebrovascular disease is the second most common cause of cognitive disorders, usually referred to as vascular contributions to cognitive impairment and dementia (VCID) and makes some contribution to about 70 % of all dementias. Despite its importance, research into VCID has lagged as compared to cognitive impairment due to Alzheimer's disease. There is an increasing appreciation that closing this gap requires large national and international collaborations. This paper highlights 24 notable large-scale national and international efforts to advance research into VCID (MarkVCID, DiverseVCID, DISCOVERY, COMPASS-ND, HBC, RHU SHIVA, UK DRI Vascular Theme, STROKOG, Meta VCI Map, ISGC, ENIGMA-Stroke Recovery, CHARGE, SVDs@target, BRIDGET, CADASIL Consortium, CADREA, AusCADASIL, DPUK, DPAU, STRIVE, HARNESS, FINESSE, VICCCS, VCD-CRE Delphi). These collaborations aim to investigate the effects on cognition from cerebrovascular disease or impaired cerebral blood flow, the mechanisms of action, means of prevention and avenues for treatment. Consensus groups have been developed to harmonise global approaches to VCID, standardise terminology and inform management and treatment, and data sharing is becoming the norm. VCID research is increasingly a global collaborative enterprise which bodes well for rapid advances in this field.
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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, New South Wales, Australia
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia
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Marcolini S, Mondragón JD, Bron EE, Biessels GJ, Claassen JA, Papma JM, Middelkoop H, Dierckx RA, Borra RJ, Ramakers IH, van der Flier WM, Maurits NM, De Deyn PP. Small vessel disease burden and functional brain connectivity in mild cognitive impairment. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 6:100192. [PMID: 38174052 PMCID: PMC10758699 DOI: 10.1016/j.cccb.2023.100192] [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: 10/11/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
Background The role of small vessel disease in the development of dementia is not yet completely understood. Functional brain connectivity has been shown to differ between individuals with and without cerebral small vessel disease. However, a comprehensive measure of small vessel disease quantifying the overall damage on the brain is not consistently used and studies using such measure in mild cognitive impairment individuals are missing. Method Functional brain connectivity differences were analyzed between mild cognitive impairment individuals with absent or low (n = 34) and high (n = 34) small vessel disease burden using data from the Parelsnoer Institute, a Dutch multicenter study. Small vessel disease was characterized using an ordinal scale considering: lacunes, microbleeds, perivascular spaces in the basal ganglia, and white matter hyperintensities. Resting state functional MRI data using 3 Tesla scanners was analyzed with group-independent component analysis using the CONN toolbox. Results Functional connectivity between areas of the cerebellum and between the cerebellum and the thalamus and caudate nucleus was higher in the absent or low small vessel disease group compared to the high small vessel disease group. Conclusion These findings might suggest that functional connectivity of mild cognitive impairment individuals with low or absent small vessel disease burden is more intact than in mild cognitive impairment individuals with high small vessel disease. These brain areas are mainly responsible for motor, attentional and executive functions, domains which in previous studies were found to be mostly associated with small vessel disease markers. Our results support findings on the involvement of the cerebellum in cognitive functioning.
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Affiliation(s)
- Sofia Marcolini
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen 9713 GZ, the Netherlands
| | - Jaime D. Mondragón
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen 9713 GZ, the Netherlands
- Universidad Nacional Autónoma de México, Instituto de Neurobiología, Departamento de Neurobiología Conductual y Cognitiva, Laboratorio de Psicofisiología, Querétaro 76230, Mexico
- San Diego State University, Department of Psychology, Life-Span Human Senses Lab, San Diego, California 92182, USA
| | - Esther E. Bron
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam 3015 GD, the Netherlands
| | - Geert J. Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht 3584 CX, the Netherlands
| | - Jurgen A.H.R. Claassen
- Department of Geriatrics, Radboud University Medical Center and Donders Institute, Nijmegen 6525 GD, the Netherlands
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Janne M. Papma
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam 3015 GD, the Netherlands
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam 3015 GD, the Netherlands
| | - Huub Middelkoop
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden 2316 XC, the Netherlands
- Department of Neurology, Leiden University Medical Centre, Leiden 2333 ZA, the Netherlands
| | - Rudi A.J.O. Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, the Netherlands
| | - Ronald J.H. Borra
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, the Netherlands
| | - Inez H.G.B. Ramakers
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht 6229 ER, the Netherlands
| | - Wiesje M. van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam 1081 HZ, the Netherlands
- Department of Epidemiology & Data Sciences, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam 1117, the Netherlands
| | - Natasha M. Maurits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen 9713 GZ, the Netherlands
| | - Peter P. De Deyn
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen 9713 GZ, the Netherlands
- Laboratory of Neurochemistry and Behavior, University of Antwerp, Antwerp 2610, Belgium
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Huang P, Chen K, Liu C, Zhen Z, Zhang R. Visualizing Cerebral Small Vessel Degeneration During Aging and Diseases Using Magnetic Resonance Imaging. J Magn Reson Imaging 2023; 58:1323-1337. [PMID: 37052571 DOI: 10.1002/jmri.28736] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/14/2023] Open
Abstract
Cerebral small vessel disease is a major contributor to brain disorders in older adults. It is associated with a much higher risk of stroke and dementia. Due to a lack of clinical and fluid biomarkers, diagnosing and grading small vessel disease are highly dependent on magnetic resonance imaging. In the past, researchers mostly used brain parenchymal imaging markers to represent small vessel damage, but the relationships between these surrogate markers and small vessel pathologies are complex. Recent progress in high-resolution magnetic resonance imaging methods, including time-of-flight MR angiography, phase-contrast MR angiography, black blood vessel wall imaging, susceptibility-weighted imaging, and contrast-enhanced methods, allow for direct visualization of cerebral small vessel structures. They could be powerful tools for understanding aging-related small vessel degeneration and improving disease diagnosis and treatment. This article will review progress in these imaging techniques and their application in aging and disease studies. Some challenges and future directions are also discussed. EVIDENCE LEVEL: 4. TECHNICAL EFFICACY: 3.
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Affiliation(s)
- Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kang Chen
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chen Liu
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhiming Zhen
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ruiting Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Anisetti B, Greco E, Stojadinovic E, Goldstein ED, Sakusic A, Badi MK, Liu MD, Lin MP, Chiang CC, Elahi FM, Worrall BB, Petrosian D, Ross O, Meschia JF. Novel grading system for CADASIL severity: A multicenter cross-sectional study. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 5:100170. [PMID: 37441712 PMCID: PMC10333271 DOI: 10.1016/j.cccb.2023.100170] [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: 04/21/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 07/15/2023]
Abstract
Background Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited progressive cerebral microangiopathy with considerable phenotypic variability. The purpose of this study was to describe the generalizability of a recently proposed grading system of CADASIL across multiple centers in the United States. Methods Electronic medical records (EMR) of an initial neurological assessment of adult patients with confirmed CADASIL were reviewed across 5 tertiary referral medical centers with expertise in CADASIL. Demographic, vascular risk factors, and neuroimaging data were abstracted from EMR. Patients were categorized into groups according to the proposed CADASIL grading system: Grade 0 (asymptomatic), Grade 1 (migraine only), Grade 2 (stroke, TIA, or MCI), Grade 3 (gait assistance or dementia), and Grade 4 (bedbound or end-stage). Inter-rater reliability (IRR) of grading was tested in a subset of cases. Results We identified 138 patients with a mean age of 50.9 ± 13.1 years, and 57.2% were female. The IRR was acceptable over 33 cases (κ=0.855, SD 0.078, p<0.001) with 81.8% being concordant. There were 15 patients (10.9%) with Grade 0, 50 (36.2%) with Grade 1, 61 (44.2%) with Grade 2, 12 (8.7%) with Grade 3, and none with Grade 4. Patients with a lower severity grade (grade 0 vs 3) tended to be younger (49.5 vs. 61.9 years) and had a lower prevalence of hypertension (50% vs. 20%, p = 0.027) and diabetes mellitus (0% vs. 25%, p = 0.018). A higher severity grade was associated with an increased number of vascular risk factors (p = 0.02) and independently associated with hypertension and diabetes (p<0.05). Comparing Grade 0 vs. 3, cortical thickness tended to be greater (2.06 vs. 1.87 mm; p = 0.06) and white matter hyperintensity volume tended to be lower (54.7 vs. 72.5 ml; p = 0.73), but the differences did not reach significance. Conclusion The CADASIL severity grading system is a pragmatic, reliable system for characterizing CADASIL phenotype that does not require testing beyond that done in standard clinical practice. Higher severity grades tended to have a higher vascular risk factor burden. This system offers a simple method of categorizing CADASIL patients which may help to describe populations in observational and interventional studies.
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Affiliation(s)
| | - Elena Greco
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Eric D. Goldstein
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Amra Sakusic
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Michael D Liu
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Fanny M Elahi
- Department of Neurology, University of California, San Francisco, California, USA
| | - Bradford B Worrall
- Department of Neurology, University of Virginia, Charlottesville, Virginia, USA
| | - Derek Petrosian
- Department of Neurology, University of Virginia, Charlottesville, Virginia, USA
| | - Owen Ross
- Mayo Clinic College of Medicine and Science, Mayo Clinic, Jacksonville, Florida, USA
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