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Mandler JM, Härtl J, Cordts I, Sturm M, Hedderich DM, Bafligil C, Baki E, Becker B, Machetanz G, Haack TB, Berthele A, Hemmer B, Deschauer M. Uncovering genetic mimics in multiple sclerosis: A single-center clinical exome sequencing study. Mult Scler J Exp Transl Clin 2024; 10:20552173241263491. [PMID: 39072298 PMCID: PMC11273569 DOI: 10.1177/20552173241263491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/05/2024] [Indexed: 07/30/2024] Open
Abstract
Background Multiple sclerosis (MS) shares clinical/radiological features with several monogenic diseases that can mimic MS. Objective We aimed to determine if exome sequencing can identify monogenic diseases in patients diagnosed with MS according to the McDonald criteria thus uncovering them as being misdiagnosed. Methods We performed whole exome sequencing in a cohort of 278 patients with MS, clinically or radiologically isolated syndrome without cerebrospinal fluid-specific oligoclonal bands (CSF-OCBs) (n = 228), a positive family history of MS (n = 44), or both (n = 6), thereby focusing on individuals potentially more likely to have underlying monogenic conditions mimicking MS. We prioritized 495 genes associated with monogenic diseases sharing features with MS. Results A disease-causing variant in NOTCH3 was identified in one patient without CSF-OCBs, no spinal lesions, with non-response to immunotherapy, and a family history of dementia, thereby converting the diagnosis to cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Moreover, 18 patients (6.5% of total) carried variants of unclear significance. Conclusion Monogenic diseases being misdiagnosed as MS seem rare in patients diagnosed with MS according to the McDonald criteria, even in CSF-OCB negative cases. The detected pathogenic NOTCH3 variant emphasizes CADASIL as a rare differential diagnosis and highlights the relevance of genetic testing in selected MS cases with atypical presentations.
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Affiliation(s)
- Julia M Mandler
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Johanna Härtl
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Isabell Cordts
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Marc Sturm
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Dennis M Hedderich
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Cemsel Bafligil
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Enayatullah Baki
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Benedikt Becker
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Gerrit Machetanz
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Centre for Rare Diseases, University of Tübingen, Tübingen, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Marcus Deschauer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
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Dilliott AA, Berberian SA, Sunderland KM, Binns MA, Zimmer J, Ozzoude M, Scott CJM, Gao F, Lang AE, Breen DP, Tartaglia MC, Tan B, Swartz RH, Rogaeva E, Borrie M, Finger E, Fischer CE, Frank A, Freedman M, Kumar S, Pasternak S, Pollock BG, Rajji TK, Tang-Wai DF, Abrahao A, Turnbull J, Zinman L, Casaubon L, Dowlatshahi D, Hassan A, Mandzia J, Sahlas D, Saposnik G, Grimes D, Marras C, Steeves T, Masellis M, Farhan SMK, Bartha R, Symons S, Hegele RA, Black SE, Ramirez J. Rare neurovascular genetic and imaging markers across neurodegenerative diseases. Alzheimers Dement 2023; 19:5583-5595. [PMID: 37272523 DOI: 10.1002/alz.13316] [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: 03/03/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Cerebral small vessel disease (SVD) is common in patients with cognitive impairment and neurodegenerative diseases such as Alzheimer's and Parkinson's. This study investigated the burden of magnetic resonance imaging (MRI)-based markers of SVD in patients with neurodegenerative diseases as a function of rare genetic variant carrier status. METHODS The Ontario Neurodegenerative Disease Research Initiative study included 520 participants, recruited from 14 tertiary care centers, diagnosed with various neurodegenerative diseases and determined the carrier status of rare non-synonymous variants in five genes (ABCC6, COL4A1/COL4A2, NOTCH3/HTRA1). RESULTS NOTCH3/HTRA1 were found to significantly influence SVD neuroimaging outcomes; however, the mechanisms by which these variants contribute to disease progression or worsen clinical correlates are not yet understood. DISCUSSION Further studies are needed to develop genetic and imaging neurovascular markers to enhance our understanding of their potential contribution to neurodegenerative diseases.
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Affiliation(s)
- Allison A Dilliott
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montréal, Quebec, Canada
| | - Stephanie A Berberian
- Dr. Sandra Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Kelly M Sunderland
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Malcolm A Binns
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Julia Zimmer
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montréal, Quebec, Canada
| | - Miracle Ozzoude
- Dr. Sandra Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Christopher J M Scott
- Dr. Sandra Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Fuqiang Gao
- Dr. Sandra Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - David P Breen
- Centre for Clinical Brain Sciences, University of Edinburgh; Anne Rowling Regenerative Neurology Clinic, University of Edinburgh; Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Maria C Tartaglia
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Brian Tan
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Richard H Swartz
- Dr. Sandra Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences and University of Toronto, Ontario, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Michael Borrie
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- St. Joseph's Healthcare Centre, London, Ontario, Canada
| | - Elizabeth Finger
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Corinne E Fischer
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Andrew Frank
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Research Institute and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Morris Freedman
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
- Department of Medicine (Neurology), Baycrest Health Sciences, Mt. Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sanjeev Kumar
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Stephen Pasternak
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Bruce G Pollock
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tarek K Rajji
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, Ontario, Canada
| | - David F Tang-Wai
- Department of Medicine (Neurology), Sunnybrook Health Sciences and University of Toronto, Ontario, Canada
| | - Agessandro Abrahao
- Department of Medicine (Neurology), Sunnybrook Health Sciences and University of Toronto, Ontario, Canada
| | - John Turnbull
- Division of Neurology, Department of Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Lorne Zinman
- Department of Medicine (Neurology), Sunnybrook Health Sciences and University of Toronto, Ontario, Canada
| | - Leanne Casaubon
- Department of Medicine (Neurology), Sunnybrook Health Sciences and University of Toronto, Ontario, Canada
| | - Dar Dowlatshahi
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Research Institute and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ayman Hassan
- Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario, Canada
| | - Jennifer Mandzia
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Demetrios Sahlas
- Division of Neurology, Department of Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Gustavo Saposnik
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David Grimes
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Research Institute and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Connie Marras
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Thomas Steeves
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mario Masellis
- Dr. Sandra Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences and University of Toronto, Ontario, Canada
| | - Sali M K Farhan
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montréal, Quebec, Canada
| | - Robert Bartha
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Sean Symons
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Robert A Hegele
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Sandra E Black
- Dr. Sandra Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences and University of Toronto, Ontario, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Joel Ramirez
- Dr. Sandra Black Centre for Brain Resilience and Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
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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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4
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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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5
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Ramirez J, Dilliott AA, Binns MA, Breen DP, Evans EC, Beaton D, McLaughlin PM, Kwan D, Holmes MF, Ozzoude M, Scott CJM, Strother SC, Symons S, Swartz RH, Grimes D, Jog M, Masellis M, Black SE, Joutel A, Marras C, Rogaeva E, Hegele RA, Lang AE. Parkinson's Disease, NOTCH3 Genetic Variants, and White Matter Hyperintensities. Mov Disord 2020; 35:2090-2095. [PMID: 32573853 DOI: 10.1002/mds.28171] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/01/2020] [Accepted: 05/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND White matter hyperintensities (WMH) on magnetic resonance imaging may influence clinical presentation in patients with Parkinson's disease (PD), although their significance and pathophysiological origins remain unresolved. Studies examining WMH have identified pathogenic variants in NOTCH3 as an underlying cause of inherited forms of cerebral small vessel disease. METHODS We examined NOTCH3 variants, WMH volumes, and clinical correlates in 139 PD patients in the Ontario Neurodegenerative Disease Research Initiative cohort. RESULTS We identified 13 PD patients (~9%) with rare (<1% of general population), nonsynonymous NOTCH3 variants. Bayesian linear modeling demonstrated a doubling of WMH between variant negative and positive patients (3.1 vs. 6.9 mL), with large effect sizes for periventricular WMH (d = 0.8) and lacunes (d = 1.2). Negative correlations were observed between WMH and global cognition (r = -0.2). CONCLUSION The NOTCH3 rare variants in PD may significantly contribute to increased WMH burden, which in turn may negatively influence cognition. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Joel Ramirez
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Allison A Dilliott
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Malcolm A Binns
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
| | - David P Breen
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom.,Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Emily C Evans
- Mississauga Academy of Medicine, University of Toronto Mississauga, Mississauga, Ontario, Canada
| | - Derek Beaton
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
| | - Paula M McLaughlin
- Queen's University, Centre for Neuroscience Studies, Kingston, Ontario.,Nova Scotia Health Authority, Dalhousie University, Department of Medicine-Geriatrics, Halifax, Nova Scotia, Canada
| | - Donna Kwan
- Queen's University, Centre for Neuroscience Studies, Kingston, Ontario
| | - Melissa F Holmes
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Miracle Ozzoude
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Christopher J M Scott
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | | | - Sean Symons
- Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Richard H Swartz
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and University of Toronto, Ontario, Canada
| | - David Grimes
- University of Ottawa Brain and Mind Research Institute, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, Western University, London, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and University of Toronto, Ontario, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and University of Toronto, Ontario, Canada
| | - Anne Joutel
- Institute of Psychiatry and Neuroscience of Paris- Institut national de la santé et de la recherche médicale (INSERM), Paris Descartes University, Paris, France
| | - Connie Marras
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Ontario, Canada
| | - Robert A Hegele
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
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6
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Giau VV, Bagyinszky E, Youn YC, An SSA, Kim SY. Genetic Factors of Cerebral Small Vessel Disease and Their Potential Clinical Outcome. Int J Mol Sci 2019; 20:ijms20174298. [PMID: 31484286 PMCID: PMC6747336 DOI: 10.3390/ijms20174298] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/27/2019] [Accepted: 09/01/2019] [Indexed: 12/23/2022] Open
Abstract
Cerebral small vessel diseases (SVD) have been causally correlated with ischemic strokes, leading to cognitive decline and vascular dementia. Neuroimaging and molecular genetic tests could improve diagnostic accuracy in patients with potential SVD. Several types of monogenic, hereditary cerebral SVD have been identified: cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL), cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), cathepsin A-related arteriopathy with strokes and leukoencephalopathy (CARASAL), hereditary diffuse leukoencephalopathy with spheroids (HDLS), COL4A1/2-related disorders, and Fabry disease. These disorders can be distinguished based on their genetics, pathological and imaging findings, clinical manifestation, and diagnosis. Genetic studies of sporadic cerebral SVD have demonstrated a high degree of heritability, particularly among patients with young-onset stroke. Common genetic variants in monogenic disease may contribute to pathological progress in several cerebral SVD subtypes, revealing distinct genetic mechanisms in different subtype of SVD. Hence, genetic molecular analysis should be used as the final gold standard of diagnosis. The purpose of this review was to summarize the recent discoveries made surrounding the genetics of cerebral SVD and their clinical significance, to provide new insights into the pathogenesis of cerebral SVD, and to highlight the possible convergence of disease mechanisms in monogenic and sporadic cerebral SVD.
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Affiliation(s)
- Vo Van Giau
- Department of Bionano Technology & Gachon Bionano Research Institute, Gachon University, Seongnam-si, Gyeonggi-do 461-701, Korea
| | - Eva Bagyinszky
- Department of Bionano Technology & Gachon Bionano Research Institute, Gachon University, Seongnam-si, Gyeonggi-do 461-701, Korea
| | - Young Chul Youn
- Department of Neurology, Chung-Ang University College of Medicine, Seoul 06973, Korea.
| | - Seong Soo A An
- Department of Bionano Technology & Gachon Bionano Research Institute, Gachon University, Seongnam-si, Gyeonggi-do 461-701, Korea.
| | - Sang Yun Kim
- Department of Neurology, Seoul National University College of Medicine & Neurocognitive Behavior Center, Seoul National University Bundang Hospital, Seoul 06973, Korea
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Sun Y, Wei YJ, Xing Y. Vascular cognitive impairment associated with NOTCH3 Exon 33 mutation: A case report. Medicine (Baltimore) 2019; 98:e16920. [PMID: 31441874 PMCID: PMC6716740 DOI: 10.1097/md.0000000000016920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Vascular cognitive impairment (VCI) is a common cause of dementia. Research suggests that hereditary factors (gene mutations) play an important role in the pathogenesis of VCI, and a mutation of the NOTCH3 locus is frequently identified in affected patients. Herein, we report the case of a patient with confirmed VCI associated with a NOTCH3 exon 33 gene mutation and review the relevant VCI literature. PATIENT CONCERNS A 48-year-old man presented to our neurology clinic with gradually progressive cognitive impairment. DIAGNOSES Brain magnetic resonance imaging revealed multiple punctate hyperintensities in the patient's periventricular white matter. Genetic analysis showed a c.6744C > T, p. Ala2223Val substitution in exon 33 of the NOTCH3 gene. We diagnosed thepatient with VCI secondary to a NOTCH3 gene mutation. INTERVENTIONS Donepezil (5 mg) and memantine (5 mg) daily. OUTCOMES The patient showed symptom improvement at his 3-month and 6-month follow-up appointments. LESSONS This patient may have a new type of mutation that is different from the one seen in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, although it involves a NOTCH3 defect. We propose that the entire NOTCH3 gene should be sequenced in patients with suspected hereditary VCI. This practice could facilitate the discovery of newpathogenic mutations and diseases.
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Rutten JW, van den Akker EB, Lesnik Oberstein SAJ. Commentary to: Masoli et al. Clinical Outcomes of CADASIL-Associated NOTCH3 mutations in 451,424 European Ancestry Community Volunteers. (Translational Stroke Research Oct 2018). Transl Stroke Res 2018; 10:458-459. [PMID: 30565089 PMCID: PMC6733833 DOI: 10.1007/s12975-018-0681-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 12/06/2018] [Indexed: 11/27/2022]
Affiliation(s)
- J W Rutten
- Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA, Leiden, The Netherlands.
| | - E B van den Akker
- Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - S A J Lesnik Oberstein
- Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA, Leiden, The Netherlands
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Muiño E, Gallego-Fabrega C, Cullell N, Carrera C, Torres N, Krupinski J, Roquer J, Montaner J, Fernández-Cadenas I. Systematic Review of Cysteine-Sparing NOTCH3 Missense Mutations in Patients with Clinical Suspicion of CADASIL. Int J Mol Sci 2017; 18:E1964. [PMID: 28902129 PMCID: PMC5618613 DOI: 10.3390/ijms18091964] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/07/2017] [Accepted: 09/10/2017] [Indexed: 11/25/2022] Open
Abstract
CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is caused by mutations in the NOTCH3 gene, affecting the number of cysteines in the extracellular domain of the receptor, causing protein misfolding and receptor aggregation. The pathogenic role of cysteine-sparing NOTCH3 missense mutations in patients with typical clinical CADASIL syndrome is unknown. The aim of this article is to describe these mutations to clarify if any could be potentially pathogenic. Articles on cysteine-sparing NOTCH3 missense mutations in patients with clinical suspicion of CADASIL were reviewed. Mutations were considered potentially pathogenic if patients had: (a) typical clinical CADASIL syndrome; (b) diffuse white matter hyperintensities; (c) the 33 NOTCH3 exons analyzed; (d) mutations that were not polymorphisms; and (e) Granular osmiophilic material (GOM) deposits in the skin biopsy. Twenty-five different mutations were listed. Four fulfill the above criteria: p.R61W; p.R75P; p.D80G; and p.R213K. Patients carrying these mutations had typical clinical CADASIL syndrome and diffuse white matter hyperintensities, mostly without anterior temporal pole involvement. Cysteine-sparing NOTCH3 missense mutations are associated with typical clinical CADASIL syndrome and typical magnetic resonance imaging (MRI) findings, although with less involvement of the anterior temporal lobe. Hence, these mutations should be further studied to confirm their pathological role in CADASIL.
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Affiliation(s)
- Elena Muiño
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mútua Terrassa, Hospital Mútua de Terrassa, 08221 Terrassa, Spain.
| | - Cristina Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mútua Terrassa, Hospital Mútua de Terrassa, 08221 Terrassa, Spain.
| | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mútua Terrassa, Hospital Mútua de Terrassa, 08221 Terrassa, Spain.
| | - Caty Carrera
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron, 08035 Barcelona, Spain; (C.C.).
| | - Nuria Torres
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mútua Terrassa, Hospital Mútua de Terrassa, 08221 Terrassa, Spain.
| | - Jurek Krupinski
- Neurology Service, Hospital Mútua de Terrassa, 08221 Terrassa, Spain.
| | - Jaume Roquer
- Neurology Service, Institut Hospital del Mar d'investigacions Mèdiques, IMIM-Hospital del Mar, 08003 Barcelona, Spain.
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron, 08035 Barcelona, Spain; (C.C.).
| | - Israel Fernández-Cadenas
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mútua Terrassa, Hospital Mútua de Terrassa, 08221 Terrassa, Spain.
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Yuan X, Dong Z. The Association Between the Genetic Variants of the NOTCH3 Gene and Ischemic Stroke Risk. Med Sci Monit 2016; 22:3910-3914. [PMID: 27770607 PMCID: PMC5081240 DOI: 10.12659/msm.896297] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Ischemic stroke (IS) is a leading cause of disability and death and NOTCH3 as a gene related with cardiac-cerebral vascular disease plays a vital role in IS development. However, the reports about the effect of genetic variants in NOTCH3 gene on IS are still few. Material/Methods In order to explore the association between NOTCH3 polymorphisms and IS, 134 patients with IS and 115 controls were enrolled in this case-control study. Polymerase chain reaction was used to do the genotyping of polymorphisms. The χ2 test was performed to evaluate Hardy-Weinberg equilibrium (HWE) in the control group and calculate odds ratio (OR) with corresponding 95% confidence interval (CI) which represented the association intensity of NOTCH3 gene polymorphisms and IS risk. Results The genotype frequencies in the control group all confirmed to HWE. TT genotype of 381C>T was associated significantly with IS risk (OR=2.441, 95%CI=1.021–5.837). TC, CC mutant genotypes of 1735T>C had higher frequencies in cases than controls and the difference was significant (P=0.013, 0.041); further, its C allele also increased 0.722 times risk in the case group than controls (OR=1.722, 95%CI=1.166–2.541). Conclusions NOTCH3 381C>T and 1735T>C polymorphisms were associated with IS and might be the risk factors for IS development, but not NOTCH3 605C>T polymorphism.
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Affiliation(s)
- Xiaoling Yuan
- Department of Neurology, People's Hospital of Liaocheng, Liaocheng, Shandong, China (mainland)
| | - Zifeng Dong
- Department of Anesthesiology, People's Hospital of Liaocheng, Liaocheng, Shandong, China (mainland)
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Lim KS, Tan AH, Lim CS, Chua KH, Lee PC, Ramli N, Rajahram GS, Hussin FT, Wong KT, Bhattacharjee MB, Ng CC. R54C Mutation of NOTCH3 Gene in the First Rungus Family with CADASIL. PLoS One 2015; 10:e0135470. [PMID: 26270344 PMCID: PMC4535948 DOI: 10.1371/journal.pone.0135470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/22/2015] [Indexed: 12/03/2022] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare hereditary stroke caused by mutations in NOTCH3 gene. We report the first case of CADASIL in an indigenous Rungus (Kadazan-Dusun) family in Kudat, Sabah, Malaysia confirmed by a R54C (c.160C>T, p.Arg54Cys) mutation in the NOTCH3. This mutation was previously reported in a Caucasian and two Korean cases of CADASIL. We recruited two generations of the affected Rungus family (n = 9) and found a missense mutation (c.160C>T) in exon 2 of NOTCH3 in three siblings. Two of the three siblings had severe white matter abnormalities in their brain MRI (Scheltens score 33 and 50 respectively), one of whom had a young stroke at the age of 38. The remaining sibling, however, did not show any clinical features of CADASIL and had only minimal changes in her brain MRI (Scheltens score 17). This further emphasized the phenotype variability among family members with the same mutation in CADASIL. This is the first reported family with CADASIL in Rungus subtribe of Kadazan-Dusun ethnicity with a known mutation at exon 2 of NOTCH3. The penetrance of this mutation was not complete during the course of this study.
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Affiliation(s)
- Kheng-Seang Lim
- Division of Neurology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai-Huey Tan
- Division of Neurology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chun-Shen Lim
- Genetics and Molecular Biology Unit, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Kek-Heng Chua
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ping-Chin Lee
- Genetics and Molecular Biology Unit, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Norlisah Ramli
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Kum-Thong Wong
- Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Meenakshi B. Bhattacharjee
- Department of Pathology and Laboratory Medicine, UT Health Science Center, Houston, TX, United States of America
| | - Ching-Ching Ng
- Genetics and Molecular Biology Unit, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
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12
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Abstract
Notch signaling is a master controller of the neural stem cell and neural development maintaining a significant role in the normal brain function. Notch genes are involved in embryogenesis, nervous system, and cardiovascular and endocrine function. On the other side, there are studies representing the involvement of Notch mutations in sporadic Alzheimer disease, other neurodegenerative diseases such as Down syndrome, Pick's and Prion's disease, and CADASIL. This manuscript attempts to present a holistic view of the positive or negative contribution of Notch signaling in the adult brain, and at the same time to present and promote the promising research fields of study.
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13
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Migraine genetics: current findings and future lines of research. Neurogenetics 2014; 16:77-95. [PMID: 25501253 DOI: 10.1007/s10048-014-0433-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 11/25/2014] [Indexed: 01/03/2023]
Abstract
In the last two decades, migraine research has greatly advanced our current knowledge of the genetic contributions and the pathophysiology of this common and debilitating disorder. Nonetheless, this knowledge still needs to grow further and to translate into more effective treatments. To date, several genes involved in syndromic and monogenic forms of migraine have been identified, allowing the generation of animal models which have significantly contributed to current knowledge of the mechanisms underlying these rare forms of migraine. Common forms of migraine are instead posing a greater challenge, as they may most often stem from complex interactions between multiple common genetic variants, with environmental triggers. This paper reviews our current understanding of migraine genetics, moving from syndromic and monogenic forms to oligogenic/polygenic migraines most recently addressed with some success through genome-wide association studies. Methodological issues in study design and future perspectives opened by biomarker research will also be briefly addressed.
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Rutten JW, Haan J, Terwindt GM, van Duinen SG, Boon EMJ, Lesnik Oberstein SAJ. Interpretation ofNOTCH3mutations in the diagnosis of CADASIL. Expert Rev Mol Diagn 2014; 14:593-603. [DOI: 10.1586/14737159.2014.922880] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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15
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Mosca L, Rivieri F, Tanel R, Bonfante A, Burlina A, Manfredini E, Primignani P, Gesu GP, Marocchi A, Penco S. Mutational screening of NOTCH3 gene reveals two novel mutations: complexity of CADASIL diagnosis. J Mol Neurosci 2014; 54:723-9. [PMID: 24816653 DOI: 10.1007/s12031-014-0311-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/16/2014] [Indexed: 12/30/2022]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an adult onset hereditary vascular disease with neurological manifestations. The classical clinical course is relentlessly progressive with early transient ischaemic attacks (TIA) or strokes, dementia and finally death in the mid-1960s. The disorder is inherited in an autosomal dominant fashion, with high penetrance and broad variable clinical course even within family. It is caused by mutations in the NOTCH3 gene; all causative mutations result in gain or loss of a cysteine residue within the extracellular domain, with exons 3 and 4 reported as hot spot mutational sites. Mutation analysis of the NOTCH3 gene was performed through direct sequencing of the 2-23 exons containing all EGF-like domains. Patients underwent genetic counselling pre and post testing. Here, we report two novel mutations located in exons 6 and 15 of the NOTCH3 gene; clinical description for the probands and for available relatives is enclosed. No reliable data on incidence or prevalence rates of this disease are available: it is therefore essential that the diagnosis is obtained in all suspected cases through the extensive analysis of the NOTCH3 gene and that all cases are brought to the attention of the scientific community.
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Affiliation(s)
- Lorena Mosca
- Department of Laboratory Medicine, Medical Genetics Unit, Niguarda Ca' Granda Hospital, Milan, Italy
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Lackovic V, Bajcetic M, Lackovic M, Novakovic I, Labudović Borović M, Pavlovic A, Zidverc-Trajkovic J, Dzolic E, Rovcanin B, Sternic N, Kostic V. Skin and sural nerve biopsies: ultrastructural findings in the first genetically confirmed cases of CADASIL in Serbia. Ultrastruct Pathol 2013; 36:325-35. [PMID: 23025651 DOI: 10.3109/01913123.2012.679352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited vascular disorder caused by Notch3 gene mutations. The main histopathological hallmark is granular osmiophilic material (GOM) deposited in the close vicinity of vascular smooth muscle cells (VSMCs). The authors report the first 7 ultrastructurally and genetically confirmed cases of CADASIL in Serbia. Samples of skin and sural nerve were investigated by transmission electron microscopy. GOM deposits were observed around degenerated VSMCs in all the skin biopsies examined. Sural nerve biopsies revealed severe alterations of nerve fibers, endoneurial blood vessels with GOM deposits, endoneurial fibroblasts, and perineurial myofibroblasts. Total genomic DNA was extracted from peripheral blood leukocytes, and exons 2-6 of the Notch3 gene were amplified by PCR and subsequently sequenced. Four different mutations in exons 2 (Cys65Tyr), 3 (Gly89Cys and Arg90Cys), and 6 (Ala319Cys), which determine the CADASIL disease, were detected among all described patients. A novel missense mutation Gly89Cys involving exon 3 was detected. Due to the difficulties in the determination of the Notch3 mutations, these data suggest that electron microscopic analysis for GOMs in dermal vessel wall provides a rapid and reliable screening method for this disease.
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Affiliation(s)
- Vesna Lackovic
- Institute of Histology and Embryology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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Testi S, Malerba G, Ferrarini M, Ragno M, Pradotto L, Mauro A, Fabrizi G. Mutational and haplotype map of NOTCH3 in a cohort of Italian patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). J Neurol Sci 2012; 319:37-41. [DOI: 10.1016/j.jns.2012.05.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 05/07/2012] [Accepted: 05/09/2012] [Indexed: 11/26/2022]
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Two novel mutations and a previously unreported intronic polymorphism in the NOTCH3 gene. Mutat Res 2012; 732:3-8. [PMID: 22373597 DOI: 10.1016/j.mrfmmm.2012.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 02/07/2012] [Accepted: 02/11/2012] [Indexed: 01/01/2023]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary disease of small vessel caused by mutations in the NOTCH3 gene (NCBI Gene ID: 4854) located on chromosome 19p13.1. NOTCH3 consists of 33 exons which encode a protein of 2321 amino acids. Exons 3 and 4 were found to be mutation hotspots, containing more than 65% of all CADASIL mutations. We performed direct sequencing on an ABI 3130 Genetic Analyser to screen for mutations and polymorphisms on 300 patients who were clinically suspected to have CADASIL. First, exons 3 and 4 were screened in NOTCH3 and if there were no variations found, then extended CADASIL testing (exons 2, 11, 18 and 19) was offered to patients. Here we report two novel non-synonymous mutations identified in the NOTCH3 gene. The first mutation, located in exon 4 was found in a 49-year-old female and causes an alanine to valine amino acid change at position 202 (605C>T). The second mutation, located in exon 11, was found in a 66-year-old female and causes a cysteine to arginine amino acid change at position 579 (1735T>C). We also report a 46-year-old male with a known polymorphism Thr101Thr (rs3815188) and an unreported polymorphism NM_000435.2:c.679+60G>A observed in intron 4 of the NOTCH3 gene. Although Ala202Ala (rs1043994) is a common polymorphism in the NOTCH3 gene, our reported novel mutation (Ala202Val) causes an amino acid change at the same locus. Our other reported mutation (Cys579Arg) correlates well with other known mutations in NOTCH3, as the majority of the CADASIL-associated mutations in NOTCH3 generally occur in the EGF-like (epidermal growth factor-like) repeat domain, causing a change in the number of cysteine residues. The intronic polymorphism NM_000435.2:c.679+60G>A lies close to the intron-exon boundary and may affect the splicing mechanism in the NOTCH3 gene.
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Guerreiro RJ, Lohmann E, Kinsella E, Brás JM, Luu N, Gurunlian N, Dursun B, Bilgic B, Santana I, Hanagasi H, Gurvit H, Gibbs JR, Oliveira C, Emre M, Singleton A. Exome sequencing reveals an unexpected genetic cause of disease: NOTCH3 mutation in a Turkish family with Alzheimer's disease. Neurobiol Aging 2011; 33:1008.e17-23. [PMID: 22153900 DOI: 10.1016/j.neurobiolaging.2011.10.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 10/06/2011] [Accepted: 10/09/2011] [Indexed: 11/26/2022]
Abstract
Alzheimer's disease (AD) is a genetically complex disorder for which the definite diagnosis is only accomplished postmortem. Mutations in 3 genes (APP, PSEN1, and PSEN2) are known to cause AD, but a large number of familial cases do not harbor mutations in these genes and several unidentified genes that contain disease-causing mutations are thought to exist. We performed whole exome sequencing in a Turkish patient clinically diagnosed with Alzheimer's disease from a consanguineous family with a complex history of neurological and immunological disorders and identified a mutation in NOTCH3 (p.R1231C), previously described as causing cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Complete screening of NOTCH3 in a cohort of 95 early onset AD cases and 95 controls did not reveal any additional pathogenic mutations. Although the complex history of disease in this family precluded us to establish segregation of the mutation found with disease, our results show that exome sequencing is a rapid, cost-effective and comprehensive tool to detect genetic mutations, allowing for the identification of unexpected genetic causes of clinical phenotypes. As etiological based therapeutics become more common, this method will be key in diagnosing and treating disease.
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Affiliation(s)
- Rita João Guerreiro
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
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20
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Mosca L, Marazzi R, Ciccone A, Santilli I, Bersano A, Sansone V, Grosso E, Mandrile G, Giachino DF, Adobbati L, Corengia E, Agostoni E, Fiumani A, Gallone S, Scarpini E, Guidotti M, Sterzi R, Ajmone C, Marocchi A, Penco S. NOTCH3 gene mutations in subjects clinically suspected of CADASIL. J Neurol Sci 2011; 307:144-8. [PMID: 21616505 DOI: 10.1016/j.jns.2011.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 03/07/2011] [Accepted: 04/22/2011] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebrovascular disease due to mutations involving loss or gain of a cysteine residue in the NOTCH3 gene. A cluster of mutations around exons 3 and 4 was originally reported. Identification of pathogenic mutation is important for diagnostic confirmation of the disease, however genetic counselling and testing of relatives at risk is critical in mutation carriers. METHODS Mutation analysis of the NOTCH3 gene was performed through direct sequencing in 140 patients with clinical suspicion of CADASIL. Patients underwent genetic counselling pre and post testing. The 2-23 exons containing all EGF-like domains were screened. RESULTS 14 familial forms of the disease have been identified with 14 different causative mutations in exons 2, 3, 4, 5, 7, 10, 14, 19, 20 and 22 of the NOTCH3 gene; no pathogenetic mutations have been identified in exons 6 and 8; several genetic variations both in coding as well as in intronic regions were identified too. CONCLUSIONS Our data confirm the importance of screening the whole EGF-like domains region of NOTCH3 gene for the molecular diagnosis of CADASIL among the Italian population too. Moreover genetic variants different from loss or gain of a cysteine residue are identified and presented.
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Affiliation(s)
- Lorena Mosca
- Department of Laboratory Medicine, Medical Genetics, Niguarda Ca' Granda Hospital, Milan, Italy
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Shahien R, Bianchi S, Bowirrat A. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy in an Israeli family. Neuropsychiatr Dis Treat 2011; 7:383-90. [PMID: 21822390 PMCID: PMC3148930 DOI: 10.2147/ndt.s19399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Indexed: 01/18/2023] Open
Abstract
Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common monogenic form of hereditary cerebral microangiopathy, and is caused by over 170 different mutations in the NOTCH3 gene at locus 19p13.1-13.26. We report the first study of familial CADASIL in a 39-year-old Jewish woman and her mother who had died previously. The patient's investigations revealed a normal hemogram with no vascular risk factors or chronic disease. Lumbar puncture was normal. Cranial computed tomography scan revealed bilateral diffuse hypodensities in the subcortical white matter. Cranial magnetic resonance imaging showed hyperintense lesions in the cerebral white matter on T2-weighted images. On electron microscopy, a characteristic granular osmiophilic material was seen in the basement membrane surrounding the pericytes and smooth muscle cells in small-sized and medium-sized vessels. Molecular analysis of the NOTCH3 gene was performed with automatic sequencing of exon 3 and 4 (and intron-exon boundaries) showing a nucleotide c.268C > T substitution, leading to a pathogenic amino acid substitution of p.Arg90Cys, confirming a diagnosis of CADASIL. This mutation was also found in the patient's mother. Although the exact prevalence of CADASIL is not known, this disorder has been reported worldwide, and now including Jews, with a genotype and clinical phenotype similar to that in other ethnic groups.
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Affiliation(s)
- Radi Shahien
- Department of Neurology, Ziv Medical Center, Safed, Israel
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Menon S, Cox HC, Kuwahata M, Quinlan S, MacMillan JC, Haupt LM, Lea RA, Griffiths LR. Association of a Notch 3 gene polymorphism with migraine susceptibility. Cephalalgia 2010; 31:264-70. [DOI: 10.1177/0333102410381143] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) shares common symptoms with migraine. Most CADASIL causative mutations occur in exons 3 and 4 of the Notch 3 gene. This study investigated the role of C381T (rs 3815188) and G684A (rs 1043994) single nucleotide polymorphisms (SNP) in exons 3 and 4, respectively, of the Notch 3 gene in migraine. Results: The first part of the study, in a population of 275 migraineurs and 275 control individuals, found a significant association between the C381T variant and migraine, specifically in migraine without aura (MO) sufferers. The G684A variant was also found to be significantly associated with migraine, specifically in migraine with aura (MA) sufferers. A follow-up study in 300 migraineurs and 300 control individuals did not show replicated association of the C381T variant with migraineurs. However, the G684A variant was again shown to be significantly associated with migraine, specifically with MA. Conclusion: Further investigation of the G684A variant and the Notch 3 gene is warranted to understand their role in migraine.
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Affiliation(s)
- S Menon
- Griffith University, Gold Coast, Australia
| | - HC Cox
- Griffith University, Gold Coast, Australia
| | - M Kuwahata
- Griffith University, Gold Coast, Australia
| | - S Quinlan
- Griffith University, Gold Coast, Australia
| | - JC MacMillan
- University of Queensland Graduate School of Medicine and Queensland Institute of Medical Research, Australia
| | - LM Haupt
- Griffith University, Gold Coast, Australia
| | - RA Lea
- Griffith University, Gold Coast, Australia
- Institute of Environmental Science and Research, New Zealand
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Iemolo F, Duro G, Rizzo C, Castiglia L, Hachinski V, Caruso C. Pathophysiology of vascular dementia. Immun Ageing 2009; 6:13. [PMID: 19895675 PMCID: PMC2784430 DOI: 10.1186/1742-4933-6-13] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 11/06/2009] [Indexed: 02/05/2023]
Abstract
The concept of Vascular Dementia (VaD) has been recognized for over a century, but its definition and diagnostic criteria remain unclear. Conventional definitions identify the patients too late, miss subjects with cognitive impairment short of dementia, and emphasize consequences rather than causes, the true bases for treatment and prevention. We should throw out current diagnostic categories and describe cognitive impairment clinically and according to commonly agreed instruments that document the demographic data in a standardized manner and undertake a systematic effort to identify the underlying aetiology in each case. Increased effort should be targeted towards the concept of and criteria for Vascular Cognitive Impairment and Post-Stroke Dementia as well as for genetic factors involved, especially as these categories hold promise for early prevention and treatment.
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Affiliation(s)
- Francesco Iemolo
- Department of Clinical Neurological Sciences University of Western Ontario, Ontario, Canada.
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