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Gasparini S, Balestrini S, Saccaro LF, Bacci G, Panichella G, Montomoli M, Cantalupo G, Bigoni S, Mancano G, Pellacani S, Leuzzi V, Volpi N, Mari F, Melani F, Cavallin M, Pisano T, Porcedda G, Vaglio A, Mei D, Barba C, Parrini E, Guerrini R. Multiorgan manifestations of COL4A1 and COL4A2 variants and proposal for a clinical management protocol. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2024:e32099. [PMID: 39016117 DOI: 10.1002/ajmg.c.32099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/23/2024] [Accepted: 06/28/2024] [Indexed: 07/18/2024]
Abstract
COL4A1/2 variants are associated with highly variable multiorgan manifestations. Depicting the whole clinical spectrum of COL4A1/2-related manifestations is challenging, and there is no consensus on management and preventative strategies. Based on a systematic review of current evidence on COL4A1/2-related disease, we developed a clinical questionnaire that we administered to 43 individuals from 23 distinct families carrying pathogenic variants. In this cohort, we extended ophthalmological and cardiological examinations to asymptomatic individuals and those with only limited or mild, often nonspecific, clinical signs commonly occurring in the general population (i.e., oligosymptomatic). The most frequent clinical findings emerging from both the literature review and the questionnaire included stroke (203/685, 29.6%), seizures or epilepsy (199/685, 29.0%), intellectual disability or developmental delay (168/685, 24.5%), porencephaly/schizencephaly (168/685, 24.5%), motor impairment (162/685, 23.6%), cataract (124/685, 18.1%), hematuria (63/685, 9.2%), and retinal arterial tortuosity (58/685, 8.5%). In oligosymptomatic and asymptomatic carriers, ophthalmological investigations detected retinal vascular tortuosity (5/13, 38.5%), dysgenesis of the anterior segment (4/13, 30.8%), and cataract (2/13, 15.4%), while cardiological investigations were unremarkable except for mild ascending aortic ectasia in 1/8 (12.5%). Our multimodal approach confirms highly variable penetrance and expressivity in COL4A1/2-related conditions, even at the intrafamilial level with neurological involvement being the most frequent and severe finding in both children and adults. We propose a protocol for prevention and management based on individualized risk estimation and periodic multiorgan evaluations.
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Affiliation(s)
- Simone Gasparini
- Neuroscience and Human Genetics Department, Meyer Children's Hospital IRCCS (full member of the European Reference Network EpiCARE), Florence, Italy
- University of Florence, Florence, Italy
| | - Simona Balestrini
- Neuroscience and Human Genetics Department, Meyer Children's Hospital IRCCS (full member of the European Reference Network EpiCARE), Florence, Italy
- University of Florence, Florence, Italy
| | - Luigi Francesco Saccaro
- Department of Psychiatry, Geneva University and Geneva University Hospitals, Geneva, Switzerland
| | - Giacomo Bacci
- Pediatric Ophthalmology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Giorgia Panichella
- University of Florence, Florence, Italy
- Department of Clinical and Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Martino Montomoli
- Neuroscience and Human Genetics Department, Meyer Children's Hospital IRCCS (full member of the European Reference Network EpiCARE), Florence, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry Unit, University Hospital of Verona (full member of the European Reference Network EpiCARE), Verona, Italy
- Department of Engineering for Innovation Medicine, Innovation Biomedicine Section, University of Verona, Verona, Italy
- Center for Research on Epilepsy in Pediatric Age (CREP), University Hospital of Verona, Verona, Italy
| | - Stefania Bigoni
- Medical Genetics Unit, Ferrara University Hospital, Ferrara, Italy
| | - Giorgia Mancano
- Neuroscience and Human Genetics Department, Meyer Children's Hospital IRCCS (full member of the European Reference Network EpiCARE), Florence, Italy
| | - Simona Pellacani
- Neuroscience and Human Genetics Department, Meyer Children's Hospital IRCCS (full member of the European Reference Network EpiCARE), Florence, Italy
- University of Florence, Florence, Italy
| | - Vincenzo Leuzzi
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Nila Volpi
- Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Francesco Mari
- Child and Adolescent Epilepsy and Clinical Neurophysiology Departmental Unit, USL Centro Toscana, Prato, Italy
| | - Federico Melani
- Neuroscience and Human Genetics Department, Meyer Children's Hospital IRCCS (full member of the European Reference Network EpiCARE), Florence, Italy
| | - Mara Cavallin
- Neuroscience and Human Genetics Department, Meyer Children's Hospital IRCCS (full member of the European Reference Network EpiCARE), Florence, Italy
| | - Tiziana Pisano
- Neuroscience and Human Genetics Department, Meyer Children's Hospital IRCCS (full member of the European Reference Network EpiCARE), Florence, Italy
| | - Giulio Porcedda
- Department of Paediatric Cardiology, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Davide Mei
- Neuroscience and Human Genetics Department, Meyer Children's Hospital IRCCS (full member of the European Reference Network EpiCARE), Florence, Italy
| | - Carmen Barba
- Neuroscience and Human Genetics Department, Meyer Children's Hospital IRCCS (full member of the European Reference Network EpiCARE), Florence, Italy
- University of Florence, Florence, Italy
| | - Elena Parrini
- Neuroscience and Human Genetics Department, Meyer Children's Hospital IRCCS (full member of the European Reference Network EpiCARE), Florence, Italy
| | - Renzo Guerrini
- Neuroscience and Human Genetics Department, Meyer Children's Hospital IRCCS (full member of the European Reference Network EpiCARE), Florence, Italy
- University of Florence, Florence, Italy
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Zedde M, Romani I, Scaravilli A, Cocozza S, Trojano L, Ragno M, Rifino N, Bersano A, Gerevini S, Pantoni L, Valzania F, Pascarella R. Expanding the Neurological Phenotype of Anderson-Fabry Disease: Proof of Concept for an Extrapyramidal Neurodegenerative Pattern and Comparison with Monogenic Vascular Parkinsonism. Cells 2024; 13:1131. [PMID: 38994983 PMCID: PMC11240674 DOI: 10.3390/cells13131131] [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: 06/02/2024] [Revised: 06/18/2024] [Accepted: 06/25/2024] [Indexed: 07/13/2024] Open
Abstract
Anderson-Fabry disease (AFD) is a genetic sphingolipidosis involving virtually the entire body. Among its manifestation, the involvement of the central and peripheral nervous system is frequent. In recent decades, it has become evident that, besides cerebrovascular damage, a pure neuronal phenotype of AFD exists in the central nervous system, which is supported by clinical, pathological, and neuroimaging data. This neurodegenerative phenotype is often clinically characterized by an extrapyramidal component similar to the one seen in prodromal Parkinson's disease (PD). We analyzed the biological, clinical pathological, and neuroimaging data supporting this phenotype recently proposed in the literature. Moreover, we compared the neurodegenerative PD phenotype of AFD with a classical monogenic vascular disease responsible for vascular parkinsonism and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). A substantial difference in the clinical and neuroimaging features of neurodegenerative and vascular parkinsonism phenotypes emerged, with AFD being potentially responsible for both forms of the extrapyramidal involvement, and CADASIL mainly associated with the vascular subtype. The available studies share some limitations regarding both patients' information and neurological and genetic investigations. Further studies are needed to clarify the potential association between AFD and extrapyramidal manifestations.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy;
| | - Ilaria Romani
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, 50139 Firenze, Italy;
| | - Alessandra Scaravilli
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80133 Napoli, Italy; (A.S.); (S.C.)
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80133 Napoli, Italy; (A.S.); (S.C.)
| | - Luigi Trojano
- Dipartimento di Psicologia, Università della Campania ‘Luigi Vanvitelli’, viale Ellittico 31, 81100 Caserta, Italy;
| | - Michele Ragno
- Centro Medico Salute 23, Via O. Licini 5, 63066 Grottammare (AP), Italy;
| | - Nicola Rifino
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy; (N.R.); (A.B.)
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy; (N.R.); (A.B.)
| | - Simonetta Gerevini
- Head Diagnostic Dept and Neuroradiology Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Leonardo Pantoni
- Neuroscience Research Center, Department of Biomedical and Clinical Science, University of Milan, 20122 Milano, Italy;
| | - Franco Valzania
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy;
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy;
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Saks DG, Bajorek B, Catts VS, Bentvelzen AC, Jiang J, Wen W, Mather KA, Thalamuthu A, Huang-Lung J, Nivison-Smith L, Griffiths LR, Smith RA, Sexton A, James P, Jayasena T, Poljak A, Hansra GK, Hosoki S, Park A, Hillenbrand CM, van Wijngaarden P, Chander RJ, Humphrey S, Chen R, Kochan NA, Helman TJ, Levi C, Brodtmann A, O'Sullivan MJ, Markus R, Butcher K, Parsons M, Kovacic JC, Sachdev PS. The protocol for an observational Australian cohort study of CADASIL: The AusCADASIL study. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100225. [PMID: 38841148 PMCID: PMC11152887 DOI: 10.1016/j.cccb.2024.100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024]
Abstract
Introduction Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a rare genetic condition with a broad phenotypic presentation. This study aims to establish the first Australian cohort of individuals affected by CADASIL (AusCADASIL) and examine its clinical features and longitudinal course, and to investigate neuroimaging and blood biomarkers to assist in early diagnosis and identify disease progression. Methods Participants will be recruited from six study centres across Australia for an observational study of CADASIL. We aim to recruit 150 participants with diagnosed CADASIL, family history of CADASIL or suspected CADASIL symptoms, and 150 cognitively normal NOTCH3 negative individuals as controls. Participants will complete: 1) online questionnaires on medical and family history, mental health, and wellbeing; 2) neuropsychological evaluation; 3) neurological examination and brain MRI; 4) ocular examination and 5) blood sample donation. Participants will have annual follow-up for 4 years to assess their progression and will be asked to invite a study partner to corroborate their self-reported cognitive and functional abilities.Primary outcomes include cognitive function and neuroimaging abnormalities. Secondary outcomes include investigation of genetics and blood and ocular biomarkers. Data from the cohort will contribute to an international consortium, and cohort participants will be invited to access future treatment/health intervention trials. Discussion AusCADASIL will be the first study of an Australian cohort of individuals with CADASIL. The study will identify common pathogenic variants in this cohort, and characterise the pattern of clinical presentation and longitudinal progression, including imaging features, blood and ocular biomarkers and cognitive profile.
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Affiliation(s)
- Danit G. Saks
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Beata Bajorek
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, 2305, Australia
- Pharmacy Department, John Hunter Hospital, Newcastle, 2305, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, 2308, Australia
| | - Vibeke S. Catts
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Adam C. Bentvelzen
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Wei Wen
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Karen A. Mather
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Anbupalam Thalamuthu
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Jessie Huang-Lung
- School of Optometry and Vision Science, University of New South Wales, Sydney, 2052, Australia
| | - Lisa Nivison-Smith
- School of Optometry and Vision Science, University of New South Wales, Sydney, 2052, Australia
| | - Lyn R. Griffiths
- Genomics Research Centre, Centre for Genomics and Personalised Health, Queensland University of Technology, Brisbane, 4059, Australia
| | - Robert A. Smith
- Genomics Research Centre, Centre for Genomics and Personalised Health, Queensland University of Technology, Brisbane, 4059, Australia
| | - Adrienne Sexton
- Genomic Medicine, Royal Melbourne Hospital, Melbourne, 3052, Australia
| | - Paul James
- Genomic Medicine, Royal Melbourne Hospital, Melbourne, 3052, Australia
| | - Tharusha Jayasena
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Anne Poljak
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
- Bioanalytical Mass Spectrometry Facility, University of New South Wales, Sydney, 2052, Australia
| | - Gurpreet K. Hansra
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Satoshi Hosoki
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Ashley Park
- Department of Neurology, Royal Melbourne Hospital, Melbourne, 3052, Australia
| | | | - Peter van Wijngaarden
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, 3002, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, 3052, Australia
| | - Russell J. Chander
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Sam Humphrey
- Department of Neurology, Royal Melbourne Hospital, Melbourne, 3052, Australia
| | - Rory Chen
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Nicole A. Kochan
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Tessa J. Helman
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Christopher Levi
- School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia
- John Hunter Health and Innovation Precinct (JHHIP), Newcastle, 2305, Australia
- Neurology Department, John Hunter Hospital, Newcastle, 2305, Australia
| | - Amy Brodtmann
- Department of Neurology, Royal Melbourne Hospital, Melbourne, 3052, Australia
| | - Michael J. O'Sullivan
- Institute for Molecular Bioscience, University of Queensland, Brisbane, 4067, Australia
| | - Romesh Markus
- Department of Neurology, St Vincent's Hospital, Sydney, 2010, Australia
| | - Ken Butcher
- Department of Neurology, Prince of Wales Hospital, Sydney, 2031, Australia
| | - Mark Parsons
- School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Jason C. Kovacic
- School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
- Victor Chang Cardiac Research Institute, Sydney, 2010, Australia
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, 2031, Australia
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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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