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Tipton PW, Atik M, Soto-Beasley AI, Day GS, Grewal SS, Chaichana K, Fermo OP, Ball CT, Heckman MG, White LJ, Quicksall ZS, Reddy JS, Ramanan VK, Vemuri P, Elder BD, Ertekin-Taner N, Ross O, Graff-Radford N. CWH43 Variants Are Associated With Disease Risk and Clinical Phenotypic Measures in Patients With Normal Pressure Hydrocephalus. Neurol Genet 2023; 9:e200086. [PMID: 37476022 PMCID: PMC10356132 DOI: 10.1212/nxg.0000000000200086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/25/2023] [Indexed: 07/22/2023]
Abstract
Background and Objectives Variants in the CWH43 gene have been associated with normal pressure hydrocephalus (NPH). We aimed to replicate these findings, identify additional CWH43 variants, and further define the clinical phenotype associated with CWH43 variants. Methods We determined the prevalence of CWH43 variants by whole-genome sequencing (WGS) in 94 patients with NPH. The odds of having CWH43 variant carriers develop NPH were determined through comparison with 532 Mayo Clinic Biobank volunteers without a history of NPH. For patients with NPH, we documented the head circumference, prevalence of disproportionate enlargement of subarachnoid hydrocephalus (DESH), microvascular changes on MRI quantified by the Fazekas scale, and ambulatory response to ventriculoperitoneal shunting. Results We identified rare (MAF <0.05) coding CWH43 variants in 15 patients with NPH. Ten patients (Leu533Terfs, n = 8; Lys696Asnfs, n = 2) harbored previously reported predicted loss-of-function variants, and combined burden analysis confirmed risk association with NPH (OR 2.60, 95% CI 1.12-6.03, p = 0.027). Additional missense variations observed included Ile292Thr (n = 2), Ala469Ser (n = 2), and Ala626Val (n = 1). Though not quite statistically significant, in single variable analysis, the odds of having a head circumference above the 75th percentile of normal controls was more than 5 times higher for CWH43 variant carriers compared with that for noncarriers (unadjusted OR 5.67, 95% CI 0.96-108.55, p = 0.057), and this was consistent after adjusting for sex and height (OR 5.42, 95% CI 0.87-106.37, p = 0.073). DESH was present in 56.7% of noncarriers and only 21.4% of carriers (p = 0.016), while sulcal trapping was also more prevalent among noncarriers (67.2% vs 35.7%, p = 0.030). All 8 of the 15 variant carriers who underwent ventriculoperitoneal shunting at our institution experienced ambulatory improvements. Discussion CWH43 variants are frequent in patients with NPH. Predicted loss-of-function mutations were the most common; we identified missense mutations that require further study. Our findings suggest that congenital factors, rather than malabsorption or vascular dysfunction, are primary contributors to the CWH43-related NPH clinical syndrome.
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Affiliation(s)
- Philip W Tipton
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Merve Atik
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Alexandra I Soto-Beasley
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Gregory S Day
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Sanjeet S Grewal
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Kaisorn Chaichana
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Olga P Fermo
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Colleen T Ball
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Michael G Heckman
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Launia J White
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Zachary S Quicksall
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Joseph S Reddy
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Vijay K Ramanan
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Prashanthi Vemuri
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Benjamin D Elder
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Nilufer Ertekin-Taner
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Owen Ross
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
| | - Neill Graff-Radford
- From the Department of Neurology (P.W.T., G.S.D., O.P.F., N.E.-T., N.G.-R.), Department of Neuroscience (M.A., A.I.S.-B., Z.S.Q., J.S.R., N.E.-T., O.R.), Department of Neurosurgery (S.S.G., K.C.), Division of Clinical Trials and Biostatistics (C.T.B., M.G.H., L.J.W.), Mayo Clinic, Jacksonville, FL; Department of Neurology (V.K.R.), Department of Radiology (P.V.), and Department of Neurosurgery (B.D.E.), Mayo Clinic, Rochester, MN
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Israelsson H, Carlberg B, Wikkelsö C, Laurell K, Kahlon B, Leijon G, Eklund A, Malm J. Vascular risk factors in INPH: A prospective case-control study (the INPH-CRasH study). Neurology 2017; 88:577-585. [PMID: 28062721 DOI: 10.1212/wnl.0000000000003583] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 10/14/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess the complete vascular risk factor (VRF) profile of idiopathic normal pressure hydrocephalus (INPH) using a large sample of representative patients with INPH and population-based controls to determine the extent to which vascular disease influences INPH pathophysiology. METHODS All patients with INPH who underwent shunting in Sweden in 2008-2010 were compared to age- and sex-matched population-based controls. Inclusion criteria were age 60-85 years and no dementia. The 10 most important VRFs and cerebrovascular and peripheral vascular disease were prospectively assessed using blood samples, clinical examinations, and standardized questionnaires. Assessed VRFs were hypertension, hyperlipidemia, diabetes, obesity, psychosocial factors, smoking habits, diet, alcohol intake, cardiac disease, and physical activity. RESULTS In total, 176 patients with INPH and 368 controls participated. Multivariable logistic regression analysis indicated that hyperlipidemia (odds ratio [OR] 2.380; 95% confidence interval [CI] 1.434-3.950), diabetes (OR 2.169; 95% CI 1.195-3.938), obesity (OR 5.428; 95% CI 2.502-11.772), and psychosocial factors (OR 5.343; 95% CI 3.219-8.868) were independently associated with INPH. Hypertension, physical inactivity, and cerebrovascular and peripheral vascular disease were also overrepresented in INPH. Moderate alcohol intake and physical activity were overrepresented among the controls. The population-attributable risk percentage was 24%. CONCLUSIONS Our findings confirm that patients with INPH have more VRFs and lack the protective factors present in the general population. Almost 25% of cases of INPH may be explained by VRFs. This suggests that INPH may be a subtype of vascular dementia. Targeted interventions against modifiable VRFs are likely to have beneficial effects on INPH.
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Affiliation(s)
- Hanna Israelsson
- From the Departments of Pharmacology and Clinical Neuroscience (H.I., K.L., J.M.), Public Health and Clinical Medicine (B.C.), and Radiation Sciences (A.E.), and Center for Biomedical Engineering and Physics (A.E.), Umeå University; Institute of Neuroscience (C.W.), Sahlgrens Academy, University of Gothenburg; Department of Neurosurgery (B.K.), Lund University; and Department of Clinical and Experimental Medicine (IKE) (G.L.), Division of Neuroscience, Linköping University, Sweden.
| | - Bo Carlberg
- From the Departments of Pharmacology and Clinical Neuroscience (H.I., K.L., J.M.), Public Health and Clinical Medicine (B.C.), and Radiation Sciences (A.E.), and Center for Biomedical Engineering and Physics (A.E.), Umeå University; Institute of Neuroscience (C.W.), Sahlgrens Academy, University of Gothenburg; Department of Neurosurgery (B.K.), Lund University; and Department of Clinical and Experimental Medicine (IKE) (G.L.), Division of Neuroscience, Linköping University, Sweden
| | - Carsten Wikkelsö
- From the Departments of Pharmacology and Clinical Neuroscience (H.I., K.L., J.M.), Public Health and Clinical Medicine (B.C.), and Radiation Sciences (A.E.), and Center for Biomedical Engineering and Physics (A.E.), Umeå University; Institute of Neuroscience (C.W.), Sahlgrens Academy, University of Gothenburg; Department of Neurosurgery (B.K.), Lund University; and Department of Clinical and Experimental Medicine (IKE) (G.L.), Division of Neuroscience, Linköping University, Sweden
| | - Katarina Laurell
- From the Departments of Pharmacology and Clinical Neuroscience (H.I., K.L., J.M.), Public Health and Clinical Medicine (B.C.), and Radiation Sciences (A.E.), and Center for Biomedical Engineering and Physics (A.E.), Umeå University; Institute of Neuroscience (C.W.), Sahlgrens Academy, University of Gothenburg; Department of Neurosurgery (B.K.), Lund University; and Department of Clinical and Experimental Medicine (IKE) (G.L.), Division of Neuroscience, Linköping University, Sweden
| | - Babar Kahlon
- From the Departments of Pharmacology and Clinical Neuroscience (H.I., K.L., J.M.), Public Health and Clinical Medicine (B.C.), and Radiation Sciences (A.E.), and Center for Biomedical Engineering and Physics (A.E.), Umeå University; Institute of Neuroscience (C.W.), Sahlgrens Academy, University of Gothenburg; Department of Neurosurgery (B.K.), Lund University; and Department of Clinical and Experimental Medicine (IKE) (G.L.), Division of Neuroscience, Linköping University, Sweden
| | - Göran Leijon
- From the Departments of Pharmacology and Clinical Neuroscience (H.I., K.L., J.M.), Public Health and Clinical Medicine (B.C.), and Radiation Sciences (A.E.), and Center for Biomedical Engineering and Physics (A.E.), Umeå University; Institute of Neuroscience (C.W.), Sahlgrens Academy, University of Gothenburg; Department of Neurosurgery (B.K.), Lund University; and Department of Clinical and Experimental Medicine (IKE) (G.L.), Division of Neuroscience, Linköping University, Sweden
| | - Anders Eklund
- From the Departments of Pharmacology and Clinical Neuroscience (H.I., K.L., J.M.), Public Health and Clinical Medicine (B.C.), and Radiation Sciences (A.E.), and Center for Biomedical Engineering and Physics (A.E.), Umeå University; Institute of Neuroscience (C.W.), Sahlgrens Academy, University of Gothenburg; Department of Neurosurgery (B.K.), Lund University; and Department of Clinical and Experimental Medicine (IKE) (G.L.), Division of Neuroscience, Linköping University, Sweden
| | - Jan Malm
- From the Departments of Pharmacology and Clinical Neuroscience (H.I., K.L., J.M.), Public Health and Clinical Medicine (B.C.), and Radiation Sciences (A.E.), and Center for Biomedical Engineering and Physics (A.E.), Umeå University; Institute of Neuroscience (C.W.), Sahlgrens Academy, University of Gothenburg; Department of Neurosurgery (B.K.), Lund University; and Department of Clinical and Experimental Medicine (IKE) (G.L.), Division of Neuroscience, Linköping University, Sweden
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