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Lin TC, Uchino H, Ito M, Yamaguchi S, Ishi Y, Fujimura M. Moyamoya syndrome after proton beam therapy in a pediatric patient with a pineal germ cell tumor and a germline polymorphism in RNF213. Childs Nerv Syst 2024:10.1007/s00381-024-06576-5. [PMID: 39167199 DOI: 10.1007/s00381-024-06576-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/12/2024] [Indexed: 08/23/2024]
Abstract
The effects of RNF213, which leads to moyamoya disease susceptibility, on radiation-induced moyamoya syndrome (MMS) remain unknown. We report a case of MMS after proton beam therapy (PBT) was deployed to treat a brain tumor in a patient with an RNF213 polymorphism. An 8-year-old boy underwent whole ventricular and local PBT for a pineal germ cell tumor and was diagnosed with radiation-induced MMS 9 months later. He underwent right and left revascularization surgeries for cerebral hemodynamic compromise at 17- and 18-years of age, respectively. Genetic analysis revealed a heterozygous germline polymorphism RNF213 p.R4810K. This is the first report to suggest an association between RNF213 polymorphism and radiation-induced MMS.
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Affiliation(s)
- Ting-Chun Lin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Haruto Uchino
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, 060-8638, Japan.
| | - Masaki Ito
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Shigeru Yamaguchi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Yukitomo Ishi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, 060-8638, Japan
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Abumiya T, Fujimura M. Moyamoya Vasculopathy and Moyamoya-Related Systemic Vasculopathy: A Review With Histopathological and Genetic Viewpoints. Stroke 2024; 55:1699-1706. [PMID: 38690664 DOI: 10.1161/strokeaha.124.046999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Systemic vasculopathy has occasionally been reported in cases of moyamoya disease (MMD). Since the pathological relationship between moyamoya vasculopathy (MMV) and moyamoya-related systemic vasculopathy (MMRSV) remains unclear, it was examined herein by a review of histopathologic studies in consideration of clinicopathological and genetic viewpoints. Although luminal stenosis was a common finding in MMV and MMRSV, histopathologic findings of vascular remodeling markedly differed. MMV showed intimal hyperplasia, marked medial atrophy, and redundant tortuosity of the internal elastic lamina, with outer diameter narrowing called negative remodeling. MMRSV showed hyperplasia, mainly in the intima and sometimes in the media, with disrupted stratification of the internal elastic lamina. Systemic vasculopathy has also been observed in patients with non-MMD carrying the RNF213 (ring finger protein 213) mutation, leading to the concept of RNF213 vasculopathy. RNF213 vasculopathy in patients with non-MMD was histopathologically similar to MMRSV. Cases of MMRSV have sometimes been diagnosed with fibromuscular dysplasia. Fibromuscular dysplasia is similar to MMD not only in the histopathologic findings of MMRSV but also from clinicopathological and genetic viewpoints. The significant histopathologic difference between MMV and MMRSV may be attributed to a difference in the original vascular wall structure and its resistance to pathological stress between the intracranial and systemic arteries. To understand the pathogeneses of MMD and MMRSV, a broader perspective that includes RNF213 vasculopathy and fibromuscular dysplasia as well as an examination of the 2- or multiple-hit theory consisting of genetic factors, vascular structural conditions, and vascular environmental factors, such as blood immune cells and hemodynamics, are needed.
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Affiliation(s)
- Takeo Abumiya
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.A., M.F.)
- Department of Neurosurgery, Miyanomori Memorial Hospital, Sapporo, Japan (T.A.)
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.A., M.F.)
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Morito D. Molecular structure and function of mysterin/RNF213. J Biochem 2024; 175:495-505. [PMID: 38378744 DOI: 10.1093/jb/mvae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/22/2024] Open
Abstract
Mysterin is a large intracellular protein harboring a RING finger ubiquitin ligase domain and is also referred to as RING finger protein 213 (RNF213). The author performed the first molecular cloning of the mysterin gene as the final step in genetic exploration of cerebrovascular moyamoya disease (MMD) and initiated the next round of exploration to understand its molecular and cellular functions. Although much remains unknown, accumulating findings suggest that mysterin functions in cells by targeting massive intracellular structures, such as lipid droplets (LDs) and various invasive pathogens. In the latter case, mysterin appears to directly surround and ubiquitylate the surface of pathogens and stimulate cell-autonomous antimicrobial reactions, such as xenophagy and inflammatory response. To date, multiple mutations causing MMD have been identified within and near the RING finger domain of mysterin; however, their functional relevance remains largely unknown. Besides the RING finger, mysterin harbors a dynein-like ATPase core and an RZ finger, another ubiquitin ligase domain unique to mysterin, while functional exploration of these domains has also just commenced. In this review, the author attempts to summarize the core findings regarding the molecular structure and function of the mysterin protein, with an emphasis on the perspective of MMD research.
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Affiliation(s)
- Daisuke Morito
- Department of Biochemistry, Showa University School of Medicine, Hatanodai 1-5-8, Shinagawa, Tokyo 142-0064, Japan
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Tu YK, Fang YC. Molecular Biomarkers Affecting Moyamoya Disease. Adv Tech Stand Neurosurg 2024; 49:1-18. [PMID: 38700677 DOI: 10.1007/978-3-031-42398-7_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Although the pathogenetic pathway of moyamoya disease (MMD) remains unknown, studies have indicated that variations in the RING finger protein RNF 213 is the strongest susceptible gene of MMD. In addition to the polymorphism of this gene, many circulating angiogenetic factors such as growth factors, vascular progenitor cells, inflammatory and immune mediators, angiogenesis related cytokines, as well as circulating proteins promoting intimal hyperplasia, excessive collateral formation, smooth muscle migration and atypical migration may also play critical roles in producing this disease. Identification of these circulating molecules biomarkers may be used for the early detection of this disease. In this chapter, how the hypothesized pathophysiology of these factors affect MMD and the interactive modulation between them are summarized.
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Affiliation(s)
- Yong-Kwang Tu
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.
- Department of Neurosurgery, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
| | - Yao-Ching Fang
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
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Gao G, Liu SM, Hao FB, Wang QN, Wang XP, Wang MJ, Bao XY, Han C, Duan L. Factors Influencing Collateral Circulation Formation After Indirect Revascularization for Moyamoya Disease: a Narrative Review. Transl Stroke Res 2023:10.1007/s12975-023-01185-x. [PMID: 37592190 DOI: 10.1007/s12975-023-01185-x] [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: 06/29/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023]
Abstract
Indirect revascularization is one of the main techniques for the treatment of Moyamoya disease. The formation of good collateral circulation is a key measure to improve cerebral blood perfusion and reduce the risk of secondary stroke, and is the main method for evaluating the effect of indirect revascularization. Therefore, how to predict and promote the formation of collateral circulation before and after surgery is important for improving the success rate of indirect revascularization in Moyamoya disease. Previous studies have shown that vascular endothelial growth factor, endothelial progenitor cells, Caveolin-1, and other factors observed in patients with Moyamoya disease may play a key role in the generation of collateral vessels after indirect revascularization through endothelial hyperplasia and smooth muscle migration. In addition, mutations in the genetic factor RNF213 have also been associated with this process. This study summarizes the factors and mechanisms influencing collateral circulation formation after indirect revascularization in Moyamoya disease.
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Affiliation(s)
- Gan Gao
- Chinese PLA Medical School, Beijing, China
- Department of Neurosurgery, Chinese PLA General Hospital, 8 Dong-Da Street, Fengtai District, 100071, Beijing, China
| | - Si-Meng Liu
- Chinese PLA Medical School, Beijing, China
- Department of Neurosurgery, Chinese PLA General Hospital, 8 Dong-Da Street, Fengtai District, 100071, Beijing, China
| | - Fang-Bin Hao
- Chinese PLA Medical School, Beijing, China
- Department of Neurosurgery, Chinese PLA General Hospital, 8 Dong-Da Street, Fengtai District, 100071, Beijing, China
| | - Qian-Nan Wang
- Department of Neurosurgery, Chinese PLA General Hospital, 8 Dong-Da Street, Fengtai District, 100071, Beijing, China
| | - Xiao-Peng Wang
- Chinese PLA Medical School, Beijing, China
- Department of Neurosurgery, Chinese PLA General Hospital, 8 Dong-Da Street, Fengtai District, 100071, Beijing, China
| | - Min-Jie Wang
- Chinese PLA Medical School, Beijing, China
- Department of Neurosurgery, Chinese PLA General Hospital, 8 Dong-Da Street, Fengtai District, 100071, Beijing, China
| | - Xiang-Yang Bao
- Department of Neurosurgery, Chinese PLA General Hospital, 8 Dong-Da Street, Fengtai District, 100071, Beijing, China
| | - Cong Han
- Department of Neurosurgery, Chinese PLA General Hospital, 8 Dong-Da Street, Fengtai District, 100071, Beijing, China
| | - Lian Duan
- Department of Neurosurgery, Chinese PLA General Hospital, 8 Dong-Da Street, Fengtai District, 100071, Beijing, China.
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Ota S, Yokoyama K, Kanamori F, Mamiya T, Uda K, Araki Y, Wakabayashi T, Yoshikawa K, Saito R. Moyamoya disease-specific extracellular vesicle-derived microRNAs in the cerebrospinal fluid revealed by comprehensive expression analysis through microRNA sequencing. Acta Neurochir (Wien) 2023; 165:2045-2055. [PMID: 37079107 DOI: 10.1007/s00701-023-05579-6] [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: 01/06/2023] [Accepted: 03/31/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE To examine the specific changes that occur in the expression levels of extracellular vesicle-derived microRNAs (miRNAs) in intracranial cerebrospinal fluid (CSF) in moyamoya disease. METHODS Patients with arteriosclerotic cerebral ischemia were used as controls to eliminate the effects of cerebral ischemia. Intracranial CSF was collected from moyamoya disease and control patients during bypass surgery. Extracellular vesicles (EVs) were extracted from the CSF. Comprehensive expression analysis of miRNAs extracted from EVs by next-generation sequencing (NGS) and validation by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was performed. RESULTS Experiments were conducted on eight cases of moyamoya disease and four control cases. In the comprehensive miRNA expression analysis, 153 miRNAs were upregulated, and 98 miRNAs were downregulated in moyamoya disease compared to the control cases (q-value < 0.05 and |log2 fold change|> 1). qRT-PCR performed on the four most variable miRNAs (hsa-miR-421, hsa-miR-361-5p, hsa-miR-320a, and hsa-miR-29b-3p) associated with vascular lesions among the differentially expressed miRNAs gave the same results as miRNA sequencing. On gene ontology (GO) analysis for the target genes, cytoplasmic stress granule was the most significant GO term. CONCLUSIONS This study is the first comprehensive expression analysis of EV-derived miRNAs in the CSF of moyamoya disease patients using NGS. The miRNAs identified here may be related to the etiology and pathophysiology of moyamoya disease.
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Affiliation(s)
- Shinji Ota
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-Ku, Nagoya City, Aichi, 466-8550, Japan
| | - Kinya Yokoyama
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-Ku, Nagoya City, Aichi, 466-8550, Japan.
| | - Fumiaki Kanamori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-Ku, Nagoya City, Aichi, 466-8550, Japan
| | - Takashi Mamiya
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-Ku, Nagoya City, Aichi, 466-8550, Japan
| | - Kenji Uda
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-Ku, Nagoya City, Aichi, 466-8550, Japan
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-Ku, Nagoya City, Aichi, 466-8550, Japan
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-Ku, Nagoya City, Aichi, 466-8550, Japan
| | - Kazuhiro Yoshikawa
- Division of Research Creation and Biobank, Research Creation Support Center, Aichi Medical University, Nagakute, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-Ku, Nagoya City, Aichi, 466-8550, Japan
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Increase of Circulating Endothelial Progenitor Cells and Released Angiogenic Factors in Children with Moyamoya Arteriopathy. Int J Mol Sci 2023; 24:ijms24021233. [PMID: 36674749 PMCID: PMC9865311 DOI: 10.3390/ijms24021233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Moyamoya arteriopathy (MMA) is a rare cerebrovascular disorder that causes recurrent ischemic and hemorrhagic strokes, leading young patients to severe neurological deficits. The pathogenesis of MMA is still unknown. The disease onset in a wide number of pediatric cases raises the question of the role of genetic factors in the disease's pathogenesis. In these patients, MMA's clinical course, or progression, is largely unclear. By performing a comprehensive molecular and cellular profile in the plasma and CSF, respectively, of MMA pediatric patients, our study is aimed at assessing the levels of circulating endothelial progenitor cells (cEPC) and the release of selected proteins at an early disease stage to clarify MMA pathogenesis and progression. We employed cytofluorimetric methods and immunoassays in pediatric MMA patients and matched control subjects by age and sex. We detected increased levels of cEPC in peripheral blood and an upregulation of angiogenic markers in CSF (i.e., angiopoietin-2 and VEGF-A). This finding is probably associated with deregulated angiogenesis, as stated by the moderate severity of collateral vessel network development (Suzuki III-IV). The absence of significant modulation of neurofilament light in CSF led us to rule out the presence of substantial neuronal injury in MMA children. Despite the limited cohort of pediatric patients, we found some peculiar cellular and molecular characteristics in their blood and CSF samples. Our findings may be confirmed by wider and perspective studies to identify predictive or prognostic circulating biomarkers and potential therapeutic targets for personalized care of MMA pediatric patients.
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Li S, Han Y, Zhang Q, Tang D, Li J, Weng L. Comprehensive molecular analyses of an autoimmune-related gene predictive model and immune infiltrations using machine learning methods in moyamoya disease. Front Mol Biosci 2022; 9:991425. [PMID: 36605987 PMCID: PMC9808060 DOI: 10.3389/fmolb.2022.991425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Growing evidence suggests the links between moyamoya disease (MMD) and autoimmune diseases. However, the molecular mechanism from genetic perspective remains unclear. This study aims to clarify the potential roles of autoimmune-related genes (ARGs) in the pathogenesis of MMD. Methods: Two transcription profiles (GSE157628 and GSE141025) of MMD were downloaded from GEO databases. ARGs were obtained from the Gene and Autoimmune Disease Association Database (GAAD) and DisGeNET databases. Differentially expressed ARGs (DEARGs) were identified using "limma" R packages. GO, KEGG, GSVA, and GSEA analyses were conducted to elucidate the underlying molecular function. There machine learning methods (LASSO logistic regression, random forest (RF), support vector machine-recursive feature elimination (SVM-RFE)) were used to screen out important genes. An artificial neural network was applied to construct an autoimmune-related signature predictive model of MMD. The immune characteristics, including immune cell infiltration, immune responses, and HLA gene expression in MMD, were explored using ssGSEA. The miRNA-gene regulatory network and the potential therapeutic drugs for hub genes were predicted. Results: A total of 260 DEARGs were identified in GSE157628 dataset. These genes were involved in immune-related pathways, infectious diseases, and autoimmune diseases. We identified six diagnostic genes by overlapping the three machine learning algorithms: CD38, PTPN11, NOTCH1, TLR7, KAT2B, and ISG15. A predictive neural network model was constructed based on the six genes and presented with great diagnostic ability with area under the curve (AUC) = 1 in the GSE157628 dataset and further validated by GSE141025 dataset. Immune infiltration analysis showed that the abundance of eosinophils, natural killer T (NKT) cells, Th2 cells were significant different between MMD and controls. The expression levels of HLA-A, HLA-B, HLA-C, HLA-DMA, HLA-DRB6, HLA-F, and HLA-G were significantly upregulated in MMD. Four miRNAs (mir-26a-5p, mir-1343-3p, mir-129-2-3p, and mir-124-3p) were identified because of their interaction at least with four hub DEARGs. Conclusion: Machine learning was used to develop a reliable predictive model for the diagnosis of MMD based on ARGs. The uncovered immune infiltration and gene-miRNA and gene-drugs regulatory network may provide new insight into the pathogenesis and treatment of MMD.
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Affiliation(s)
- Shifu Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China
| | - Ying Han
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital of Central South University, Changsha, Hunan, China,Center for Medical Genetics and Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Qian Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China
| | - Dong Tang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China
| | - Jian Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China,Hydrocephalus Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ling Weng
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China,Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China,Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, China,Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China,*Correspondence: Ling Weng,
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Angioarchitectural Factors Associated with Postoperative Cerebral Infarction in Ischemic Moyamoya Disease. Brain Sci 2022; 12:brainsci12101270. [PMID: 36291204 PMCID: PMC9599360 DOI: 10.3390/brainsci12101270] [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: 08/20/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: To investigate the angioarchitectural factors associated with postoperative cerebral infarction in ischemic moyamoya disease. Methods: Data on patients who underwent surgery for ischemic MMD from 1 October 2015 to 31 October 2020, at Peking University International Hospital were collected and retrospectively analyzed. General conditions such as patient sex, age, site of surgery, preoperative manifestations such as TIA attack and old cerebral infarction, and seven angioarchitectural factors of the MMD based on DSA were selected and measured. Statistical analysis was performed by the Pearson chi-square statistic, analysis of variance (ANOVA), and multifactor logistic regression analysis. Results: Age (OR, 0.969; 95%CI, 0.939–1.000; p = 0.049), A1stenosis (OR, 5.843; 95%CI, 1.730–19.732; p = 0.004), M1stenosis (OR, 6.206; 95%CI, 2.079–18.526; p = 0.001), PCA anomalies (OR, 4.367; 95%CI, 1.452–13.129; p = 0.049), Unstable compensation (OR, 5.335; 95%CI, 1.427–19.948; p = 0.013), TIA (OR, 4.264; 95%CI, 1.844–9.863; p = 0.001), Old cerebral infarction (OR, 2.972; 95%CI, 1.194–7.397; p = 0.019). The above seven factors can be used in the regression equation to predict the probability of postoperative cerebral infarction. The prediction accuracy is 90.2%. Conclusions: Age, TIA attack, old cerebral infarction, and five angioarchitectural factors of MMD are strongly associated with postoperative cerebral infarction. Seven factors, including age, TIA attack, old infarction, and four angioarchitectural factors, can be taken to quantify the probability of surgical cerebral infarction in MMD.
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Moyamoya disease emerging as an immune-related angiopathy. Trends Mol Med 2022; 28:939-950. [DOI: 10.1016/j.molmed.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/22/2022]
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Plasma Lipid Profiling Contributes to Untangle the Complexity of Moyamoya Arteriopathy. Int J Mol Sci 2021; 22:ijms222413410. [PMID: 34948203 PMCID: PMC8708587 DOI: 10.3390/ijms222413410] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 12/12/2022] Open
Abstract
Moyamoya arteriopathy (MA) is a rare cerebrovascular disorder characterized by ischemic/hemorrhagic strokes. The pathophysiology is unknown. A deregulation of vasculogenic/angiogenic/inflammatory pathways has been hypothesized as a possible pathophysiological mechanism. Since lipids are implicated in modulating neo-vascularization/angiogenesis and inflammation, their deregulation is potentially involved in MA. Our aim is to evaluate angiogenic/vasculogenic/inflammatory proteins and lipid profile in plasma of MA patients and control subjects (healthy donors HD or subjects with atherosclerotic cerebrovascular disease ACVD). Angiogenic and inflammatory protein levels were measured by ELISA and a complete lipidomic analysis was performed on plasma by mass spectrometry. ELISA showed a significant decrease for MMP-9 released in plasma of MA. The untargeted lipidomic analysis showed a cumulative depletion of lipid asset in plasma of MA as compared to HD. Specifically, a decrease in membrane complex glycosphingolipids peripherally circulating in MA plasma with respect to HD was observed, likely suggestive of cerebral cellular recruitment. The quantitative targeted approach demonstrated an increase in free sphingoid bases, likely associated with a deregulated angiogenesis. Our findings indicate that lipid signature could play a central role in MA and that a detailed biomarker profile may contribute to untangle the complex, and still obscure, pathogenesis of MA.
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Iodice A, Signa S, Severino M, Tortora D, Zanetti A, Amico G, Piatelli G, Bertamino M, Pavanello M. Combined medical therapy and neurosurgical revascularization preventing stroke in post-varicella angiopathy: Case report and review of literature. Brain Dev 2021; 43:1051-1056. [PMID: 34332825 DOI: 10.1016/j.braindev.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/12/2021] [Accepted: 07/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Post varicella angiopathy (PVA) is an underdiagnosed but potentially severe disease in both pediatric and adult settings. No guidelines are available for the medical and neurosurgical management of this condition. We report the first pediatric case with headache and PVA who was treated with surgical revascularization before the onset of ischemic events. METHODS This case report was conducted via retrospective chart review. A literature review was also completed, in order to identify previously described PVA undergone to revascularization. RESULTS We report on a 9-year-old boy presenting with a long history of headache and PVA involving the distal left middle cerebral artery. The arterial lesion rapidly worsened over a 10 months' period with formation of focal moyamoya-like collaterals, despite an adequate intravenous antiviral treatment. The pattern of headaches significantly changed with a clear left-side lateralization and a "re-build-up" phenomenon on EEG. The patient was treated with left superficial temporal artery - middle cerebral artery (STA-MCA) bypass and encephalo-duro-arterio-myo-pericranial-synangiosis. This combined treatment resulted in an immediate and persistent improvement of brain perfusion, accompanied by prompt resolution of neurological symptoms. Two cases who presented with Suzuki stage III (unilateral or bilateral) moyamoya PVA and recurrent strokes or transient ischemic attacks despite adequate pharmacological prophylaxis have been surgically treated using both indirect and direct revascularization technique. The outcome was good in both cases. CONCLUSION Surgical revascularization may have a role in the treatment of PVA and may prevent stroke. Given the lack of standardized treatment algorithms, individualized regimens should be formulated on a case-specific basis.
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Affiliation(s)
| | - Sara Signa
- Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI) Università di Genova, Genoa, Italy; Autoinflammatory Diseases and Immunodeficiencies Center, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alice Zanetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giulia Amico
- Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI) Università di Genova, Genoa, Italy; Medical Genetic Unit,IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Marta Bertamino
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Marco Pavanello
- Neurosurgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Fox BM, Dorschel KB, Lawton MT, Wanebo JE. Pathophysiology of Vascular Stenosis and Remodeling in Moyamoya Disease. Front Neurol 2021; 12:661578. [PMID: 34539540 PMCID: PMC8446194 DOI: 10.3389/fneur.2021.661578] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 08/09/2021] [Indexed: 12/04/2022] Open
Abstract
Moyamoya disease (MMD) and moyamoya syndrome (MMS) are progressive vascular pathologies unique to the cerebrovasculature that are important causes of stroke in both children and adults. The natural history of MMD is characterized by primary progressive stenosis of the supraclinoid internal carotid artery, followed by the formation of fragile collateral vascular networks. In MMS, stenosis and collateralization occur in patients with an associated disease or condition. The pathological features of the stenosis associated with MMD include neointimal hyperplasia, disruption of the internal elastic lamina, and medial attenuation, which ultimately lead to progressive decreases in both luminal and external arterial diameter. Several molecular pathways have been implicated in the pathophysiology of stenosis in MMD with functions in cellular proliferation and migration, extracellular matrix remodeling, apoptosis, and vascular inflammation. Importantly, several of these molecular pathways overlap with those known to contribute to diseases of systemic arterial stenosis, such as atherosclerosis and fibromuscular dysplasia (FMD). Despite these possible shared mechanisms of stenosis, the contrast of MMD with other stenotic pathologies highlights the central questions underlying its pathogenesis. These questions include why the stenosis that is associated with MMD occurs in such a specific and limited anatomic location and what process initiates this stenosis. Further investigation of these questions is critical to developing an understanding of MMD that may lead to disease-modifying medical therapies. This review may be of interest to scientists, neurosurgeons, and neurologists involved in both moyamoya research and treatment and provides a review of pathophysiologic processes relevant to diseases of arterial stenosis on a broader scale.
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Affiliation(s)
- Brandon M Fox
- Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Kirsten B Dorschel
- Medical Faculty, Heidelberg University Medical School, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Michael T Lawton
- Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - John E Wanebo
- Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
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Rallo MS, Akel O, Gurram A, Sun H. Experimental animal models for moyamoya disease and treatment: a pathogenesis-oriented scoping review. Neurosurg Focus 2021; 51:E5. [PMID: 34469865 DOI: 10.3171/2021.6.focus21284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Moyamoya disease (MMD) is an intracranial steno-occlusive pathology characterized by progressive narrowing of proximal large vessels, including the terminal internal carotid arteries (ICAs), middle cerebral arteries, or anterior cerebral arteries. Named for the "puff of smoke" appearance of the anomalous vascularization visualized on cerebral angiography, MMD lacks a well-defined etiology, although significant insights have been made, including the identification of a susceptibility gene, RNF213, in humans with the disease. A limitation to advancing the understanding and treatment of MMD has been the lack of experimental animal models that authentically reflect the clinical pathogenesis. In an effort to analyze characteristics of currently available models and identify strategies for future model generation, the authors performed a scoping review of experimental animal models that have been used to study MMD. METHODS A systematic search of PubMed, Web of Science, and Scopus was performed to identify articles describing animal models used to study MMD. Additional articles were identified via citation searching. Study selection and data extraction were performed by two independent reviewers based on defined inclusion and exclusion criteria. RESULTS A total of 44 articles were included for full-text review. The methods used to generate these animal models were broadly classified as surgical (n = 25, 56.8%), immunological (n = 7, 15.9%), genetic (n = 6, 13.6%), or a combination (n = 6, 13.6%). Surgical models typically involved permanent ligation of one or both of the common carotid arteries or ICAs to produce chronic cerebral hypoperfusion. Genetic models utilized known MMD or cerebrovascular disease-related genes, such as RNF213 or ACTA2, to induce heritable cerebral vasculopathy. Finally, immunological models attempted to induce vasculitis-type pathology by recapitulating the inflammatory milieu thought to underlie MMD. CONCLUSIONS Models generated for MMD have involved three general approaches: surgical, immunological, and genetic. Although each reflects a key aspect of MMD pathogenesis, the failure of any individual model to recapitulate the development, progression, and consequences of the disease underscores the importance of future work in developing a multietiology model.
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Dorschel KB, Wanebo JE. Genetic and Proteomic Contributions to the Pathophysiology of Moyamoya Angiopathy and Related Vascular Diseases. Appl Clin Genet 2021; 14:145-171. [PMID: 33776470 PMCID: PMC7987310 DOI: 10.2147/tacg.s252736] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 12/26/2020] [Indexed: 12/13/2022] Open
Abstract
RATIONALE This literature review describes the pathophysiological mechanisms of the current classes of proteins, cells, genes, and signaling pathways relevant to moyamoya angiopathy (MA), along with future research directions and implementation of current knowledge in clinical practice. OBJECTIVE This article is intended for physicians diagnosing, treating, and researching MA. METHODS AND RESULTS References were identified using a PubMed/Medline systematic computerized search of the medical literature from January 1, 1957, through August 4, 2020, conducted by the authors, using the key words and various combinations of the key words "moyamoya disease," "moyamoya syndrome," "biomarker," "proteome," "genetics," "stroke," "angiogenesis," "cerebral arteriopathy," "pathophysiology," and "etiology." Relevant articles and supplemental basic science articles published in English were included. Intimal hyperplasia, medial thinning, irregular elastic lamina, and creation of moyamoya vessels are the end pathologies of many distinct molecular and genetic processes. Currently, 8 primary classes of proteins are implicated in the pathophysiology of MA: gene-mutation products, enzymes, growth factors, transcription factors, adhesion molecules, inflammatory/coagulation peptides, immune-related factors, and novel biomarker candidate proteins. We anticipate that this article will need to be updated in 5 years. CONCLUSION It is increasingly apparent that MA encompasses a variety of distinct pathophysiologic conditions. Continued research into biomarkers, genetics, and signaling pathways associated with MA will improve and refine our understanding of moyamoya's complex pathophysiology. Future efforts will benefit from multicenter studies, family-based analyses, comparative trials, and close collaboration between the clinical setting and laboratory research.
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Affiliation(s)
- Kirsten B Dorschel
- Heidelberg University Medical School, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - John E Wanebo
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
- Department of Neuroscience, HonorHealth Research Institute, Scottsdale, AZ, USA
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16
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Mitri F, Bersano A, Hervé D, Kraemer M. Cutaneous manifestations in Moyamoya angiopathy: A review. Eur J Neurol 2021; 28:1784-1793. [PMID: 33486780 DOI: 10.1111/ene.14754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Moyamoya angiopathy (MA) is a progressive cerebrovascular disease with a poorly understood pathophysiology. It is mainly characterized by progressive bilateral stenosis of the terminal intracranial part of the supraclinoid internal carotid arteries and the proximal parts of the middle and anterior cerebral arteries. This results in early-onset ischemic or hemorrhagic strokes. The disease may be idiopathic (known as Moyamoya disease) or associated with other heritable or acquired conditions, including type 1 neurofibromatosis or other RASopathies, sickle cell disease, Down syndrome, or autoimmune disorders (known as Moyamoya syndrome). Apart from the brain, other organ manifestations including cutaneous ones have also been described in MA patients. MATERIALS AND METHODS A literature research on PubMed was performed for articles mentioning the cutaneous association in MA and published between 1994 and October 2020. CONCLUSION The present review summarizes the cutaneous associations as well as the coincidental dermatological findings seen in MA patients. Those include changes in the epidermis, dermis, or skin appendages for example café-au-lait spots, hypomelanosis of Ito, livedo racemosa, hemangiomas, premature graying of hair, chilblains etc.
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Affiliation(s)
- Fouad Mitri
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Dominique Hervé
- CERVCO Centre de Référence des maladies Vasculaires rares du Cerveau et de l'Oeil, Hôpital Lariboisière, Paris, France
| | - Markus Kraemer
- Department of Neurology, Alfried Krupp von Bohlen und Halbach Hospital, Essen, Germany.,Department of Neurology, Heinrich Heine University Hospital, Düsseldorf, Germany
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Fang YC, Wei LF, Hu CJ, Tu YK. Pathological Circulating Factors in Moyamoya Disease. Int J Mol Sci 2021; 22:ijms22041696. [PMID: 33567654 PMCID: PMC7915927 DOI: 10.3390/ijms22041696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/20/2022] Open
Abstract
Moyamoya disease (MMD) is a cerebrovascular disease that presents with vascular stenosis and a hazy network of collateral formations in angiography. However, the detailed pathogenic pathway remains unknown. Studies have indicated that in addition to variations in the of genetic factor RNF213, unusual circulating angiogenetic factors observed in patients with MMD may play a critical role in producing “Moyamoya vessels”. Circulating angiogenetic factors, such as growth factors, vascular progenitor cells, cytokines, inflammatory factors, and other circulating proteins, could promote intimal hyperplasia in vessels and excessive collateral formation with defect structures through endothelial hyperplasia, smooth muscle migration, and atypical neovascularization. This study summarizes the hypothesized pathophysiology of how these circulating factors affect MMD and the interactive modulation between them.
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Affiliation(s)
- Yao-Ching Fang
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan; (Y.-C.F.); (L.-F.W.)
| | - Ling-Fei Wei
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan; (Y.-C.F.); (L.-F.W.)
| | - Chaur-Jong Hu
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan; (Y.-C.F.); (L.-F.W.)
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Correspondence: (C.-J.H.); (Y.-K.T.); Tel.: +88-6222490088-561 (C.-J.H.); +88-6222490088-8120 (Y.-K.T.); Fax: +88-6222490088-8120 (C.-J.H.); +88-6222490088-8120 (Y.-K.T.)
| | - Yong-Kwang Tu
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan; (Y.-C.F.); (L.-F.W.)
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Correspondence: (C.-J.H.); (Y.-K.T.); Tel.: +88-6222490088-561 (C.-J.H.); +88-6222490088-8120 (Y.-K.T.); Fax: +88-6222490088-8120 (C.-J.H.); +88-6222490088-8120 (Y.-K.T.)
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Habu T, Harada KH. UBC13 is an RNF213-associated E2 ubiquitin-conjugating enzyme, and Lysine 63-linked ubiquitination by the RNF213-UBC13 axis is responsible for angiogenic activity. FASEB Bioadv 2021; 3:243-258. [PMID: 33842849 PMCID: PMC8019261 DOI: 10.1096/fba.2019-00092] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/26/2020] [Accepted: 12/30/2020] [Indexed: 12/13/2022] Open
Abstract
Moyamoya disease (MMD) is a cryptogenic vascular disorder in the intracranial arteries. RING protein 213 (RNF213) is the susceptibility gene for MMD, and encodes a RING domain and a Walker motif. Herein, we identified UBC13 (UBE2N) as an E2 ubiquitin‐conjugating enzyme for RNF213 E3 ubiquitin ligase by yeast two‐hybrid screening with a fragment containing RNF213 RING domain as bait, and the immunocomplex of RNF213‐UBC13 was detected in vivo. Analysis of the ubiquitin chain on RNF213 by monitoring autoubiquitination showed that RNF213 was autoubiquitinated in a K63 chain fashion, but not in a K48 chain fashion. Finally, this RNF213 ubiquitination in a UBC13‐dependent manner was required for cell mobility and invasion activity for HUVEC cells in UBC13 knock‐down and ubiquitination‐dead RNF213 mutant expressing experiments. These findings demonstrated that RNF213 is a K63‐linked E3 ubiquitin ligase, and UBC13 is responsible for RNF213 dependent ubiquitination. The RNF213‐UBC13 axis may be associated with angiogenic activity and MMD.
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Affiliation(s)
- Toshiyuki Habu
- Department of Food Sciences and Nutrition School of Food Sciences and Nutrition Mukogawa Women's University Nishinomiya Hyogo Japan
| | - Kouji H Harada
- Department of Health and Environmental Sciences Kyoto University Graduate School of Medicine Kyoto Japan
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Si X, Li L, Fang Y, Yan Y, Pu J. A Patient With Multiple Sclerosis and Coexisting Moyamoya Disease: Why and How. Front Neurol 2020; 11:516587. [PMID: 33178096 PMCID: PMC7593562 DOI: 10.3389/fneur.2020.516587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 08/24/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Multiple sclerosis (MS) and moyamoya (MM) are two separate diseases that rarely coexist. A special case with the two diseases coexisting was reported herein, and previously published articles were reviewed to investigate the clinical manifestations, management, outcomes, and underlying pathogenesis. Patient concerns: A 42-year-old male presented with gradual right limb weakness and slow response for 3 months. However, these symptoms abruptly progressed during his hospital stay. Diagnosis: This patient was diagnosed with coexisting MS and MM finally. The diagnosis of MS was made according to McDonald criteria of multiple lesions and multiple time episodes. Meanwhile, cerebral angiography indicated the diagnosis of MM. Interventions: This patient was treated with methylprednisolone and antiplatelet drug and received bilateral superficial temporal artery bypass surgery for the occulted artery. Outcomes: This patient's right limbs recovered to 4/5-grade muscle strength after 1 month of follow-up after hospital discharge, and his speech function improved after 3 months after hospital discharge. Conclusion: We reported a rare scenario in a patient with the coexistence of MS and MM. We suspect that MS might induce immune response that plays a role in the pathogenesis of MM, while MM might accelerate the demyelination of MS. However, the pathogenesis and therapeutics of MM and MS coexistence need further investigation.
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Affiliation(s)
- Xiaoli Si
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lingfei Li
- Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuanjian Fang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yaping Yan
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiali Pu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Tokairin K, Hamauchi S, Ito M, Kazumata K, Sugiyama T, Nakayama N, Kawabori M, Osanai T, Houkin K. Vascular Smooth Muscle Cell Derived from IPS Cell of Moyamoya Disease - Comparative Characterization with Endothelial Cell Transcriptome. J Stroke Cerebrovasc Dis 2020; 29:105305. [PMID: 32992193 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/24/2020] [Accepted: 09/06/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Moyamoya disease (MMD) is an occlusive cerebrovascular disease, causing stroke in children and young adults with unknown etiology. The fundamental pathology is fibrocellular intimal thickening of cerebral arteries, in which vascular smooth muscle cells (VSMCs) are observed as one of the major cell types. Although the characteristics of circulating smooth muscle progenitor cells have been previously reported, the VSMCs are poorly characterized in MMD. We aimed to characterize VSMCs in MMD using induced pluripotent stem cell (iPSC)-technology. METHODS We differentiated VSMCs from neural crest stem cells (NCSCs) using peripheral blood mononuclear cell-derived iPSCs and compared biological and transcriptome features under naïve culture conditions between three independent healthy control (HC) subjects and three MMD patients. VSMC transcriptome profiles were also compared to those of endothelial cells (ECs) differentiated from the same iPSCs. RESULTS Homogeneous spindle-shaped cells differentiated from iPSCs exhibited smooth muscle cell marker expressions, including α-smooth muscle actin (αSMA, 82.3 ± 6.7% and 81.0 ± 6.7%); calponin (91.3 ± 2.1% and 90.9 ± 1.3%); myosin heavy chain-11 (MYH11, 96.9 ± 0.7% and 97.1 ± 0.3%) without significance of differences between the two groups. Real-time PCR showed few PECAM1 and CD34 gene expressions in both groups, indicating features of differentiated VSMCs. There were no significant differences in cellular proliferation (p = 0.45), migration (p = 0.60), and contractile abilities (p = 0.96) between the two groups. Transcriptome analysis demonstrated similar gene expression profiles of VSMCs in HC subjects and MMD patients with six differentially expressed genes (DEGs); while ECs showed a distinct transcriptome profile in MMD patients with 120 DEGs. The Wnt-signaling pathway was a significant pathway in VSMCs. CONCLUSIONS This is the first study that established VSMCs from NCSCs using MMD patient-derived iPSCs and demonstrated similar biological function and transcriptome profile of iPSC-derived VMSCs in MMD patients and HC subjects under naïve single culture condition. Comparative transcriptome features between iPSC-derived VSMCs and ECs, displaying distinct transcriptome in the ECs, suggested that pathological traits can be driven by naïve ECs predominantly and VSMCs may require specific environmental factors in MMD, which provides novel insight into the pathophysiology of MMD. Our iPSC derived VSMC model can contribute to further investigations of diagnostic and therapeutic target of MMD in addition to the current iPSC derived EC model.
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Affiliation(s)
- Kikutaro Tokairin
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan, 060-8638.
| | - Shuji Hamauchi
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan, 060-8638.
| | - Masaki Ito
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan, 060-8638; Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro, Japan, 085-8533.
| | - Ken Kazumata
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan, 060-8638.
| | - Taku Sugiyama
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan, 060-8638.
| | - Naoki Nakayama
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan, 060-8638.
| | - Masahito Kawabori
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan, 060-8638
| | - Toshiya Osanai
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan, 060-8638.
| | - Kiyohiro Houkin
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan, 060-8638.
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Gao XY, Li Q, Li JR, Zhou Q, Qu JX, Yao ZW. A perfusion territory shift attributable solely to the secondary collaterals in moyamoya patients: a potential risk factor for preoperative hemorrhagic stroke revealed by t-ASL and 3D-TOF-MRA. J Neurosurg 2020; 133:780-788. [PMID: 31398708 DOI: 10.3171/2019.5.jns19803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/01/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors conducted a study to noninvasively and nonradioactively reveal moyamoya disease (MMD) intracerebral perfusion and perfusion territory supplied by the unilateral internal carotid artery (ICA) and external carotid artery (ECA) and bilateral vertebral arteries (VAs) before surgery and to further identify risk factors for preoperative hemorrhage in adult MMD. METHODS Forty-three consecutive adult patients with bilateral MMD underwent unenhanced T1-weighted MRI, territorial arterial spin labeling (t-ASL), and unenhanced 3D time-of-flight MRA (3D-TOF-MRA). Clinical factors, including age, sex, hypertension, diabetes mellitus, hyperlipidemia, current smoking status, and history of taking aspirin, were gathered and stratified. Univariate logistic regression analyses were used to examine the relationship between various risk factors and the occurrence of preoperative hemorrhage. Stepwise multivariate logistic regression analyses were used to determine independent risk factors of preoperative hemorrhage in MMD. RESULTS Among the 86 MMD hemispheres, t-ASL revealed 137 perfusion territory shifts in 79 hemispheres. Five distinct categories of perfusion territory shifts were observed on t-ASL maps. The subtypes of perfusion territory shift on t-ASL maps were further subdivided into 2 different categories, group A and group B, in combination with findings on 3D-TOF-MRA. A perfusion territory shift attributable solely to the secondary collaterals was a potential independent risk factor for preoperative hemorrhage (p = 0.026; 95% CI 1.201-18.615; OR 4.729). After eliminating the influence of the secondary collaterals, the primary collaterals had no significant effect on the risk of preoperative hemorrhage (p = 0.182). CONCLUSIONS t-ASL could reveal comprehensive MMD cerebral blood perfusion and the vivid perfusion territory shifts fed by the unilateral ICA and ECA and bilateral VAs in a noninvasive, straightforward, nonradioactive, and nonenhanced manner. 3D-TOF-MRA could subdivide t-ASL perfusion territory shifts according to their shunt arteries. A perfusion territory shift attributable to the secondary collaterals is a potential independent risk factor for preoperative hemorrhage in MMD patients. A perfusion territory shift fed by the primary collaterals may not have a strong effect on preoperative hemorrhage in MMD patients. These findings make the combined modalities of t-ASL and 3D-TOF-MRA a feasible tool for MMD disease assessment, management, and surgical strategy planning.
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Affiliation(s)
- Xin-Yi Gao
- 1Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province
| | - Qiao Li
- 2Department of Radiology, Shanghai Cancer Center, Fudan University
| | - Jing-Run Li
- 3Department of Neurosurgery, Huashan Hospital, Fudan University
| | - Qian Zhou
- 4Shanghai International Travel Medical Center
| | - Jian-Xun Qu
- 5Department of GE Healthcare China, MR Research China; and
| | - Zhen-Wei Yao
- 6Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
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22
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Vascular Remodeling in Moyamoya Angiopathy: From Peripheral Blood Mononuclear Cells to Endothelial Cells. Int J Mol Sci 2020; 21:ijms21165763. [PMID: 32796702 PMCID: PMC7460840 DOI: 10.3390/ijms21165763] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/30/2020] [Accepted: 08/06/2020] [Indexed: 12/13/2022] Open
Abstract
The pathophysiological mechanisms of Moyamoya angiopathy (MA), which is a rare cerebrovascular condition characterized by recurrent ischemic/hemorrhagic strokes, are still largely unknown. An imbalance of vasculogenic/angiogenic mechanisms has been proposed as one possible disease aspect. Circulating endothelial progenitor cells (cEPCs) have been hypothesized to contribute to vascular remodeling of MA, but it remains unclear whether they might be considered a disease effect or have a role in disease pathogenesis. The aim of the present study was to provide a morphological, phenotypical, and functional characterization of the cEPCs from MA patients to uncover their role in the disease pathophysiology. cEPCs were identified from whole blood as CD45dimCD34+CD133+ mononuclear cells. Morphological, biochemical, and functional assays were performed to characterize cEPCs. A significant reduced level of cEPCs was found in blood samples collected from a homogeneous group of adult (mean age 46.86 ± 11.7; 86.36% females), Caucasian, non-operated MA patients with respect to healthy donors (HD; p = 0.032). Since no difference in cEPC characteristics and functionality was observed between MA patients and HD, a defective recruitment mechanism could be involved in the disease pathophysiology. Collectively, our results suggest that cEPC level more than endothelial progenitor cell (EPC) functionality seems to be a potential marker of MA. The validation of our results on a larger population and the correlation with clinical data as well as the use of more complex cellular model could help our understanding of EPC role in MA pathophysiology.
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Significance of Serum Angiopoietin-2 in Patients with Hemorrhage in Adult-Onset Moyamoya Disease. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8209313. [PMID: 32802878 PMCID: PMC7424502 DOI: 10.1155/2020/8209313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/18/2020] [Accepted: 07/15/2020] [Indexed: 12/31/2022]
Abstract
Background Moyamoya disease (MMD) is a progressive occlusive cerebrovascular disease that is characterized by abnormal angiogenesis at the base of the brain. This pathological abnormal angiogenesis is susceptible to disturbances, including spontaneous hemorrhage and vasogenic edema. However, the underlying mechanisms of pathological angiogenesis and occurrence of hemorrhage are unclear. Angiopoietins play a fundamental role in the pathophysiology of central nervous system disorders in angiogenesis. This study was aimed at examining whether angiopoietins are associated with formation of abnormal collateral vessels and the occurrence of hemorrhage in adult-onset moyamoya disease (HMMD). Methods A total of 27 consecutive adult patients with HMMD were enrolled from June 2011 to May 2017. Serum levels of angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) were examined by enzyme-linked immunosorbent assay. Patients with HMMD were compared with those with spontaneous hemorrhage (controls) and nonhemorrhagic-onset MMD (NHMMD). Results Serum Ang-2 levels were significantly higher in patients with adult HMMD than in those with spontaneous hemorrhage and NHMMD. The ROC curve identified that a baseline serum Ang-2 level > 1230 ng/ml may be associated with adult HMMD with 88.39% sensitivity and 70.37% specificity (area under the curve (AUC), 0.89; 95% CI, 0.808-0.973; P < 0.001). Moreover, serum Ang-2 levels were significantly elevated in stages II, III, and IV. In subgroup analysis of a high and low degree of moyamoya vessels, serum Ang-2 levels were significantly higher in the high moyamoya vessel group than in the low moyamoya vessel group. Serum Ang-2 levels were also significantly higher in the low moyamoya vessel group compared with the control group. Serum Ang-1 levels were not significantly different among the groups. Conclusion Increased serum Ang-2 levels may contribute to pathological abnormal angiogenesis and/or to the instability of vascular structure and function, thus causing brain hemorrhage in adult HMMD.
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Das S, Dubey S, Acharya M, Ghosh R, Chatterjee S, Hazra A, Lahiri D, Segupta S, Chatterjee S, Das G, Sarkar N, Ray BK, Kraemer M. The disease presentation of Moyamoya angiopathy in Eastern India. J Stroke Cerebrovasc Dis 2020; 29:104957. [PMID: 32689603 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104957] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/18/2020] [Accepted: 05/12/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Clinical spectrum of Moyamoya angiopathy (MMA) differs across populations with different ethnicity. This study, the largest one done among Indian population was undertaken to assess clinico-radiological profile of MMA patients in eastern India. METHODS A single centre cross-sectional study was undertaken among 76 MMA cases. Each patient was evaluated for epidemiological, clinical and radiological characteristics. SPSS 25 was used for statistical analysis. P < 0.05 was taken as statistically significant. RESULTS 36 (47.4%) were children without gender preponderance. There were female predominance among adults (male:female = 1:2.33). Mean age at onset of first neurological symptoms for children was 4.2 ± 2.0years, followed by 34.9 ± 58.2months of latency with final diagnosis at the mean age of 7.4 ± 3.5years. For adults, mean age of onset of first neurological symptoms was 31.5 ± 12.3years, followed by 14.7 ± 41.7months time gap and diagnosed at the mean age of 33.5 ± 12.5years. There was a statistically significant difference between child and adult regarding the diagnostic latency (p = 0.035). Fixed motor weakness (FMW) was the predominant symptom across the whole disease course. Among children predominant first neurological symptom was fixed motor weakness (FMW) (52.8%), followed by seizures (22.2%). FMW was predominant (55%) first neurological complaint, followed by headache (22.5%) among adults. Seizure was more prevalent among children both as first (p = 0.002) and presenting symptom at the time of diagnosis (p = 0.048). Over the course of the disease seizure was more common among children (p = 0.001), while headache was more common among adults (p = 0.017). Recurrence of symptoms was more common among children (p = 0.059). Infarcts were more common among children (91.7%) than adults (72.5%), while hemorrhage was seen only among adults (25%) (p = 0.004). Isolated cerebral cortex was involved more commonly among children (59.4%) than adults (36.1%), while isolated subcortical involvement was seen only among adults (19.4%) (p = 0.016). Majority of the MMA cases were of Suzuki stage 4 (39.5%) and 5 (27.6%). Brain atrophy was associated with diagnostic latency (p = 0.009). CONCLUSION Indian Moyamoya presents similar to disease presentation in Caucasian and Japanese patients. It is a frequently overlooked cause of stroke in young, often with various non-motor presentations, failure to recognize which leads to delay in diagnosis. Radiological burden disproportionate to number of acute vascular events, with subtle neurological manifestations like headache or seizure, often with cognitive decline, should raise suspicion of MMA.
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Affiliation(s)
- Shambaditya Das
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research& SSKM Hospital, Kolkata, West Bengal, India
| | - Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research& SSKM Hospital, Kolkata, West Bengal, India
| | - Mrinal Acharya
- Department of Neurology, Malda Medical College and Hospital, Malda, West Bengal, India
| | - Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Subhankar Chatterjee
- Department of General Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Avijit Hazra
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India
| | - Durjoy Lahiri
- Department of Neuromedicine, R.G. Kar Medical College & Hospital, Kolkata, West Bengal, India
| | - Samya Segupta
- Department of Medicine, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Subham Chatterjee
- Institute of Psychiatry, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India
| | - Goutam Das
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research& SSKM Hospital, Kolkata, West Bengal, India
| | - Niladri Sarkar
- Department of General Medicine, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India
| | - Biman Kanti Ray
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research& SSKM Hospital, Kolkata, West Bengal, India.
| | - Markus Kraemer
- Department of Neurology, Alfried Krupp Von Bohlen Und Halbach Hospital, Alfried-Krupp-Str. 21, 45117, Essen, Germany and Heinrich Heine University of Duesseldorf, Medical Faculity, Duesseldorf, Germany
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25
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Roder C, Hauser TK, Ernemann U, Tatagiba M, Khan N, Bender B. Arterial wall contrast enhancement in progressive moyamoya disease. J Neurosurg 2020; 132:1845-1853. [PMID: 31125967 DOI: 10.3171/2019.2.jns19106] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate chronological patterns of arterial wall contrast enhancement in contrast-enhanced high-resolution MRI (CE-HR-MRI) in patients with moyamoya disease (MMD). METHODS The authors performed a blinded analysis of clinical and imaging data from MMD patients. Data were analyzed chronologically for each patient and the intensity of arterial wall enhancement was correlated with the clinical and imaging-based progression status of the disease. RESULTS A total of 31 MMD patients and 61 imaging time points were included. CE-HR-MRI results were available for 56 time points, representing 112 hemispheric analyses. No arterial wall contrast enhancement (grade 1) was seen in 54 (48%) of the analyses, mild enhancement (grade 2) in 24 (21%), moderate enhancement (grade 3) in 15 (13%), and strong (grade 4) mainly concentric arterial wall contrast enhancement in 19 (17%). Grade 4 contrast enhancement was significantly (p < 0.001) associated with clinical disease progression within 6 months (before or after the MRI) compared to grades 1-3, with positive and negative predictive values of 0.8 and 0.88, respectively. Grades 1 and 2 (no contrast enhancement and only mild contrast enhancement) were highly predictive for stable disease (negative predictive value: 0.95). CONCLUSIONS A specific chronological increasing and decreasing pattern of arterial wall contrast enhancement associated with "beginning" as well as progression of angiopathy occurs in MMD patients. In clinical practice, CE-HR-MRI of the arterial wall may help to identify patients at risk of new strokes caused by disease progression and hence impel early treatment for future stroke prevention. Understanding of this temporary enhancement of the arterial wall might also bring new insights into the etiology of MMD.
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Affiliation(s)
- Constantin Roder
- 1Department of Neurosurgery and Center for Moyamoya and Cerebral Revascularization and
| | - Till-Karsten Hauser
- 2Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany; and
| | - Ulrike Ernemann
- 2Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany; and
| | - Marcos Tatagiba
- 1Department of Neurosurgery and Center for Moyamoya and Cerebral Revascularization and
| | - Nadia Khan
- 1Department of Neurosurgery and Center for Moyamoya and Cerebral Revascularization and
- 3Moyamoya Center, Division of Pediatric Neurosurgery, University Children's Hospital Zürich, Zürich, Switzerland
| | - Benjamin Bender
- 2Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany; and
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26
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Bersano A, Kraemer M, Burlina A, Mancuso M, Finsterer J, Sacco S, Salvarani C, Caputi L, Chabriat H, Oberstein SL, Federico A, Lasserve ET, Hunt D, Dichgans M, Arnold M, Debette S, Markus HS. Heritable and non-heritable uncommon causes of stroke. J Neurol 2020; 268:2780-2807. [PMID: 32318851 DOI: 10.1007/s00415-020-09836-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/15/2022]
Abstract
Despite intensive investigations, about 30% of stroke cases remains of undetermined origin. After exclusion of common causes of stroke, there is a number of rare heritable and non-heritable conditions, which often remain misdiagnosed, that should be additionally considered in the diagnosis of cryptogenic stroke. The identification of these diseases requires a complex work up including detailed clinical evaluation for the detection of systemic symptoms and signs, an adequate neuroimaging assessment and a careful family history collection. The task becomes more complicated by phenotype heterogeneity since stroke could be the primary or unique manifestation of a syndrome or represent just a manifestation (sometimes minor) of a multisystem disorder. The aim of this review paper is to provide clinicians with an update on clinical and neuroradiological features and a set of practical suggestions for the diagnostic work up and management of these uncommon causes of stroke. The identification of these stroke causes is important to avoid inappropriate and expensive diagnostic tests, to establish appropriate management measures, including presymptomatic testing, genetic counseling, and, if available, therapy. Therefore, physicians should become familiar with these diseases to provide future risk assessment and family counseling.
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Affiliation(s)
- A Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - M Kraemer
- Department of Neurology Alfried, Krupp-Hospital, Essen, Germany.,Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - A Burlina
- Neurological Unit, St. Bassano Hospital, Bassano del Grappa, Italy
| | - M Mancuso
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - J Finsterer
- Krankenanstalt Rudolfstiftung, Messerli Institute, Vienna, Austria
| | - S Sacco
- Department of Neurology, Avezzano Hospital, University of L'Aquila, L'Aquila, Italy
| | - C Salvarani
- University of Modena and Reggio Emilia, and Azienda USL-IRCCS, Reggio Emilia, Italy
| | - L Caputi
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - H Chabriat
- Department of Neurology and CERVCO, DHU Neurovasc, INSERM U1141, University of Paris, Paris, France
| | - S Lesnik Oberstein
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - A Federico
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - E Tournier Lasserve
- Department of Genetics, Lariboisière Hospital and INSERM U1141, Paris-Diderot University, Paris, France
| | - D Hunt
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - M Dichgans
- Institute for Stroke and Dementia Research, Klinikum Der Universität München, Munich, Germany
| | - M Arnold
- Inserm Centre Bordeaux Population Health (U1219), University of Bordeaux, Bordeaux, France
| | - S Debette
- Department of Neurology, INSELSPITAL, University Hospital Bern, Bern, Switzerland
| | - H S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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27
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Lee WJ, Jeong SK, Han KS, Lee SH, Ryu YJ, Sohn CH, Jung KH. Impact of Endothelial Shear Stress on the Bilateral Progression of Unilateral Moyamoya Disease. Stroke 2020; 51:775-783. [DOI: 10.1161/strokeaha.119.028117] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
In unilateral moyamoya disease, altered endothelial shear stress on the intact-side terminal internal carotid artery might trigger the progression to bilateral disease. We analyzed the endothelial shear stress parameters of the normally appearing terminal internal carotid artery in unilateral moyamoya disease and its association with the progression to bilateral disease.
Methods—
This retrospective cohort study included patients diagnosed with unilateral moyamoya disease by cerebral angiography and followed-up with regular magnetic resonance imaging/magnetic resonance angiography evaluations for >1 year. Endothelial shear stress parameters acquired were mean and maximum signal intensity gradients (SIG) and SIG SD at the vessel boundary in time-of-flight sequences in initial brain magnetic resonance imaging/magnetic resonance angiography. Contralateral disease progression defined as the detection of newly developed vessel steno-occlusion with an magnetic resonance angiography steno-occlusive stage of ≥2, in the previously intact side of the brain on follow-up magnetic resonance imaging/magnetic resonance angiography evaluation.
Results—
Among 146 patients (66 males [45.2%] and 80 females [54.8%]; 76 pediatric [52.1%]), contralateral disease progression was detected in 43 patients (29.5%) after a mean follow-up of 4.3±2.4 years. Multivariate analysis showed that SIG SD was significantly associated with this progression (odds ratio, 13.001 [95% CI, 1.764−95.794],
P
=0.012). In receiver operating characteristic curve analysis, SIG SD predicted the contralateral progression with area under the curve values of 0.803 (95% CI, 0.726−0.880,
P
<0.001). The regression model was reproduced in the external cohort of 31 patients.
Conclusions—
Increased spatial variability of the endothelial shear stress around the normally appearing terminal internal carotid artery, as measured by SIG SD in time-of-flight sequences, may predict the contralateral progression of unilateral moyamoya disease.
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Affiliation(s)
- Woo-Jin Lee
- From the Department of Neurology (W.-J.L., K.-H.J.), Seoul National University Hospital, South Korea
| | - Seul-Ki Jeong
- Jeong Seul-Ki Neurology Clinic, Medi Image, Inc, Seoul, South Korea (S.-K.J.)
| | - Kap-Soo Han
- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea (K.-S.H.)
| | - Sang Hyuk Lee
- Nuclear Equipment Qualification & Safety Research Group, Korea Institute of Machinery & Materials, Daejeon, South Korea (S.H.L.)
| | - Young Jin Ryu
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea (Y.J.R.)
| | - Chul-Ho Sohn
- Department of Radiology (C.-H.S.), Seoul National University Hospital, South Korea
| | - Keun-Hwa Jung
- From the Department of Neurology (W.-J.L., K.-H.J.), Seoul National University Hospital, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, South Korea (K.-H.J.)
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28
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Sander O, Schwitalla JC, Ringelstein M, Aktas O, Schneider M, Berlit P, Hartung HP, Albrecht P, Kraemer M. Capillary microscopy in Europeans with idiopathic Moyamoya angiopathy. Microcirculation 2020; 27:e12616. [PMID: 32108981 DOI: 10.1111/micc.12616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE In Europe, MMA is a very rare non-inflammatory vasculopathy. MMA is an important differential diagnosis of cerebral vasculitis. Systemic manifestations, such as livedo racemosa or renal artery stenosis, associated with Moyamoya variants suggest the involvement also of non-cerebral vessels. Hypothetically, capillary microscopy could be a promising non-invasive screening method to visualize microcirculation, for example prior to cerebral angiography. METHODS Standardized capillary microscopic images were taken in European patients with MMA and subsequently evaluated in a blinded analysis, using data obtained from a large NP cohort and a large SLE cohort by the same blinded Investigator as controls. RESULTS Twenty-four European MMD patients and 14 healthy accompanying controls were included in this study. The results were compared to 116 SLE patients and 754 NP subjects. In MMD patients, no capillary morphological differences were found in comparison with NP, in particular no density reduction or increased neoangiogenesis. The pattern observed in the SLE cohort was clearly distinct from NP and MMD with regard to vascular density, vascular damage, and neoangiogenesis. CONCLUSIONS MMD is not associated with microvascular changes of the nailfold capillaries. In this respect, it is clearly distinct from SLE.
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Affiliation(s)
- Oliver Sander
- Department of Rheumatology and Hiller Research Institute, Medical Faculty, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jan Claudius Schwitalla
- Department of General Zoology and Neurobiology, Ruhr-University Bochum, Bochum, Germany.,Department of Neurology, Alfried Krupp Hospital, Essen, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Matthias Schneider
- Department of Rheumatology and Hiller Research Institute, Medical Faculty, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Peter Berlit
- Department of Neurology, Alfried Krupp Hospital, Essen, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Markus Kraemer
- Department of Neurology, Alfried Krupp Hospital, Essen, Germany.,Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
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29
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Outcomes in Patients with Moyamoya Syndrome and Sickle Cell Disease: A Systematic Review. World Neurosurg 2019; 135:165-170. [PMID: 31790841 DOI: 10.1016/j.wneu.2019.11.137] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Moyamoya syndrome, a progressive, idiopathic stenosis of the internal carotid arteries, results in increased risk for both ischemic and hemorrhagic strokes. Revascularization procedures have been shown in small studies to be both safe and efficacious for these patients; however, randomized controlled trials are lacking. The goal of this systematic review is to organize the literature evaluating surgical intervention versus conservative medical management. METHODS A systematic review was performed including studies with 3 or more participants with moyamoya syndrome in the setting of sickle cell disease and a measured outcome after either medical or surgical intervention. Relevant studies were identified using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria and a set of predetermined key words. RESULTS Sixty-one articles were identified with 6 articles ultimately included in this review (N = 122). Of the patients, 73 (59.8%) were revascularized surgically (all indirect procedures), whereas 49 (40.2%) remained on chronic transfusion therapy. Of the patients that underwent indirect revascularization surgery, a total of 1 perioperative (1.4%) and 4 postoperative strokes (5.5%) were reported over 44 months (1 stroke per 53.3 patient-years). In comparison, an average of 46.5% of patients who were receiving chronic transfusions had major events (stroke or transient ischemic attack) while undergoing therapy (1 stroke per 13.65 patient-years, P = 0.00215). CONCLUSIONS We present a large systematic review of the literature regarding outcomes of surgical and medical management for patients with moyamoya syndrome and sickle cell disease. The findings redemonstrate the efficacy and safety of surgical revascularization, and advocate for earlier discussion around surgical intervention.
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30
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Peng X, Zhang Z, Ye D, Xing P, Zou Z, Lei H, Duan L. Gene dysregulation in peripheral blood of moyamoya disease and comparison with other vascular disorders. PLoS One 2019; 14:e0221811. [PMID: 31532776 PMCID: PMC6750579 DOI: 10.1371/journal.pone.0221811] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/15/2019] [Indexed: 12/21/2022] Open
Abstract
Objective Moyamoya disease (MMD) is a chronic occlusive cerebrovascular disease with unknown etiology, sharing many similar clinical symptoms with other vascular disorders. This study aimed to investigate gene dysregulation in peripheral blood of MMD and compare it with other vascular disorders. Methods Transcriptomic profiles of 12 MMD patients and 8 healthy controls were obtained using RNA sequencing. Differentially expressed genes (DEGs) were identified and several were validated by quantitative real-time PCR in independent samples. Biological pathway enrichment analysis of DEGs and deconvolution of leukocyte subsets in peripheral blood were performed. Expression profiles for other vascular diseases were downloaded from public database and consistent DEGs were calculated. Gene set enrichment analysis (GSEA) was conducted to compare gene dysregulation pattern between MMD and other vascular diseases. Results A total of 533 DEGs were identified for MMD. Up-regulated genes were mainly involved in extracellular matrix (ECM) organization, whereas down-regulated genes were primarily associated with inflammatory and immune responses. As for cell populations, significantly increased naïve B cells and naïve CD4 cells as well as obviously decreased resting natural killer cells were observed in peripheral blood of MMD patients. GSEA analysis indicated that only up-regulated genes of ischemic stroke and down-regulated genes of coronary artery disease and myocardial infarction were enriched in up-regulated and down-regulated genes of MMD, respectively. Conclusion Dysregulated genes in peripheral blood of MMD mainly played key roles in ECM organization, inflammatory and immune responses. This gene dysregulation pattern was specific compared with other vascular diseases. Besides, naïve B cells, naïve CD4 cells and resting natural killer cells were aberrantly disrupted in peripheral blood of MMD patients. These results will help elucidate the complicated pathogenic mechanism of MMD.
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Affiliation(s)
- Xing Peng
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Zhengshan Zhang
- Department of Neurosurgery, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Dongqing Ye
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
| | - Peiqi Xing
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Zhengxing Zou
- Department of Neurosurgery, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hongxing Lei
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China.,Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China
| | - Lian Duan
- Department of Neurosurgery, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
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31
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Mikami T, Suzuki H, Komatsu K, Mikuni N. Influence of Inflammatory Disease on the Pathophysiology of Moyamoya Disease and Quasi-moyamoya Disease. Neurol Med Chir (Tokyo) 2019; 59:361-370. [PMID: 31281171 PMCID: PMC6796064 DOI: 10.2176/nmc.ra.2019-0059] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Moyamoya disease is a unique cerebrovascular disease that is characterized by progressive bilateral stenotic alteration at the terminal portion of the internal carotid arteries. These changes induce the formation of an abnormal vascular network composed of collateral pathways known as moyamoya vessels. In quasi-moyamoya disease, a similar stenotic vascular abnormality is associated with an underlying disease, which is sometimes an inflammatory disease. Recent advances in moyamoya disease research implicate genetic background and immunological mediators, and postulate an association with inflammatory disease as a cause of, or progressive factor in, quasi-moyamoya disease. Although this disease has well-defined clinical and radiological characteristics, the role of inflammation has not been rigorously explored. Herein, we focused on reviewing two main themes: (1) molecular biology of inflammation in moyamoya disease, and (2) clinical significance of inflammation in quasi-moyamoya disease. We have summarized the findings of the former theme according to the following topics: (1) inflammatory biomarkers, (2) genetic background of inflammatory response, (3) endothelial progenitor cells, and (4) noncoding ribonucleic acids. Under the latter theme, we summarized the findings according to the following topics: (1) influence of inflammatory disease, (2) vascular remodeling, and (3) mechanisms gleaned from clinical cases. This review includes articles published up to February 2019 and provides novel insights for the treatment of the moyamoya disease and quasi-moyamoya disease.
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Affiliation(s)
| | - Hime Suzuki
- Department of Neurosurgery, Sapporo Medical University
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32
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Kraemer M, Keyvani K, Berlit P, Diesner F, Marquardt M. Histopathology of Moyamoya angiopathy in a European patient. J Neurol 2019; 266:2258-2262. [DOI: 10.1007/s00415-019-09406-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/25/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
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Moyamoya syndrome as a manifestation of varicella-associated cerebral vasculopathy-case report and review of literature. Childs Nerv Syst 2019; 35:601-606. [PMID: 30805822 DOI: 10.1007/s00381-019-04091-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/14/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Varicella-associated cerebral vasculopathy (VACV) is a serious complication of Varicella zoster virus (VZV) infection. VACV has protean manifestations, with varying clinical, radiological features and prognosis. CASE DESCRIPTION Moyamoya syndrome (MMS) with VACV is reported in few cases in the past. All the patients were in paediatric age group, presenting with multiple episodes of transient ischemic attacks (TIAs) and infarct. Our case was a 10-year-old Indian girl with ischemic stroke due to VACV who was treated with intravenous acyclovir. She presented 11 months later with multiple episodes of TIAs. Her angiogram showed bilateral moyamoya vasculature. Acetazolamide challenge study revealed areas of hypoperfusion. Previously reported such cases had been treated medically with steroids and antiplatelets. Most of these patients had resolution of motor symptoms after long follow-up; however, this period was marred by recurrent symptoms. Our patient underwent cerebral revascularisation procedure, following which her TIAs resolved, there was improvement in her limb power and, according to her parents, her performance in school has improved at 2-year follow-up. CONCLUSION MMS can be a manifestation of VACV and should be suspected in paediatric patient of non-east Asian population. These patients require treatment with intravenous acyclovir to inactivate the virus. Those with TIAs should undergo cerebral revascularisation procedures. Medical management should be reserved for patients with adequate collaterals.
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Misdiagnoses and delay of diagnoses in Moyamoya angiopathy—a large Caucasian case series. J Neurol 2019; 266:1153-1159. [DOI: 10.1007/s00415-019-09245-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/09/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
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35
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Choi SA, Chong S, Kwak PA, Moon YJ, Jangra A, Phi JH, Lee JY, Park SH, Kim SK. Impaired functional recovery of endothelial colony-forming cells from moyamoya disease in a chronic cerebral hypoperfusion rat model. J Neurosurg Pediatr 2019; 23:204-213. [PMID: 30668528 DOI: 10.3171/2018.8.peds1883] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVEEndothelial colony-forming cells (ECFCs) isolated from pediatric patients with moyamoya disease (MMD) have demonstrated decreased numbers and defective functioning in in vitro experiments. However, the function of ECFCs has not been evaluated using in vivo animal models. In this study, the authors compared normal and MMD ECFCs using a chronic cerebral hypoperfusion (CCH) rat model.METHODSA CCH rat model was made via ligation of the bilateral common carotid arteries (2-vessel occlusion [2-VO]). The rats were divided into three experimental groups: vehicle-treated (n = 8), normal ECFC-treated (n = 8), and MMD ECFC-treated (n = 8). ECFCs were injected into the cisterna magna. A laser Doppler flowmeter was used to evaluate cerebral blood flow, and a radial arm maze test was used to examine cognitive function. Neuropathological examinations of the hippocampus and agranular cortex were performed using hematoxylin and eosin and Luxol fast blue staining in addition to immunofluorescence with CD31, von Willebrand factor, NeuN, myelin basic protein, glial fibrillary acidic protein, and cleaved caspase-3 antibodies.RESULTSThe normal ECFC-treated group exhibited improvement in the restoration of cerebral perfusion and in behavior compared with the vehicle-treated and MMD ECFC-treated groups at the 12-week follow-up after the 2-VO surgery. The normal ECFC-treated group showed a greater amount of neovasculogenesis and neurogenesis, with less apoptosis, than the other groups.CONCLUSIONSThese results support the impaired functional recovery of MMD ECFCs compared with normal ECFCs in a CCH rat model. This in vivo study suggests the functional role of ECFCs in the pathogenesis of MMD.
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Affiliation(s)
- Seung Ah Choi
- 1Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital
- 2Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Sangjoon Chong
- 1Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital
- 2Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Pil Ae Kwak
- 1Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital
- 2Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Youn Joo Moon
- 1Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital
- 2Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Anshika Jangra
- 1Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital
- 2Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Ji Hoon Phi
- 1Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital
- 2Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Ji Yeoun Lee
- 1Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital
- 2Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine
- 3Department of Anatomy, Seoul National University College of Medicine; and
| | - Sung-Hye Park
- 4Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Seung-Ki Kim
- 1Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital
- 2Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine
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Uchino H, Ito M, Kazumata K, Hama Y, Hamauchi S, Terasaka S, Sasaki H, Houkin K. Circulating miRNome profiling in Moyamoya disease-discordant monozygotic twins and endothelial microRNA expression analysis using iPS cell line. BMC Med Genomics 2018; 11:72. [PMID: 30157848 PMCID: PMC6114494 DOI: 10.1186/s12920-018-0385-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background Moyamoya disease (MMD) is characterized by progressive stenosis of intracranial arteries in the circle of Willis with unknown etiology even after the identification of a Moyamoya susceptible gene, RNF213. Recently, differences in epigenetic regulations have been investigated by a case-control study in MMD. Here, we employed a disease discordant monozygotic twin-based study design to unmask potential confounders. Methods Circulating genome-wide microRNA (miRNome) profiling was performed in MMD-discordant monozygotic twins, non-twin-MMD patients, and non-MMD healthy volunteers by microarray followed by qPCRvalidation, using blood samples. Differential plasma-microRNAs were further quantified in endothelial cells differentiated from iPS cell lines (iPSECs) derived from another independent non-twin cohort. Lastly, their target gene expression in the iPSECs was analyzed. Results Microarray detected 309 plasma-microRNAs in MMD-discordant monozygotic twins that were also detected in the non-twin cohort. Principal component analysis of the plasma-microRNA expression level demonstrated distinct 2 groups separated by MMD and healthy control in the twin- and non-twin cohorts. Of these, differential upregulations of hsa-miR-6722-3p/− 328-3p were validated in the plasma of MMD (absolute log2 expression fold change (logFC) > 0.26 for the twin cohort; absolute logFC > 0.26, p < 0.05, and q < 0.15 for the non-twin cohort). In MMD derived iPSECs, hsa-miR-6722-3p/− 328-3p showed a trend of up-regulation with a 3.0- or higher expression fold change. Bioinformatics analysis revealed that 41 target genes of miR-6722-3p/− 328-3p were significantly down-regulated in MMD derived iPSECs and were involved in STAT3, IGF-1-, and PTEN-signaling, suggesting a potential microRNA-gene expression interaction between circulating plasma and endothelial cells. Conclusions Our MMD-discordant monozygotic twin-based study confirmed a novel circulating microRNA signature in MMD as a potential diagnostic biomarker minimally confounded by genetic heterogeneity. The novel circulating microRNA signature can contribute for the future functional microRNA analysis to find new diagnostic and therapeutic target of MMD. Electronic supplementary material The online version of this article (10.1186/s12920-018-0385-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Haruto Uchino
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Sapporo, 0608638, Japan
| | - Masaki Ito
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Sapporo, 0608638, Japan.
| | - Ken Kazumata
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Sapporo, 0608638, Japan
| | - Yuka Hama
- Department of Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shuji Hamauchi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Sapporo, 0608638, Japan
| | - Shunsuke Terasaka
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Sapporo, 0608638, Japan
| | - Hidenao Sasaki
- Department of Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Sapporo, 0608638, Japan
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TOMINAGA T, SUZUKI N, MIYAMOTO S, KOIZUMI A, KURODA S, TAKAHASHI JC, FUJIMURA M, HOUKIN K. Recommendations for the Management of Moyamoya Disease: A Statement from Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) [2nd Edition]. ACTA ACUST UNITED AC 2018. [DOI: 10.2335/scs.46.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Teiji TOMINAGA
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Norihiro SUZUKI
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Susumu MIYAMOTO
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Akio KOIZUMI
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Satoshi KURODA
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Jun C. TAKAHASHI
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Miki FUJIMURA
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Kiyohiro HOUKIN
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
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Elevation of Proenkephalin 143–183 in Cerebrospinal Fluid in Moyamoya Disease. World Neurosurg 2018; 109:e446-e459. [DOI: 10.1016/j.wneu.2017.09.204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/29/2017] [Accepted: 09/30/2017] [Indexed: 01/25/2023]
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Ren SC, Gao BQ, Yang WL, Feng WX, Xu J, Li SW, Wang YJ. Von Willebrand factor and coagulation factor VIII in Moyamoya disease associated with Graves' disease: A case report. Exp Ther Med 2016; 12:3195-3200. [PMID: 27882137 PMCID: PMC5103767 DOI: 10.3892/etm.2016.3769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/09/2016] [Indexed: 11/06/2022] Open
Abstract
The present study reported the case of a Chinese boy who was diagnosed with Moyamoya disease (MMD) associated with Graves' disease (GD). An overactivation of von Willebrand factor (vWF) and coagulation factor VIII (FVIII) was identified in the plasma of the patient. Thiamazole and metoprolol treatment was thus administrated. After 2 months of treatment, the patient's thyroid function returned to normal and the neurological symptoms improved gradually. At the same time, the activities of vWF and FVIII were depressed. During the 20-month follow-up, information regarding the neurological symptoms, cerebrovascular imaging, thyroid function, thyroid autoantibodies and coagulation parameters was collected. High levels of thyroid autoantibodies persisted throughout the follow-up period, while other coagulation parameters remained in the normal range. In conclusion, considering the vital role of vWF and FVIII in vascular diseases, it is hypothesized that these two factors may serve an important role in the occurrence of GD associated with MMD.
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Affiliation(s)
- Shou-Chen Ren
- Department of Pediatrics, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Bao-Qin Gao
- Department of Pediatrics, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Wei-Li Yang
- Department of Pediatrics, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Wei-Xin Feng
- Department of Pediatrics, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Jian Xu
- Department of Endocrinology, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Shao-Wu Li
- Department of Functional Neuroimaging, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P.R. China
| | - Yong-Jun Wang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
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Raso A, Biassoni R, Mascelli S, Nozza P, Ugolotti E, Di Marco E, De Marco P, Merello E, Cama A, Pavanello M, Capra V. Moyamoya vasculopathy shows a genetic mutational gradient decreasing from East to West. J Neurosurg Sci 2016; 64:165-172. [PMID: 27787485 DOI: 10.23736/s0390-5616.16.03900-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Moyamoya disease (MMD) is a chronic, occlusive cerebrovascular disease characterized by bilateral steno-occlusive changes at the terminal portion of the internal carotid arteries and an abnormal vascular network at the base of the brain determining stroke in children. Patients with a similar vasculopathy and associated conditions are affected by the moyamoya syndrome (MMS). Most of the studies focused on MMD were carried out on East-Asian population. Ring Finger 213 (RNF213) has been identified as the strongest susceptibility gene for MMD in East-Asian people. Overall, 74.5% of the East-Asian patients carry the founder variant p.Arg4810Lys of RNF213 never reported in Caucasians. A different genetic landscape among the diverse ethnic populations seems to exist. METHODS We sequenced the coding sequence region of RNF213, TGFB1 and PDGFRB in 21 ethnically homogeneous Italian children with moyamoya; comprehensive sequencing data are available from parents of eight of them. The analyses were carried out by NGS on Thermo-fisher PGM platform. We also performed a comprehensive review of the literature about the variations of these three genes in Caucasian patients. RESULTS Several new variants of RNF213 gene were detected, in particular, two new pathogenic mutations on RNF213 (p.Trp4677Leu and p.Cys4017Ser) were identified in one MMS case and in one MMD case, respectively. Moreover, in a MMS case a new probably causing disease mutation p.Pro1063Thr of PDGFRB was detected. CONCLUSIONS The genetic susceptibility of Asian moyamoya vasculopathy seems to differ from the Caucasian disease. No additional differences seem to exist between MMD and MMS.
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Affiliation(s)
- Alessandro Raso
- Unit of Neurosurgery, Giannina Gaslini Institute, Genoa, Italy -
| | | | | | - Paolo Nozza
- Unit of Neurosurgery, Giannina Gaslini Institute, Genoa, Italy
| | | | - Eddi Di Marco
- Unit of Neurosurgery, Giannina Gaslini Institute, Genoa, Italy
| | | | - Elisa Merello
- Unit of Neurosurgery, Giannina Gaslini Institute, Genoa, Italy
| | - Armando Cama
- Unit of Neurosurgery, Giannina Gaslini Institute, Genoa, Italy
| | - Marco Pavanello
- Unit of Neurosurgery, Giannina Gaslini Institute, Genoa, Italy
| | - Valeria Capra
- Unit of Neurosurgery, Giannina Gaslini Institute, Genoa, Italy
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Cellular Functions and Gene and Protein Expression Profiles in Endothelial Cells Derived from Moyamoya Disease-Specific iPS Cells. PLoS One 2016; 11:e0163561. [PMID: 27662211 PMCID: PMC5035048 DOI: 10.1371/journal.pone.0163561] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 09/11/2016] [Indexed: 01/16/2023] Open
Abstract
Background and purpose Moyamoya disease (MMD) is a slow, progressive steno-occlusive disease, arising in the terminal portions of the cerebral internal carotid artery. However, the functions and characteristics of the endothelial cells (ECs) in MMD are unknown. We analyzed these features using induced pluripotent stem cell (iPSC)-derived ECs. Methods iPSC lines were established from the peripheral blood of three patients with MMD carrying the variant RNF213 R4810K, and three healthy persons used as controls. After the endothelial differentiation of iPSCs, CD31+CD144+ cells were purified as ECs using a cell sorter. We analyzed their proliferation, angiogenesis, and responses to some angiogenic factors, namely VEGF, bFGF, TGF-β, and BMP4. The ECs were also analyzed using DNA microarray and proteomics to perform comprehensive gene and protein expression analysis. Results Angiogenesis was significantly impaired in MMD regardless of the presence of any angiogenic factor. On the contrary, endothelial proliferation was not significant between control- and MMD-derived cells. Regarding DNA microarray, pathway analysis illustrated that extracellular matrix (ECM) receptor-related genes, including integrin β3, were significantly downregulated in MMD. Proteomic analysis revealed that cytoskeleton-related proteins were downregulated and splicing regulation-related proteins were upregulated in MMD. Conclusions Downregulation of ECM receptor-related genes may be associated with impaired angiogenic activity in ECs derived from iPSCs from patients with MMD. Upregulation of splicing regulation-related proteins implied differences in splicing patterns between control and MMD ECs.
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Ghilain V, Wiame E, Fomekong E, Vincent MF, Dumitriu D, Nassogne MC. Unusual association between lysinuric protein intolerance and moyamoya vasculopathy. Eur J Paediatr Neurol 2016; 20:777-81. [PMID: 27321952 DOI: 10.1016/j.ejpn.2016.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 03/22/2016] [Accepted: 05/25/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Lysinuric protein intolerance (LPI) is a form of inherited aminoaciduria caused by a deficiency in the cationic amino acid transport process on the basolateral membrane of enterocytes and renal tubular cells. Clinical signs include gastrointestinal symptoms, failure to thrive, hepatosplenomegaly, osteoporosis, episodes of coma, intellectual deficiency, lung and renal involvement, bone marrow abnormalities, as well as altered immune response. Moyamoya disease is a cerebrovascular disorder predisposing sufferers to stroke through progressive stenosis of the intracranial internal carotid arteries and their proximal branches. Patients with characteristic moyamoya vasculopathy who also exhibit well-recognized associated conditions, such as Down syndrome or sickle-cell disease, are diagnosed with moyamoya syndrome, whereas those with no known associated risk factors are said to suffer from moyamoya disease. CASE STUDY A 5-year-old girl exhibiting aversion to protein-rich food and splenomegaly presented with a history of recurrent ischemic strokes. Cerebral angiography confirmed moyamoya vasculopathy. Metabolic investigation revealed abnormalities characteristic of LPI. This diagnosis was confirmed by the detection of a mutation within the SLC7A7 gene upon molecular investigation. CONCLUSION To the best of our knowledge, this is the first reported case of an association between moyamoya vasculopathy and LPI. While the question of association or coincidence cannot yet be answered, several pathophysiological consequences of LPI can be defined as separate, such as links between the impact of low arginine levels on the function of vascular endothelium and brain nitric oxide metabolism, as well as hemophagocytic syndrome associated with the risk of vasculitis, thus accounting for the development of moyamoya vasculopathy.
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Affiliation(s)
- Valérie Ghilain
- Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Elsa Wiame
- Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Edward Fomekong
- Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Dana Dumitriu
- Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Marie-Cécile Nassogne
- Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium.
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Jamil M, Tan GXY, Huq M, Kang H, Lee ZR, Tang PH, Hu XH, Yap CH. Changes to the geometry and fluid mechanics of the carotid siphon in the pediatric Moyamoya disease. Comput Methods Biomech Biomed Engin 2016; 19:1760-1771. [DOI: 10.1080/10255842.2016.1184655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Tanioka S, Shiba M, Umeda Y, Sano T, Maeda M, Suzuki H. A Case of Moyamoya Disease with a Transient Neurologic Deterioration Associated with Subcortical Low Intensity on Fluid-Attenuated Inversion Recovery Magnetic Resonance Images After Bypass Surgery. World Neurosurg 2016; 88:688.e17-688.e21. [DOI: 10.1016/j.wneu.2015.11.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
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Braun T, Juenemann M, Gündüz D, Schmetsdorf S, Roessler F, Grams A, Gramsch C, Tanislav C. Diagnosing moyamoya syndrome using ultrasound - a case report. BMC Neurol 2015; 15:263. [PMID: 26696391 PMCID: PMC4688980 DOI: 10.1186/s12883-015-0518-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/10/2015] [Indexed: 11/11/2022] Open
Abstract
Background Moyamoya syndrome is a vasculopathy characterised by progressive occlusion of the cerebral arteries resulting in the development of abnormal collateral circulation. To diagnose this syndrome, imaging of the cerebral arteries is required including CT- or MR-angiography and conventional angiography. We present a case of moyamoya disease with typical findings detected in the sonography. The diagnosis was suspected after reviewing the initial ultrasound images of the cerebral arteries with evidence for obliterated intracranial arteries and the detection of an existing collateral circulation network. Case presentation A 62 years old male patient presented in the hospital’s emergency department with symptoms indicating a subacute cerebrovascular event. Immediate sonographic studies showed a right-sided pulsatile Doppler-signal in the common and internal carotid arteries, suggestive of distal stenoses. In addition, the transcranial examination indicated obliteration of both middle cerebral arteries. Numerous arterial vessels suggestive of leptomeningeal collateral arteries revealed a strong arterial leptomeningeal flow. At this stage of the diagnostic work-up, the collateral circulation network, characteristic of moyamoya disease, was indicated by sonography. Moyamoya syndrome was verified by conventional angiography. The aetiological work remained empty, so the diagnosis of moyamoya disease was established. Conclusion Our case report indicates that sonography can be a useful tool for detecting the vaculopathy in moyamoya syndrome. In case routine procedures, such as the CT- or MR-angiography, with evidence for obliterated intracerebral arteries, ultrasound studies might provide important information regarding an existing collateral network in the scope of a moyamoya syndrome.
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Affiliation(s)
- Tobias Braun
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Martin Juenemann
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Dursun Gündüz
- Department of Cardiology and Angiology, Justus Liebig University, Giessen, Germany.
| | - Stefanie Schmetsdorf
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Florian Roessler
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Astrid Grams
- Department of Neuroradiology, Justus Liebig University, Giessen, Germany. .,Department of Neuroradiology, University Innsbruck, Innsbruck, Germany.
| | - Carolin Gramsch
- Department of Neuroradiology, Justus Liebig University, Giessen, Germany.
| | - Christian Tanislav
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
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Lee WJ, Jung KH, Lee KJ, Kim JM, Lee ST, Chu K, Lee SK, Roh JK. Sonographic findings associated with stenosis progression and vascular complications in moyamoya disease. J Neurosurg 2015; 125:689-97. [PMID: 26654185 DOI: 10.3171/2015.6.jns15933] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The progression of arterial stenosis in patients with moyamoya disease (MMD) has variable courses and an unclear mechanism. The authors hypothesized that elevated wall shear stress (WSS) at the terminal internal carotid artery (ICA) and proximal middle cerebral artery (MCA) may facilitate MMD progression. They indirectly evaluated the relative magnitude of WSS (WSS value [WSSV]) with MR angiography (MRA) and transcranial Doppler to determine its predictive value for stenosis progression (SP) and the development of vascular complications. METHODS Thirty-one medically treated patients (58 hemispheres and 95 nonoccluded vessels) were analyzed with serial MRA (median follow-up 23 months). The parameters studied were SP, SP rates (SPRs) for individual ICAs/MCAs, and their mean values from the ipsilateral hemispheres as mean SP (MSP) and MSP rates (MSPRs). Significant progression was defined as decrements of ≥ 20% for SP and MSP and ≥ 10%/year for SPR and MSPR. The development of vascular complications in relevant hemispheres was also recorded. The WSSV (dyne/cm(2)) was defined as the shear rate multiplied by blood viscosity. RESULTS After adjusting the initial stenosis degree and MRA stage of MMD, an SP of ≥ 20% and an SPR of ≥ 10%/year were associated with the highest-quartile WSSVs for all individual vessels and for MCAs and ICAs separately. For each hemisphere, an MSP of ≥ 20% and an MSPR of ≥ 10%/year were associated with the highest-quartile mean WSSVs. Furthermore, significant SP was highly correlated with vascular complications, and the highest-quartile mean WSSV was independently associated with vascular complications in relevant hemispheres. CONCLUSIONS An elevated WSSV is an independent predictor for SP and vascular complications in nonoccluded MMD.
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Affiliation(s)
- Woo-Jin Lee
- Department of Neurology, Seoul National University Hospital
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital;,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University
| | - Keon-Joo Lee
- Department of Neurology, Seoul National University Hospital
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University Hospital, Seoul; and
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital;,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital;,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital;,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University
| | - Jae-Kyu Roh
- Department of Neurology, Seoul National University Hospital;,Department of Neurology, The Armed Forces Capital Hospital, Sungnam, South Korea
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Disease Variant Landscape of a Large Multiethnic Population of Moyamoya Patients by Exome Sequencing. G3-GENES GENOMES GENETICS 2015; 6:41-9. [PMID: 26530418 DOI: 10.1534/g3.115.020321] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Moyamoya disease (MMD) is a rare disorder characterized by cerebrovascular occlusion and development of hemorrhage-prone collateral vessels. Approximately 10-12% of cases are familial, with a presumed low penetrance autosomal dominant pattern of inheritance. Diagnosis commonly occurs only after clinical presentation. The recent identification of the RNF213 founder mutation (p.R4810K) in the Asian population has made a significant contribution, but the etiology of this disease remains unclear. To further develop the variant landscape of MMD, we performed high-depth whole exome sequencing of 125 unrelated, predominantly nonfamilial, ethnically diverse MMD patients in parallel with 125 internally sequenced, matched controls using the same exome and analysis platform. Three subpopulations were established: Asian, Caucasian, and non-RNF213 founder mutation cases. We provided additional support for the previously observed RNF213 founder mutation (p.R4810K) in Asian cases (P = 6.01×10(-5)) that was enriched among East Asians compared to Southeast Asian and Pacific Islander cases (P = 9.52×10(-4)) and was absent in all Caucasian cases. The most enriched variant in Caucasian (P = 7.93×10(-4)) and non-RNF213 founder mutation (P = 1.51×10(-3)) cases was ZXDC (p.P562L), a gene involved in MHC Class II activation. Collapsing variant methodology ranked OBSCN, a gene involved in myofibrillogenesis, as most enriched in Caucasian (P = 1.07×10(-4)) and non-RNF213 founder mutation cases (P = 5.31×10(-5)). These findings further support the East Asian origins of the RNF213 (p.R4810K) variant and more fully describe the genetic landscape of multiethnic MMD, revealing novel, alternative candidate variants and genes that may be important in MMD etiology and diagnosis.
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Kobayashi H, Matsuda Y, Hitomi T, Okuda H, Shioi H, Matsuda T, Imai H, Sone M, Taura D, Harada KH, Habu T, Takagi Y, Miyamoto S, Koizumi A. Biochemical and Functional Characterization of RNF213 (Mysterin) R4810K, a Susceptibility Mutation of Moyamoya Disease, in Angiogenesis In Vitro and In Vivo. J Am Heart Assoc 2015; 4:JAHA.115.002146. [PMID: 26126547 PMCID: PMC4608092 DOI: 10.1161/jaha.115.002146] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background P.R4810K of RNF213 (mysterin: rs112735431), which is an AAA+ ATPase, is the susceptibility polymorphism for moyamoya disease (MMD) in East Asians. However, the role of RNF213 R4810K in the etiology of MMD is unknown. Methods and Results To clarify the role of RNF213 in known angiogenic pathways, RNF213 expression was analyzed in endothelial cells (ECs) treated with several angiogenic and antiangiogenic factors, including interferons (IFNs). RNF213 was upregulated by IFN-β through signal transducer and activator of transcription x in the promoter and mediated antiangiogenic activity of IFN-β. RNF213 wild-type (WT) overexpression could not lower angiogenesis without IFN-β, but RNF213 R4810K overexpression could. To correlate biochemical function as ATPase and the role of RNF213 oligomer formation with antiangiogenic activity, we investigated the effects of mutations in the AAA+ module. A mutation of the Walker B motif (WEQ), which stabilizes oligomerization, inhibited angiogenesis, but AAA+ module deletion, which cannot initiate oligomerization, did not. Intriguingly, R4810K, similar to WEQ, decreased ATPase activity, suggesting its antiangiogenic activity through stabilizing oligomers. To confirm the antiangiogenic effect of RNF213 upregulation in vivo, vascular EC- or smooth muscle cell-specific Rnf213 R4757K (R4810K ortholog) or WT transgenic (Tg) mice were exposed to hypoxia. Cerebral angiogenesis by hypoxia was suppressed in EC-specific Rnf213 R4757K Tg mice, whereas it was not suppressed in other mice. Conclusions This study suggests the importance of inflammatory signals as environmental factors and R4810K carriers for susceptibility to cerebral hypoxia. A specific inhibitor of ATP binding to the first AAA+ could be a promising therapeutic candidate for MMD.
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Affiliation(s)
- Hatasu Kobayashi
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.K., T.H., H.O., H.S., K.H.H., A.K.)
| | - Yoshiko Matsuda
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Y.M., Y.T., S.M.)
| | - Toshiaki Hitomi
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.K., T.H., H.O., H.S., K.H.H., A.K.) Department of Preventive Medicine, St Marianna University School of Medicine, Kawasaki, Japan (T.H.)
| | - Hiroko Okuda
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.K., T.H., H.O., H.S., K.H.H., A.K.)
| | - Hirotomo Shioi
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.K., T.H., H.O., H.S., K.H.H., A.K.)
| | - Tetsuya Matsuda
- Department of Systems Science, Graduate School of Informatics, Kyoto University, Kyoto, Japan (T.M., H.I.)
| | - Hirohiko Imai
- Department of Systems Science, Graduate School of Informatics, Kyoto University, Kyoto, Japan (T.M., H.I.)
| | - Masakatsu Sone
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan (M.S., D.T.)
| | - Daisuke Taura
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan (M.S., D.T.)
| | - Kouji H Harada
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.K., T.H., H.O., H.S., K.H.H., A.K.)
| | - Toshiyuki Habu
- Radiation Biology Center, Kyoto University, Kyoto, Japan (T.H.)
| | - Yasushi Takagi
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Y.M., Y.T., S.M.)
| | - Susumu Miyamoto
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Y.M., Y.T., S.M.)
| | - Akio Koizumi
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.K., T.H., H.O., H.S., K.H.H., A.K.)
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Ismail I, Al-Khafaji K, Mutyala M, Aggarwal S, Al-Khafaji N, Kovacs D, Khosla S, Arora R. 'Smoke in the air': a rare cerebrovascular cause of neurological signs and symptoms in a young adult. J Community Hosp Intern Med Perspect 2015; 5:27664. [PMID: 26091661 PMCID: PMC4475270 DOI: 10.3402/jchimp.v5.27664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/11/2015] [Accepted: 04/14/2015] [Indexed: 11/25/2022] Open
Abstract
Moyamoya disease is a rare neurological condition that affects children and adults of all ages. It is characterized by chronic, progressive stenosis of the circle of Willis that ultimately leads to the development of extensive collateral vessels. Presenting symptoms are usually due to cerebral ischemia or hemorrhage. The Japanese term moyamoya (meaning puffy or obscure) was coined to describe the characteristic 'smoke in the air' appearance of these vessels on cerebral angiography. Moyamoya has the highest recorded incidence in Japan (0.28 per 100,000). In the west it is an extremely rare condition with an overall incidence of (0.086 per 100,000) in the Western United States. Etiology for the most part is unknown; however, genetic susceptibility related to RNF213 gene on chromosome 17q25.3 has been suggested. Moyamoya is being diagnosed more frequently in all races with varying clinical manifestations. Moyamoya disease is a rare progressive neurologic condition characterized by occlusion of the cerebral circulation with extensive collaterals recruitment in children and adults. Distinguished radiological findings confirm the diagnosis. Early recognition and swift institution of therapy is vital in order to minimize neurological deficits. We present the case of a 19-year-old African American female who presented with left-sided parastheia, weakness, and headache for 2 days duration.
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Affiliation(s)
- Imtiaz Ismail
- Department of Internal Medicine, Rosalind Franklin University of Medicine and Science, Waukegan, IL, USA;
| | - Khalid Al-Khafaji
- Department of Internal Medicine, Rosalind Franklin University of Medicine and Science, Waukegan, IL, USA
| | - Monica Mutyala
- Department of Internal Medicine, Rosalind Franklin University of Medicine and Science, Waukegan, IL, USA
| | | | - Nawfal Al-Khafaji
- Department of Internal Medicine, Rosalind Franklin University of Medicine and Science, Waukegan, IL, USA
| | - Daniela Kovacs
- Department of Internal Medicine, Rosalind Franklin University of Medicine and Science, Waukegan, IL, USA
| | - Sandeep Khosla
- Department of Internal Medicine, Rosalind Franklin University of Medicine and Science, Waukegan, IL, USA
| | - Rohit Arora
- Department of Internal Medicine, Rosalind Franklin University of Medicine and Science, Waukegan, IL, USA
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Lee JY, Moon YJ, Lee HO, Park AK, Choi SA, Wang KC, Han JW, Joung JG, Kang HS, Kim JE, Phi JH, Park WY, Kim SK. Deregulation of Retinaldehyde Dehydrogenase 2 Leads to Defective Angiogenic Function of Endothelial Colony-Forming Cells in Pediatric Moyamoya Disease. Arterioscler Thromb Vasc Biol 2015; 35:1670-7. [PMID: 26023078 DOI: 10.1161/atvbaha.115.305363] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 05/06/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE-- Moyamoya disease (MMD) is a common cause of childhood stroke, in which the abnormal function of the endothelial colony-forming cell (ECFC) plays a key role in the pathogenesis of the disease. This study was designed to identify genes involved in MMD pathogenesis using gene expression profiling and to understand the defective function of MMD ECFCs. APPROACH AND RESULTS-- We compared gene expression profiles of ECFCs isolated from patients with MMD and normal controls. Among the differentially expressed genes, we selected a gene with the most downregulated expression, retinaldehyde dehydrogenase 2 (RALDH2). The activity of RALDH2 in MMD ECFCs was assessed by in vitro tube formation assay and in vivo Matrigel plug assay in the presence of all-trans retinoic acid. The transcriptional control of RALDH2 was tested using ChIP assays on acetyl-histone H3. In the results, MMD ECFCs inefficiently formed capillary tubes in vitro and capillaries in vivo, a defect restored by all-trans retinoic acid treatment. Knockdown of RALDH2 mRNA in normal ECFCs also induced decreased activity of capillary formation in vitro. The decreased level of RALDH2 mRNA in MMD ECFCs was attributed to defective acetyl-histone H3 binding to the promoter region. CONCLUSIONS-- From these results, we conclude that the expression of RALDH2 was epigenetically suppressed in ECFCs from patients with MMD, which may play a key role in their functional impairment.
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Affiliation(s)
- Ji Yeoun Lee
- From the Department of Anatomy (J.Y.L.), Division of Pediatric Neurosurgery, Seoul National University Children's Hospital (J.Y.L., Y.J.M., S.-A.C., K.-C.W., J.W.H., J.H.P., S.-K.K.), and Department of Neurosurgery (H.S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Seoul, Korea (H.-O.L., J.-G.J., W.-Y.P.); College of Pharmacy, Sunchon National University, Jeonnam, Korea (A.-K.P.); and Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea (H.-O.L., W.-Y.P.)
| | - Youn Joo Moon
- From the Department of Anatomy (J.Y.L.), Division of Pediatric Neurosurgery, Seoul National University Children's Hospital (J.Y.L., Y.J.M., S.-A.C., K.-C.W., J.W.H., J.H.P., S.-K.K.), and Department of Neurosurgery (H.S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Seoul, Korea (H.-O.L., J.-G.J., W.-Y.P.); College of Pharmacy, Sunchon National University, Jeonnam, Korea (A.-K.P.); and Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea (H.-O.L., W.-Y.P.)
| | - Hae-Ock Lee
- From the Department of Anatomy (J.Y.L.), Division of Pediatric Neurosurgery, Seoul National University Children's Hospital (J.Y.L., Y.J.M., S.-A.C., K.-C.W., J.W.H., J.H.P., S.-K.K.), and Department of Neurosurgery (H.S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Seoul, Korea (H.-O.L., J.-G.J., W.-Y.P.); College of Pharmacy, Sunchon National University, Jeonnam, Korea (A.-K.P.); and Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea (H.-O.L., W.-Y.P.)
| | - Ae-Kyung Park
- From the Department of Anatomy (J.Y.L.), Division of Pediatric Neurosurgery, Seoul National University Children's Hospital (J.Y.L., Y.J.M., S.-A.C., K.-C.W., J.W.H., J.H.P., S.-K.K.), and Department of Neurosurgery (H.S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Seoul, Korea (H.-O.L., J.-G.J., W.-Y.P.); College of Pharmacy, Sunchon National University, Jeonnam, Korea (A.-K.P.); and Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea (H.-O.L., W.-Y.P.)
| | - Seung-Ah Choi
- From the Department of Anatomy (J.Y.L.), Division of Pediatric Neurosurgery, Seoul National University Children's Hospital (J.Y.L., Y.J.M., S.-A.C., K.-C.W., J.W.H., J.H.P., S.-K.K.), and Department of Neurosurgery (H.S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Seoul, Korea (H.-O.L., J.-G.J., W.-Y.P.); College of Pharmacy, Sunchon National University, Jeonnam, Korea (A.-K.P.); and Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea (H.-O.L., W.-Y.P.)
| | - Kyu-Chang Wang
- From the Department of Anatomy (J.Y.L.), Division of Pediatric Neurosurgery, Seoul National University Children's Hospital (J.Y.L., Y.J.M., S.-A.C., K.-C.W., J.W.H., J.H.P., S.-K.K.), and Department of Neurosurgery (H.S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Seoul, Korea (H.-O.L., J.-G.J., W.-Y.P.); College of Pharmacy, Sunchon National University, Jeonnam, Korea (A.-K.P.); and Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea (H.-O.L., W.-Y.P.)
| | - Jung Woo Han
- From the Department of Anatomy (J.Y.L.), Division of Pediatric Neurosurgery, Seoul National University Children's Hospital (J.Y.L., Y.J.M., S.-A.C., K.-C.W., J.W.H., J.H.P., S.-K.K.), and Department of Neurosurgery (H.S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Seoul, Korea (H.-O.L., J.-G.J., W.-Y.P.); College of Pharmacy, Sunchon National University, Jeonnam, Korea (A.-K.P.); and Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea (H.-O.L., W.-Y.P.)
| | - Je-Gun Joung
- From the Department of Anatomy (J.Y.L.), Division of Pediatric Neurosurgery, Seoul National University Children's Hospital (J.Y.L., Y.J.M., S.-A.C., K.-C.W., J.W.H., J.H.P., S.-K.K.), and Department of Neurosurgery (H.S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Seoul, Korea (H.-O.L., J.-G.J., W.-Y.P.); College of Pharmacy, Sunchon National University, Jeonnam, Korea (A.-K.P.); and Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea (H.-O.L., W.-Y.P.)
| | - Hyun Seung Kang
- From the Department of Anatomy (J.Y.L.), Division of Pediatric Neurosurgery, Seoul National University Children's Hospital (J.Y.L., Y.J.M., S.-A.C., K.-C.W., J.W.H., J.H.P., S.-K.K.), and Department of Neurosurgery (H.S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Seoul, Korea (H.-O.L., J.-G.J., W.-Y.P.); College of Pharmacy, Sunchon National University, Jeonnam, Korea (A.-K.P.); and Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea (H.-O.L., W.-Y.P.)
| | - Jeong Eun Kim
- From the Department of Anatomy (J.Y.L.), Division of Pediatric Neurosurgery, Seoul National University Children's Hospital (J.Y.L., Y.J.M., S.-A.C., K.-C.W., J.W.H., J.H.P., S.-K.K.), and Department of Neurosurgery (H.S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Seoul, Korea (H.-O.L., J.-G.J., W.-Y.P.); College of Pharmacy, Sunchon National University, Jeonnam, Korea (A.-K.P.); and Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea (H.-O.L., W.-Y.P.)
| | - Ji Hoon Phi
- From the Department of Anatomy (J.Y.L.), Division of Pediatric Neurosurgery, Seoul National University Children's Hospital (J.Y.L., Y.J.M., S.-A.C., K.-C.W., J.W.H., J.H.P., S.-K.K.), and Department of Neurosurgery (H.S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Seoul, Korea (H.-O.L., J.-G.J., W.-Y.P.); College of Pharmacy, Sunchon National University, Jeonnam, Korea (A.-K.P.); and Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea (H.-O.L., W.-Y.P.)
| | - Woong-Yang Park
- From the Department of Anatomy (J.Y.L.), Division of Pediatric Neurosurgery, Seoul National University Children's Hospital (J.Y.L., Y.J.M., S.-A.C., K.-C.W., J.W.H., J.H.P., S.-K.K.), and Department of Neurosurgery (H.S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Seoul, Korea (H.-O.L., J.-G.J., W.-Y.P.); College of Pharmacy, Sunchon National University, Jeonnam, Korea (A.-K.P.); and Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea (H.-O.L., W.-Y.P.).
| | - Seung-Ki Kim
- From the Department of Anatomy (J.Y.L.), Division of Pediatric Neurosurgery, Seoul National University Children's Hospital (J.Y.L., Y.J.M., S.-A.C., K.-C.W., J.W.H., J.H.P., S.-K.K.), and Department of Neurosurgery (H.S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Seoul, Korea (H.-O.L., J.-G.J., W.-Y.P.); College of Pharmacy, Sunchon National University, Jeonnam, Korea (A.-K.P.); and Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea (H.-O.L., W.-Y.P.).
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