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Leach DF, Margam S, Gustin A, Gustin PJ, Jajeh MN, Chavis YC, Walker KV, Bentley JS. Case Report: A rare presentation of rapidly progressive moyamoya disease refractory to unilateral surgical revascularization. Front Surg 2024; 11:1409692. [PMID: 39220621 PMCID: PMC11361982 DOI: 10.3389/fsurg.2024.1409692] [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: 03/30/2024] [Accepted: 07/02/2024] [Indexed: 09/04/2024] Open
Abstract
Moyamoya disease (MMD) is a chronic, occlusive cerebrovasculopathy typified by progressive steno-occlusive disease of the intracranial internal carotid arteries (ICAs) and their proximal branches. Moyamoya syndrome (MMS) categorizes patients with characteristic MMD plus associated conditions. As such, the most usual presentations are those that occur with cerebral ischemia, specifically transient ischemic attack, acute ischemic stroke, and seizures. Hemorrhagic stroke, headaches, and migraines can also occur secondary to the compensatory growth of fragile collateral vessels propagated by chronic cerebral ischemia. While the pathophysiology of MMD is unknown, there remain numerous clinical associations including radiation therapy to the brain, inherited genetic syndromes, hematologic disorders, and autoimmune conditions. We describe the case of a 31-year-old woman who presented with recurrent ischemic cerebral infarcts secondary to rapidly progressive, bilateral MMD despite undergoing early unilateral surgical revascularization with direct arterial bypass. She had numerous metabolic conditions and rapidly decompensated, ultimately passing away despite intensive and aggressive interventions. The present case highlights that progression of moyamoya disease to bilateral involvement can occur very rapidly, within a mere 6 weeks, a phenomenon which has not been documented in the literature to our knowledge.
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Affiliation(s)
- Daniel Friel Leach
- Department of Radiation Oncology, University of Virginia Health, Charlottesville, VA, United States
| | - Srivikram Margam
- Research, Alabama College of Osteopathic Medicine, Dothan, AL, United States
| | - Aaron Gustin
- Neurological Surgery, Carle BroMenn Medical Center, Normal, IL, United States
| | - Paul J. Gustin
- Neurological Surgery, Carle BroMenn Medical Center, Normal, IL, United States
| | | | - Yhana C. Chavis
- Department of Radiation Oncology, University of Virginia Health, Charlottesville, VA, United States
| | - Kristin V. Walker
- Department of Radiation Oncology, University of Virginia Health, Charlottesville, VA, United States
| | - Joshua S. Bentley
- Cerebrovascular and Endovascular Neurosurgery, Southeast Health, Dothan, AL, United States
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Thamamongood T, Hara S, Akagawa H, Inaji M, Tanaka Y, Nariai T, Maehara T. Synergistic Interaction of Thyroid Autoantibodies and Ring Finger Protein 213 Variant in Moyamoya Disease. Neurol Med Chir (Tokyo) 2024; 64:43-49. [PMID: 38057092 PMCID: PMC10835577 DOI: 10.2176/jns-nmc.2023-0169] [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: 07/25/2023] [Accepted: 10/11/2023] [Indexed: 12/08/2023] Open
Abstract
Recently, thyroid autoantibodies were found to be associated with moyamoya disease (MMD). The ring finger protein 213 (RNF213) p.R4810K variant represents the most important susceptibility genotype of this disease, but its relationship with thyroid autoantibodies remains to be elucidated. Thus, in this study, we aimed to evaluate the clinical relevance of thyroid autoantibodies in each RNF213 genotype in patients with MMD. Included in this study were patients with MMD without a thyroid disease history and in euthyroid status; they were then classified into the mutated or nonmutated based on the RNF213 p.R4810K genotype and positive or negative based on thyroid autoantibody (thyroperoxidase and thyroglobulin) levels. Clinical data of each group were thereafter evaluated. Among the 209 patients, the mutated RNF213 p.R4810K variant and positive thyroid autoantibodies were detected in 155 and 41 patients, respectively. Positive thyroid autoantibodies were found to be more common in the nonmutated patients than in the mutated patients (31.5% vs. 15.5%; P = 0.011). In the mutated patients, as compared to autoantibody-negative patients, autoantibody-positive patients were determined to be more likely to have advanced disease with posterior cerebral artery involvement (54.2% vs. 29.0%; P = 0.017), white matter infarction (58.3% vs. 37.6%; P = 0.046), and a higher modified Rankin Scale at last visit (16.7% vs. 3.1%; P = 0.021). These results suggest that thyroid autoantibodies can act as an immunity inducer in patients with MMD lacking the susceptibility gene RNF213 p.R4810K variant. Moreover, the simultaneous presence of thyroid autoantibodies and the variant seems to aggravate the disease, which indicates synergy between thyroid autoantibodies and the variant.
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Affiliation(s)
- Thiparpa Thamamongood
- Department of Neurosurgery, Tokyo Medical and Dental University
- Tokyo Women's Medical University Institute for Integrated Medical Sciences
| | - Shoko Hara
- Department of Neurosurgery, Tokyo Medical and Dental University
| | - Hiroyuki Akagawa
- Tokyo Women's Medical University Institute for Integrated Medical Sciences
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University
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3
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Zhang G, Liu E, Tan X, Liu C, Yang S. Research progress on moyamoya disease combined with thyroid diseases. Front Endocrinol (Lausanne) 2023; 14:1233567. [PMID: 37900127 PMCID: PMC10600369 DOI: 10.3389/fendo.2023.1233567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/04/2023] [Indexed: 10/31/2023] Open
Abstract
Moyamoya disease (MMD), also known as abnormal cerebral vascular network disease, is characterized by progressive occlusion or stenosis of the internal carotid and cerebral arteries, as well as the formation of an abnormal cerebral vascular network. It can occur anywhere in the world but is most common in China, Japan, and the Republic of Korea. In recent years, there have been increasing reports on the coexistence of thyroid diseases and MMD, but the mechanism of their coexistence is still unclear. For this article, we used keywords such as "moyamoya disease", "thyroid", "Grave disease", "thyrotoxicosis", and "thyroid autoimmune antibodies" to search for 52 articles that met the requirements in medical databases such as PubMed and Web of Science. This article also reviews the research on the role of thyroid hormone, the mechanism of immune antibodies, the possible correlation between thyroid diseases and MMD disease genes, and the treatment methods, and discusses the possible relationship between MMD and thyroid diseases to provide a reference for the pathogenesis and treatment of MMD with thyroid diseases.
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Affiliation(s)
- Guibo Zhang
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- The First People’s Hospital of Yunnan Province, Kunming, China
| | - Erheng Liu
- Department of Neurosurgery, Kaiyuan Municipal People’s Hospital, Kaiyuan, China
| | - XueYi Tan
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- The First People’s Hospital of Yunnan Province, Kunming, China
| | - Chengyuan Liu
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- The First People’s Hospital of Yunnan Province, Kunming, China
| | - Shuaifeng Yang
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- The First People’s Hospital of Yunnan Province, Kunming, China
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Dorschel KB, Wanebo JE. Physiological and pathophysiological mechanisms of the molecular and cellular biology of angiogenesis and inflammation in moyamoya angiopathy and related vascular diseases. Front Neurol 2023; 14:661611. [PMID: 37273690 PMCID: PMC10236939 DOI: 10.3389/fneur.2023.661611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 01/16/2023] [Indexed: 06/06/2023] Open
Abstract
Rationale The etiology and pathophysiological mechanisms of moyamoya angiopathy (MMA) remain largely unknown. MMA is a progressive, occlusive cerebrovascular disorder characterized by recurrent ischemic and hemorrhagic strokes; with compensatory formation of an abnormal network of perforating blood vessels that creates a collateral circulation; and by aberrant angiogenesis at the base of the brain. Imbalance of angiogenic and vasculogenic mechanisms has been proposed as a potential cause of MMA. Moyamoya vessels suggest that aberrant angiogenic, arteriogenic, and vasculogenic processes may be involved in the pathophysiology of MMA. Circulating endothelial progenitor cells have been hypothesized to contribute to vascular remodeling in MMA. MMA is associated with increased expression of angiogenic factors and proinflammatory molecules. Systemic inflammation may be related to MMA pathogenesis. Objective This literature review describes the molecular mechanisms associated with cerebrovascular dysfunction, aberrant angiogenesis, and inflammation in MMA and related cerebrovascular diseases along with treatment strategies and future research perspectives. Methods and results References were identified through a systematic computerized search of the medical literature from January 1, 1983, through July 29, 2022, using the PubMed, EMBASE, BIOSIS Previews, CNKI, ISI web of science, and Medline databases and various combinations of the keywords "moyamoya," "angiogenesis," "anastomotic network," "molecular mechanism," "physiology," "pathophysiology," "pathogenesis," "biomarker," "genetics," "signaling pathway," "blood-brain barrier," "endothelial progenitor cells," "endothelial function," "inflammation," "intracranial hemorrhage," and "stroke." Relevant articles and supplemental basic science articles almost exclusively published in English were included. Review of the reference lists of relevant publications for additional sources resulted in 350 publications which met the study inclusion criteria. Detection of growth factors, chemokines, and cytokines in MMA patients suggests the hypothesis of aberrant angiogenesis being involved in MMA pathogenesis. It remains to be ascertained whether these findings are consequences of MMA or are etiological factors of MMA. Conclusions MMA is a heterogeneous disorder, comprising various genotypes and phenotypes, with a complex pathophysiology. Additional research may advance our understanding of the pathophysiology involved in aberrant angiogenesis, arterial stenosis, and the formation of moyamoya collaterals and anastomotic networks. Future research will benefit from researching molecular pathophysiologic mechanisms and the correlation of clinical and basic research results.
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Affiliation(s)
- Kirsten B. Dorschel
- Medical Faculty, Heidelberg University Medical School, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - John E. Wanebo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
- Department of Neuroscience, HonorHealth Research Institute, Scottsdale, AZ, United States
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Guevara‐Rodriguez N, Marmanillo‐Mendoza G, Castelar J, Ciobanu C, Fulger I. Unusual presentation of acquired thrombotic thrombocytopenic purpura (TTP) versus catastrophic antiphospholipid syndrome in a patient with Moya-Moya disease, case report, and literature review. Clin Case Rep 2023; 11:e7317. [PMID: 37192853 PMCID: PMC10182009 DOI: 10.1002/ccr3.7317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/18/2023] Open
Abstract
Coincidences in medicine are not so common. We are presenting a case of a patient diagnosed with Moya-Moya disease and antiphospholipid syndrome (APS) who presented with clinical and laboratory characteristics of catastrophic APS versus TTP. The diagnosis was a challenge because characteristics were overlapping. Nevertheless, a decision to treat the patient for TTP was made with afterward improvement. MMD has been associated with multiple immune disorders; however, only one case of acquired thrombotic thrombocytopenic purpura has been documented in association with this disease. None has been associated with catastrophic antiphospholipid syndrome. We are presenting a challenging case where all these three medical conditions were present at the same time.
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Affiliation(s)
| | | | - Jorge Castelar
- Department of Medicine, Internal MedicineSt. Barnabas Hospital Health SystemThe BronxNew YorkUSA
| | - Camelia Ciobanu
- Department of Medicine, Internal MedicineSt. Barnabas Hospital Health SystemThe BronxNew YorkUSA
| | - Ilmana Fulger
- Department of Medicine, Internal Medicine, Department of Hemato‐OncologySt. Barnabas Hospital Health SystemThe BronxNew YorkUSA
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6
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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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7
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Cao L, Dong Y, Sun K, Li D, Wang H, Li H, Yang B. Experimental Animal Models for Moyamoya Disease: A Species-Oriented Scoping Review. Front Surg 2022; 9:929871. [PMID: 35846951 PMCID: PMC9283787 DOI: 10.3389/fsurg.2022.929871] [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: 04/27/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by progressive stenosis of large intracranial arteries and a hazy network of basal collaterals called moyamoya vessels. The etiology and pathogenesis of MMD are still obscure. The biggest obstacles in the basic research of MMD are difficulty in obtaining specimens and the lack of an animal model. It is necessary to use appropriate and rationally designed animal models for the correct evaluation. Several animal models and methods have been developed to produce an effective MMD model, such as zebrafish, mice and rats, rabbits, primates, felines, canines, and peripheral blood cells, each with advantages and disadvantages. There are three mechanisms for developing animal models, including genetic, immunological/inflammatory, and ischemic animal models. This review aims to analyze the characteristics of currently available models, providing an overview of the animal models framework and the convenience of selecting model types for MMD research. It will be a great benefit to identify strategies for future model generations.
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Affiliation(s)
| | | | | | | | | | | | - Bo Yang
- Correspondence: Bo Yang Hongwei Li
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8
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Mertens R, Graupera M, Gerhardt H, Bersano A, Tournier-Lasserve E, Mensah MA, Mundlos S, Vajkoczy P. The Genetic Basis of Moyamoya Disease. Transl Stroke Res 2021; 13:25-45. [PMID: 34529262 PMCID: PMC8766392 DOI: 10.1007/s12975-021-00940-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/19/2022]
Abstract
Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by progressive spontaneous bilateral occlusion of the intracranial internal cerebral arteries (ICA) and their major branches with compensatory capillary collaterals resembling a “puff of smoke” (Japanese: Moyamoya) on cerebral angiography. These pathological alterations of the vessels are called Moyamoya arteriopathy or vasculopathy and a further distinction is made between primary and secondary MMD. Clinical presentation depends on age and population, with hemorrhage and ischemic infarcts in particular leading to severe neurological dysfunction or even death. Although the diagnostic suspicion can be posed by MRA or CTA, cerebral angiography is mandatory for diagnostic confirmation. Since no therapy to limit the stenotic lesions or the development of a collateral network is available, the only treatment established so far is surgical revascularization. The pathophysiology still remains unknown. Due to the early age of onset, familial cases and the variable incidence rate between different ethnic groups, the focus was put on genetic aspects early on. Several genetic risk loci as well as individual risk genes have been reported; however, few of them could be replicated in independent series. Linkage studies revealed linkage to the 17q25 locus. Multiple studies on the association of SNPs and MMD have been conducted, mainly focussing on the endothelium, smooth muscle cells, cytokines and growth factors. A variant of the RNF213 gene was shown to be strongly associated with MMD with a founder effect in the East Asian population. Although it is unknown how mutations in the RNF213 gene, encoding for a ubiquitously expressed 591 kDa cytosolic protein, lead to clinical features of MMD, RNF213 has been confirmed as a susceptibility gene in several studies with a gene dosage-dependent clinical phenotype, allowing preventive screening and possibly the development of new therapeutic approaches. This review focuses on the genetic basis of primary MMD only.
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Affiliation(s)
- R Mertens
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Berlin, Germany
| | - M Graupera
- Vascular Biology and Signalling Group, ProCURE, Oncobell Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Barcelona, Spain
| | - H Gerhardt
- Integrative Vascular Biology Laboratory, Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - A Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - E Tournier-Lasserve
- Department of Genetics, NeuroDiderot, Lariboisière Hospital and INSERM UMR-1141, Paris-Diderot University, Paris, France
| | - M A Mensah
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Genetics and Human Genetics, Berlin, Germany.,BIH Biomedical Innovation Academy, Digital Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Mundlos
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Genetics and Human Genetics, Berlin, Germany.,Max Planck Institute for Molecular Genetics, RG Development & Disease, Berlin, Germany
| | - P Vajkoczy
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Berlin, Germany.
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9
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Santoro JD, Lee S, Wang AC, Ho E, Nagesh D, Khoshnood M, Tanna R, Durazo-Arvizu RA, Manning MA, Skotko BG, Steinberg GK, Rafii MS. Increased Autoimmunity in Individuals With Down Syndrome and Moyamoya Disease. Front Neurol 2021; 12:724969. [PMID: 34566869 PMCID: PMC8455812 DOI: 10.3389/fneur.2021.724969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/09/2021] [Indexed: 12/31/2022] Open
Abstract
Objective: To determine if elevated rates of autoimmune disease are present in children with both Down syndrome and moyamoya disease given the high rates of autoimmune disease reported in both conditions and unknown etiology of angiopathy in this population. Methods: A multi-center retrospective case-control study of children with Down syndrome and moyamoya syndrome, idiopathic moyamoya disease, and Down syndrome without cerebrovascular disease was performed. Outcome measures included presence of autoimmune disease, presence of autoantibodies and angiopathy severity data. Comparisons across groups was performed using the Kruskal-Wallis, χ2 and multivariate Poisson regression. Results: The prevalence of autoimmune disease were 57.7, 20.3, and 35.3% in persons with Down syndrome and moyamoya syndrome, idiopathic moyamoya disease, and Down syndrome only groups, respectively (p < 0.001). The prevalence of autoimmune disease among children with Down syndrome and moyamoya syndrome is 3.2 times (p < 0.001, 95% CI: 1.82-5.58) higher than the idiopathic moyamoya group and 1.5 times (p = 0.002, 95% CI: 1.17-1.99) higher than the Down syndrome only group when adjusting for age and sex. The most common autoimmune diseases were thyroid disorders, type I diabetes and Celiac disease. No individuals with idiopathic moyamoya disease had more than one type of autoimmune disorder while 15.4% of individuals with Down syndrome and moyamoya syndrome and 4.8% of individuals with Down syndrome only had >1 disorder (p = 0.05, 95%CI: 1.08-6.08). Interpretation: This study reports elevated rates of autoimmune disease in persons with Down syndrome and moyamoya syndrome providing a nidus for study of the role of autoimmunity in angiopathy in this population.
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Affiliation(s)
- Jonathan D. Santoro
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States,Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, United States,*Correspondence: Jonathan D. Santoro
| | - Sarah Lee
- Department of Neurology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Anthony C. Wang
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Eugenia Ho
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States,Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, United States
| | - Deepti Nagesh
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States,Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, United States
| | - Mellad Khoshnood
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Runi Tanna
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Ramon A. Durazo-Arvizu
- Biostatistics Core, Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, CA, United States
| | - Melanie A. Manning
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States,Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Brian G. Skotko
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States,Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | - Gary K. Steinberg
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Michael S. Rafii
- Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, United States,Alzheimer's Therapeutic Research Institute (ATRI), Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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10
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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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11
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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: 17] [Impact Index Per Article: 5.7] [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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12
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Ge P, Zhang Q, Ye X, Liu X, Deng X, Wang J, Wang R, Zhang Y, Zhang D, Zhao J. Modifiable Risk Factors Associated With Moyamoya Disease: A Case-Control Study. Stroke 2020; 51:2472-2479. [PMID: 32640948 DOI: 10.1161/strokeaha.120.030027] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE The cause of moyamoya disease (MMD) remains unknown. We aimed to investigate the association between modifiable risk factors and MMD in a prospective, case-control study. METHODS Clinical and laboratory characteristics were evaluated in consecutively recruited adult patients with MMD and age-matched healthy control individuals. The potential risk factors for MMD were estimated by logistic regression analysis. RESULTS Our prospective study included 138 adult patients and 138 healthy control subjects. Logistic regression analyses showed that increased body mass index (odds ratio [OR], 1.121 [95% CI, 1.018-1.234]; P=0.020) and homocysteine (OR, 1.201 [95% CI, 1.081-1.334]; P=0.001) were associated with higher risk of MMD. Whereas increased albumin (OR, 1.043 [95% CI, 1.004-1.082]; P=0.028) and high-density lipoprotein cholesterol (OR, 1.043 [95% CI, 1.004-1.082]; P=0.028) were correlated with a lower risk of MMD. Furthermore, homocysteine (OR, 1.070 [95% CI, 1.010-1.134]; P=0.023) was significantly related to unilateral lesions. CONCLUSIONS Increased body mass index and homocysteine were associated with a higher risk of MMD. In contrast, increased albumin and high-density lipoprotein cholesterol were correlated with a lower risk of MMD. Furthermore, increased homocysteine was related to a higher prevalence of unilateral MMD. More attention should be paid to the modifiable risk factors of MMD, as these might help us finding its cause and new therapeutic regimen. Registration: URL: http://www.chictr.org. Unique identifier: ChiCTR2000031412.
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Affiliation(s)
- Peicong Ge
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Qian Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Xun Ye
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Xingju Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Xiaofeng Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Jia Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China (J.Z.)
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Pines AR, Rodriguez D, Bendok BR, Dhamija R. Clinical Characteristics of Moyamoya Angiopathy in a Pediatric Cohort. J Child Neurol 2020; 35:389-392. [PMID: 32089044 DOI: 10.1177/0883073820902297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Moyamoya angiopathy is a rare cerebral vasculopathy characterized by a progressive stenosis of the terminal portion of the internal carotid arteries and the development of abnormal collateral vessels. Children with moyamoya angiopathy become symptomatic because of cerebral ischemic complications, and many patients eventually need revascularization. In most pediatric patients with this disease, the etiology is likely genetic. We aim to report clinical characteristics of a single-center cohort of pediatric patients with moyamoya. We performed a retrospective chart review of patients <18 years with angiographically confirmed moyamoya disease evaluated at our institution. An in-house text search tool, Advanced Cohort Explorer, was used to filter electronic medical records for patients with a diagnosis of moyamoya angiopathy from January 1999 to December 2018. The inclusion criteria were age <18 years at the time of onset of disease and a diagnosis confirmed at Mayo clinic. Fifty-one patients met the inclusion criteria. Fifty-five percent of our cohort were male, and the median age was 9 years. Three patients had a family history of moyamoya disease. Approximately half of our patients had bilateral disease. Sixteen patients had a genetic or chromosomal diagnosis (Down syndrome and NF1 being most common). Congenital anomalies like heart defects and renal dysplasia were also noted. This study is unique in that it was a large study on pediatric patients with moyamoya angiopathy. It also highlights the importance of considering genetic syndromes as an underlying cause when moyamoya angiopathy starts early in life.
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Affiliation(s)
- Andrew R Pines
- Mayo Clinic Alix School of Medicine, Department of Neurosurgery, Neurology and Clinical Genomics, Mayo Clinic, Phoenix, AZ, USA.,These authors contributed equally to this article
| | - Dan Rodriguez
- Mayo Clinic Alix School of Medicine, Department of Neurosurgery, Neurology and Clinical Genomics, Mayo Clinic, Phoenix, AZ, USA.,These authors contributed equally to this article
| | - Bernard R Bendok
- Department of Neurosurgery, Neurology and Clinical Genomics, Mayo Clinic, Phoenix, AZ, USA
| | - Radhika Dhamija
- Neurology and Clinical Genomics, Mayo Clinic, Phoenix, AZ, USA.,Clinical Genomics, Mayo Clinic, Phoenix, AZ, USA
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Chen H, Jiang X, Shi Y, Yuan F, Hu Z. Systemic sclerosis associated with moyamoya syndrome: A case report and literature review. Immunobiology 2019; 225:151882. [PMID: 31812345 DOI: 10.1016/j.imbio.2019.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Abstract
Systemic sclerosis (SSc) associated with moyamoya syndrome (MMS) is a clinically rare disease. To further understand the clinical characteristics of SSc associated with MMS, we investigated and analyzed one case of SSc associated with MMS and conducted a literature review about this disease. Publications retrieved from MEDLINE and Wanfang databases were reviewed and discussed, and we found five well-described cases of SSc associated with MMS. The five patients had no family history of moyamoya disease, and the risk factors (cardiovascular disease) `were found in one of the five patients. The patients included in this study were more frequently female, and they often had limited or diffuse SSc. Unilateral involvement was frequently observed with clinical symptoms including hemiplegia, headache, loss of eyesight, and aphasia. The medical treatments included corticosteroids, immunosuppressive agents, antiplatelet agents, and anticoagulant therapy. The treatment with extra-intracranial revascularization was an effective treatment strategy for MMD and MMS. Unilateral MMD was more likely to be associated with SSc. The efficacy of corticosteroids and immunosuppressive agents was uncertain.
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Affiliation(s)
- Haifeng Chen
- The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi Children's Hospital, Jiangsu, China
| | - Xinyu Jiang
- The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi Children's Hospital, Jiangsu, China
| | - Yitian Shi
- The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi Children's Hospital, Jiangsu, China
| | - Fenghong Yuan
- The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi Children's Hospital, Jiangsu, China.
| | - Zhigang Hu
- The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi Children's Hospital, Jiangsu, China.
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Tashiro R, Niizuma K, Khor SS, Tokunaga K, Fujimura M, Sakata H, Endo H, Inoko H, Ogasawara K, Tominaga T. Identification of HLA-DRB1*04:10 allele as risk allele for Japanese moyamoya disease and its association with autoimmune thyroid disease: A case-control study. PLoS One 2019; 14:e0220858. [PMID: 31412073 PMCID: PMC6693760 DOI: 10.1371/journal.pone.0220858] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 07/24/2019] [Indexed: 11/28/2022] Open
Abstract
Background and purpose Moyamoya disease (MMD) is a progressive cerebrovascular disease with unknown etiology. Growing evidence suggest its involvement of autoimmune and genetic mechanisms in the pathogenesis of MMD. This study aims to clarify the association between HLA allele and MMD. Methods Case-control study: the DNA of 136 MMD patients in Japan was extracted and the genotype of human leukocyte antigen (HLA) from this DNA was determined by super-high-resolution single-molecule sequence-based typing using next-generation sequencing. Next, the frequency of each HLA allele (HLA-A, HLA-B, HLA-C, HLA-DRB1, HLA-DQB1, and HLA-DPB1) was compared with those in the Japanese control database. In addition, haplotype estimation was performed using the expectation maximization algorithm. Results The frequencies of the HLA-DRB1*04:10 allele (4.77% vs. 1.47% in the control group; P = 1.7 × 10−3; odds ratio [OR] = 3.35) and of the HLA-DRB1*04:10–HLA-DQB1*04:02 haplotype (haplotype frequency 4.41% vs. 1.35% in the control group; P = 2.0 × 10−3; OR = 3.37) significantly increased. The frequency of thyroid diseases, such as Graves’ disease and Hashimoto thyroiditis, increased in HLA-DRB1*04:10-positive MMD patients compared with that in HLA-DRB1*04:10-negative MMD patients. Conclusions HLA-DRB1*04:10 is a risk allele and HLA-DRB1*04:10–HLA-DQB1*04:02 a risk haplotype for MMD. In addition, HLA-DRB1*04:10 is associated with thyroid disease in MMD patients.
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Affiliation(s)
- Ryosuke Tashiro
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Immunobiology, Tohoku University Institute of Development, Aging and Cancer, Sendai, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
- * E-mail:
| | - Seik-Soon Khor
- Department of Human Genetics, the University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Katsushi Tokunaga
- Department of Human Genetics, the University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Hiroyuki Sakata
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Koetsu Ogasawara
- Department of Immunobiology, Tohoku University Institute of Development, Aging and Cancer, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Yu Z, Zheng J, Guo R, Li H, You C, Ma L. Patterns of Acute Intracranial Hemorrhage in Adult Patients with Bilateral and Unilateral Moyamoya Disease. Curr Neurovasc Res 2019; 16:202-207. [PMID: 31223087 DOI: 10.2174/1567202616666190621093652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/26/2019] [Accepted: 05/01/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Moyamoya disease (MMD) is a rare cerebrovascular disease. The difference of hemorrhagic patterns in adult patients with bilateral and unilateral MMD is still unclear. OBJECTIVE For a better understanding of their characteristics, we compared the patterns of acute intracranial hemorrhage in adult patients with bilateral and unilateral MMD. METHODS Adult MMD patients with acute intracranial hemorrhage were retrospectively included. Clinical and radiological characteristics of adult patients with bilateral and unilateral MMD were collected and analyzed. Chi-square test, t-test, or rank sum test were used for statistical analyses. RESULTS A total of 107 patients were included. Among 74 patients with bilateral MMD, 9 (12.2%) were at Suzuki Stage 2, 48 (64.9%) were at Stage 3, 16 (21.6%) were at Stage 4, and another (1.4%) was at Stage 5. However, in patients with unilateral MMD, 8 (24.2%) were at Stage 2, 23 (69.7%) were at Stage 3, and 2 (6.1%) were at Stage 4. Intraparenchymal hemorrhage was found in 40 (54.1%) patients with bilateral MMD and 16 (48.5%) patients with unilateral MMD (P=0.594). Intraventricular hemorrhage was shown in 65 (87.8%) patients with bilateral MMD and 19 (57.6%) patients with unilateral MMD (P<0.001). Subarachnoid hemorrhage was observed in 17 (23.0%) patients with bilateral MMD and 18 (54.5%) patients with unilateral MMD (P=0.001). CONCLUSION Unilateral MMD patients with acute intracranial hemorrhage are at the earlier Suzuki stage than the bilateral MMD patients. Intraventricular hemorrhage occurs more frequently in bilateral MMD, while subarachnoid hemorrhage is more frequent in unilateral MMD.
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Affiliation(s)
- Zhiyuan Yu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Zheng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Guo
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
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Kumar S, Lanzino G, Brinjikji W, Hocquard KW, Flemming KD. Infratentorial Developmental Venous Abnormalities and Inflammation Increase Odds of Sporadic Cavernous Malformation. J Stroke Cerebrovasc Dis 2019; 28:1662-1667. [PMID: 30878367 DOI: 10.1016/j.jstrokecerebrovasdis.2019.02.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/12/2019] [Accepted: 02/16/2019] [Indexed: 12/27/2022] Open
Abstract
GOAL Sporadic brain cavernous malformations commonly correlate with developmental venous anomalies; however, developmental venous anomalies may exist without cavernous malformations. Infratentorial location and specific angioarchitectural features of the developmental venous anomaly increase the odds of a concomitant malformation. Animal data also suggest chronic inflammatory disease, oxidative stress, and angiogenesis promote cavernous malformation development. We sought to determine potential clinical and radiologic factors promoting development of sporadic cavernous malformations. METHODS One hundred and forty-five patients with sporadic, nonradiation-induced brain cavernous malformations (63 with radiologic-apparent and 82 with radiologic-occult developmental venous anomalies) were compared to developmental venous anomaly controls without associated malformation. Data collection included demographic information, comorbidities, medications at diagnosis, and location of the developmental venous anomaly and/or malformation. Logistic regression with likelihood ratios, odds ratios and 95% confidence intervals were calculated comparing malformation cases with controls. A similar analysis compared malformations with radiologic-apparent anomalies to controls. RESULTS Compared to controls, cases were more likely to have had a major infectious illness (10.3% versus 2.3%; P = .0003 and/or chronic inflammatory disease (31.7% versus 21.3%; P = .0184) prior to diagnostic magnetic resonance imaging. Infratentorial location was more common in cavernous malformation cases (31.7% versus 15.7% controls; P ≤ .0001) with similar findings in cavernous malformation with radiologic-apparent developmental venous anomalies versus controls. CONCLUSIONS Infratentorial developmental venous anomalies location, major infectious illness, and chronic inflammatory disorders increase the odds of sporadic cavernous malformation formation. Inflammation may promote local thrombosis of developmental venous anomalies, trigger angiogenic response through increased vascular permeability, or promote cavernous malformation through Toll-like receptor 4.
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Affiliation(s)
- Shivram Kumar
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
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Shen W, Liao Y, Garcia R, Kesavabhotla K, Xu B, Li H. Association of CD40 SNPs with Moyamoya in a Chinese children population. Br J Neurosurg 2019; 33:398-401. [PMID: 30681383 DOI: 10.1080/02688697.2018.1559275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The etiology of Moyamoya disease (MMD) remains unknown to a large extent. Immune and inflammation dysfunction may play a role in the pathogenesis of this rare disease. Coexisting Kawasaki disease (KD) with MMD were reported and both diseases have a feature of vasculopathy, raising the hypothesis that there may be some common pathologic factors. We investigated single nucleotide polymorphisms (SNPs) previously identified in KD and performed a genetic analysis among Chinese pediatric patients with MMD. Results: We analyzed patients' DNA for the SNPs in B lymphoid tyrosine kinase, CD40, and coatomer protein complex beta-2 subunit, which had been associated with KD by literatures. Genotyping was performed by sequencing the genetic regions containing the SNPs with customized primers. A total of 5 genotype polymorphisms were examined among 48 pediatric MMD cases and 50 healthy controls. The mean age of MMD children was 6.72 ± 3.63 years old, while 7.31 ± 3.79 in controls. We found two SNPs of CD40 were associated with MMD. Polymorphisms rs4813003 major allele CC and rs1535045 minor allele TT were significantly higher in MMD cases. The other SNPs showed no statistical difference between MMD cases and controls. Conclusions: Our findings provide evidence that there may be a relationship between MMD and auto-immune dysfunction. We hypothesize that these genetic features may lead to the pathogenesis within the vascular wall. Further study regarding whether CD40 can function as the personalized target of MMD should be investigated in future.
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Affiliation(s)
- Wenjun Shen
- a Department of Pediatric Neurosurgery, Children's Hospital of Fudan University , Shanghai , China
| | - Yujun Liao
- b Department of Neurosurgery, Huashan Hospital of Fudan University , Shanghai , China
| | - Roxanna Garcia
- c Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago , IL , USA
| | - Kartik Kesavabhotla
- c Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago , IL , USA
| | - Bin Xu
- b Department of Neurosurgery, Huashan Hospital of Fudan University , Shanghai , China
| | - Hao Li
- a Department of Pediatric Neurosurgery, Children's Hospital of Fudan University , Shanghai , China
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Bao XY, Zhang Y, Wang QN, Zhang Q, Wang H, Zhang ZS, Li DS, Duan L. Long-term Outcomes After Encephaloduroarteriosynangiosis in Adult Patients with Moyamoya Disease Presenting with Ischemia. World Neurosurg 2018; 115:e482-e489. [PMID: 29684518 DOI: 10.1016/j.wneu.2018.04.076] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND In adult Moyamoya disease (MMD), there remains controversy about the effectiveness of revascularization surgeries because randomized studies have not been performed to compare the efficacy of surgical techniques. This study was conducted to assess the most appropriate surgical treatment for adult patients with MMD. METHODS Encephaloduroarteriosynangiosis (EDAS) was performed on 247 hemispheres in 145 patients. The clinical and demographic characteristics of patients were obtained via retrospective chart review. Clinical and angiographic states were evaluated retrospectively using quantitative methods. The mean duration of clinical follow up was 141.4 ± 19.5 months. RESULTS A total of 247 EDAS procedures were performed in 145 patients, including 15 EDAS performed using the occipital artery as the donor vessel. The mortality rate was 0%, and the permanent morbidity rates were 1.2% per operation and 2.0% per person. The mean modified Rankin Scale score was 1.21 ± 1.31 postoperatively and 1.01 ± 1.39 at the last follow-up. Of the 109 hemispheres studied, 45% were classified as grade A, 34% as grade B, and 21% as grade C collateral circulation. The annual rates of stroke were calculated to be 0.73% per person-year. Overall, the 1-,5-, and 10-year actuarial stroke rates were 2.1±1.2%, 6.8±2.1%, and 8.9±2.4%, respectively. Bilateral involvement was a common significant factor in any, hemorrhagic, and ischemic strokes. Hypertension was a risk factor for ischemic strokes during follow-up. CONCLUSIONS EDAS is an effective procedure in a Chinese cohort of patients with MMD. EDAS resulted in satisfactory long-term improvement of clinical states and prevention of recurrent strokes.
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Affiliation(s)
- Xiang-Yang Bao
- Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China
| | - Yong Zhang
- Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China; Department of Neurosurgery, 307th Hospital of People's Liberation Army, 307 Clinical College, Anhui Medical University, Beijing, China
| | - Qian-Nan Wang
- Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China
| | - Qian Zhang
- Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China
| | - Hui- Wang
- Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China
| | - Zheng-Shan Zhang
- Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China
| | - De-Sheng Li
- Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China
| | - Lian Duan
- Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China.
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Lanterna LA, Galliani S, Brembilla C, Longhi L, Gritti P, Bernucci C. Association of moyamoya disease with thyroid autoantibodies and thyroid function. Eur J Neurol 2018; 24:e9. [PMID: 28102046 DOI: 10.1111/ene.13209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 10/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- L A Lanterna
- Department of Neuroscience and Surgery of the Nervous System, Azienda Ospedaliera Papa Giovanni XXIII - Bergamo, Bergamo, Italy
| | - S Galliani
- Department of Endocrinology and Metabolic Disease, Azienda Ospedaliera Papa Giovanni XXIII - Bergamo, Bergamo, Italy
| | - C Brembilla
- Department of Neuroscience and Surgery of the Nervous System, Azienda Ospedaliera Papa Giovanni XXIII - Bergamo, Bergamo, Italy
| | - L Longhi
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliera Papa Giovanni XXIII - Bergamo, Bergamo, Italy
| | - P Gritti
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliera Papa Giovanni XXIII - Bergamo, Bergamo, Italy
| | - C Bernucci
- Department of Neuroscience and Surgery of the Nervous System, Azienda Ospedaliera Papa Giovanni XXIII - Bergamo, Bergamo, Italy
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Factors Associated with Moyamoya Syndrome in a Kentucky Regional Population. J Stroke Cerebrovasc Dis 2018; 27:793-800. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/24/2017] [Accepted: 10/12/2017] [Indexed: 11/22/2022] Open
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Lanterna LA, Galliani S, Zangari R, Conti L, Brembilla C, Gritti P, Colleoni ML, Bernucci C. Thyroid Autoantibodies and the Clinical Presentation of Moyamoya Disease: A Prospective Study. J Stroke Cerebrovasc Dis 2018; 27:1194-1199. [PMID: 29305275 DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/28/2017] [Accepted: 11/26/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Moyamoya is a rare cerebrovascular disease characterized by the progressive occlusion of the intracranial carotid artery. Thyroid autoantibodies have been found to be associated with the disease, but their clinical significance has never been studied. The objective of this study was to investigate the relationship between thyroid autoantibodies and the clinical presentation of moyamoya. METHODS This is a prospective study including 37 patients with moyamoya disease (MMD) or unilateral moyamoya (uMM). Thyroid function and thyroid autoantibodies (e.g., antithyroperoxidase and antithyroglobulin) were investigated. We studied the effect of gender, age, type of moyamoya (uMM versus MMD), and thyroid autoantibodies on the clinical presentation, dichotomized into aggressive (hemorrhage, major stroke, or frequent transient ischemic attack [TIA]) and nonaggressive presentation (headache, rare TIAs, and incidental diagnosis) according to the criteria of the Research Committee on Spontaneous Occlusion of the Circle of Willis. RESULTS Of the 37 patients included in the study, the autoantibodies were elevated in 9 (24.3%). An aggressive presentation occurred in 21 patients (hemorrhage in 11, major stroke in 9, frequent TIAs in 1). The autoantibodies were elevated in 8 of the 21 patients (38.09%) with an aggressive presentation and in 1 of those presenting with minor symptoms (6.2%). The presence of elevated autoantibodies was the only variable associated with an aggressive presentation in the multivariate logistic analysis (P = .048). CONCLUSIONS When the serum concentration of the thyroid autoantibodies is increased, the patients have a higher risk of an aggressive presentation. Our results support the hypothesis that activation of immune-mediated processes affects the moyamoya physiopathology.
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Affiliation(s)
- Luigi A Lanterna
- Department of Neuroscience and Surgery of the Nervous System, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Silvia Galliani
- Department of Endocrinology and Metabolic disease, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Rosalia Zangari
- Research Foundation Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luciano Conti
- Laboratory of Stem Cell Biology, Centre for Integrative Biology-CIBIO, University of Trento, Trento, Italy
| | - Carlo Brembilla
- Department of Neuroscience and Surgery of the Nervous System, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paolo Gritti
- Department of Neuroradiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Claudio Bernucci
- Department of Neuroscience and Surgery of the Nervous System, Papa Giovanni XXIII Hospital, Bergamo, Italy; Department of Neuroscience and Surgery of the Nervous System, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Yang F, Ge P, Ye X. Moyamoya disease associated with ankylosing spondylitis in a 9-year-old child: a case report. Chin Neurosurg J 2017. [DOI: 10.1186/s41016-017-0084-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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24
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Moyamoya and Inflammation. World Neurosurg 2017; 100:575-578. [PMID: 28093343 DOI: 10.1016/j.wneu.2017.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 11/27/2016] [Accepted: 01/04/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND More than 50 years have elapsed since moyamoya disease was initially described; however, the disease etiology remains unknown. Although certain genetic loci and immunologic characteristics are associated with moyamoya disease, this does not fully explain its pathophysiology. An association with inflammatory disease has been postulated but not rigorously explored. We sought to examine the epidemiologic association of moyamoya and inflammatory diseases by analyzing data from a large administrative database. METHODS The National Inpatient Sample database for 2009-2012 was obtained. The diagnoses of moyamoya disease and inflammatory diseases were made using the International Classification of Disease, 9th revision. Sample prevalence, sex, age, and admission type were recorded. Patients were grouped into inflammatory disease clusters on the basis of the presence of diagnosis codes for atherosclerotic, adult-onset autoimmune, and juvenile-onset autoimmune diseases. RESULTS There were 2633 total admissions for moyamoya disease. Atherosclerotic (P < 0.05) and juvenile-onset autoimmune disease (P < 0.05) were associated with moyamoya disease in both pediatric and adult patient groups. Adult-onset autoimmune disease was associated with moyamoya disease in pediatric (P < 0.05) but not adult groups. CONCLUSION Moyamoya is associated with inflammatory disease clusters in both pediatric and adult populations. Further studies are warranted to investigate the pathophysiologic association between moyamoya disease and inflammatory disease processes.
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Zhang Q, Wang R, Liu Y, Zhang Y, Wang S, Cao Y, Zhao Y, Liu X, Wang J, Deng X, Gao F, Yang Z, Zhao M, Ge P, Ma Y, Zhao J, Zhang D. Clinical Features and Long-Term Outcomes of Unilateral Moyamoya Disease. World Neurosurg 2016; 96:474-482. [DOI: 10.1016/j.wneu.2016.09.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 10/21/2022]
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Jeon JP, Kim JE. A Recent Update of Clinical and Research Topics Concerning Adult Moyamoya Disease. J Korean Neurosurg Soc 2016; 59:537-543. [PMID: 27847564 PMCID: PMC5106350 DOI: 10.3340/jkns.2016.59.6.537] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/02/2016] [Accepted: 07/20/2016] [Indexed: 01/12/2023] Open
Abstract
A better understanding of moyamoya disease (MMD), such as natural clinical course, surgical outcomes and research, has been obtained. This review article focuses on an giving an update for adult MMD in the Korean population. In this paper, we mainly discuss the results of our domestic investigations including meta-analysis, and related subjects from other countries.
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Affiliation(s)
- Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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AlKhater SA. CNS vasculitis and stroke as a complication of DOCK8 deficiency: a case report. BMC Neurol 2016; 16:54. [PMID: 27113444 PMCID: PMC4845487 DOI: 10.1186/s12883-016-0578-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 04/23/2016] [Indexed: 11/23/2022] Open
Abstract
Background Primary immunodeficiency disorders associated with autoimmunity are poorly understood. Central nervous system (CNS) vasculitis can complicate the courses of such entities, but it is underappreciated. Deletion of the dedicator of cytokinesis 8 (DOCK8) gene is considered to be the autosomal recessive form of hyperimmunoglobulin E syndrome which is a rare type of primary immunodeficiency disease characterized by elevated levels of IgE antibody, eczema, and recurrent staphylococcal infections. DOCK8 deletion is associated with fatal CNS vasculitis. However, descriptions of such cases and their outcomes are scarce in the literature. Case presentation This report describes a young female with a DOCK8 gene deletion presenting acutely with squint, fatigue and visual hallucinations. The patient was diagnosed as having neuritis of the third oculomotor nerve and encephalitis, which were thought to be related to her underlying immune deficiency, however, she subsequently was diagnosed with CNS vasculitis based on brain magnetic imaging and magnetic resonance angiography findings. We provide here a comprehensive description of the patient’s clinical outcome and outline an effective treatment approach that may be useful for similar patients and includes the use of steroids and mycophenolate mofetil (MMF). The treatment was well tolerated and enabled the patient to recover most of her neurological deficits. However, despite the initial improvement, she later developed stroke. Conclusions To the best of our knowledge, this is the first report in the literature of a case of primary immunodeficiency complicated by CNS vasculitis demonstrating a successful outcome. Our observations indicate that the combination of MMF and steroids is an effective treatment for CNS vasculitis associated with DOCK8 deficiency. However, lack of awareness of the neurological comorbidities associated with primary immunodeficiencies and the delay in diagnosis likely contributed to the development of acute cerebral infarction. Early treatment and aggressive control of the disease’s initial inflammation is essential for preventing catastrophic stroke.
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Affiliation(s)
- Suzan A AlKhater
- Department of Pediatrics, College of Medicine, University of Dammam, Dammam, Saudi Arabia. .,King Fahad University Hospital, P.O. Box 2208, Al-Khobar, 31592, Saudi Arabia.
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