1
|
Hao F, Han C, Lu M, Wang Y, Gao G, Wang Q, Liu S, Liu S, Wang M, Ren B, Zou Z, Yu D, Sun C, Zhang Q, Guo Q, Liu W, Sun Z, Cai J, Duan L. High-resolution MRI vessel wall enhancement in moyamoya disease: risk factors and clinical outcomes. Eur Radiol 2024; 34:5179-5189. [PMID: 38172442 DOI: 10.1007/s00330-023-10535-0] [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: 08/17/2023] [Revised: 10/20/2023] [Accepted: 11/25/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES Intracranial vessel wall enhancement (VWE) on high-resolution magnetic resonance imaging (HRMRI) is associated with the progression and poor prognosis of moyamoya disease (MMD). This study assessed potential risk factors for VWE in MMD. METHODS We evaluated MMD patients using HRMRI and traditional angiography examinations. The participants were divided into VWE and non-VWE groups based on HRMRI. Logistic regression was performed to compare the risk factors for VWE in MMD. The incidence of cerebrovascular events of the different subgroups according to risk factors was compared using Kaplan-Meier survival and Cox regression. RESULTS We included 283 MMD patients, 84 of whom had VWE on HRMRI. The VWE group had higher modified Rankin Scale scores at admission (p = 0.014) and a higher incidence of ischaemia and haemorrhage (p = 0.002) than did the non-VWE group. Risk factors for VWE included the ring finger protein 213 (RNF213) p.R4810K variant (odds ratio [OR] 2.01, 95% confidence interval [CI] 1.08-3.76, p = 0.028), hyperhomocysteinaemia (HHcy) (OR 5.08, 95% CI 2.34-11.05, p < 0.001), and smoking history (OR 3.49, 95% CI 1.08-11.31, p = 0.037). During the follow-up of 63.9 ± 13.2 months (median 65 months), 18 recurrent stroke events occurred. Cox regression showed that VWE and the RNF213 p.R4810K variant were risk factors for stroke. CONCLUSION The RNF213 p.R4810K variant is strongly associated with VWE and poor prognosis in MMD. HHcy and smoking are independent risk factors for VWE. CLINICAL RELEVANCE STATEMENT Vessel wall enhancement in moyamoya disease is closely associated with poor prognosis, especially related to the ring finger protein 213 p.R4810K variant, hyperhomocysteinaemia, and smoking, providing crucial risk assessment information for the clinic. KEY POINTS • The baseline presence of vessel wall enhancement is significantly associated with poor prognosis in moyamoya disease. • The ring finger protein 213 p.R4810K variant is strongly associated with vessel wall enhancement and poor prognosis in moyamoya disease. • Hyperhomocysteinaemia and smoking are independent risk factors for vessel wall enhancement in moyamoya disease.
Collapse
Affiliation(s)
- Fangbin Hao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Cong Han
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Mingming Lu
- Department of Radiology, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yue Wang
- Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Gan Gao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Qiannan Wang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Shitong Liu
- Chinese PLA Medical School, Beijing, China
- Department of Radiology, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Simeng Liu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Minjie Wang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Bin Ren
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Zhengxing Zou
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Dan Yu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Caihong Sun
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Qian Zhang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Qingbao Guo
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Wanyang Liu
- Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Zhenghui Sun
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Jianming Cai
- Department of Radiology, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China.
| | - Lian Duan
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China.
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China.
| |
Collapse
|
2
|
Xu M, Zhao X, Zhao J, Tan Z, Zhang C, Huang Y, Zhong H, Guo M, Zhang C, Ye P, Zheng W. UCH-L1 Inhibitor Alleviates Nerve Damage Caused by Moyamoya Disease. Appl Bionics Biomech 2024; 2024:2550642. [PMID: 39104593 PMCID: PMC11300054 DOI: 10.1155/2024/2550642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/08/2024] [Accepted: 06/20/2024] [Indexed: 08/07/2024] Open
Abstract
Background Moyamoya disease (MMD) leads to nerve injury. Exosomes are touted as bio-shuttles for the delivery of distinct biomolecules inside the cells. Recently, UCH-L1 was shown to play a vital role in nerve injury. However, it is still unknown whether UCH-L1 can improve the nerve injury of MMD. Materials and Methods Exosomes were isolated from the serum of patients with MMD and healthy controls. The total RNA was extracted from the exosomes, and the level of GFAP and UCH-L1 between the serum exosomes of the two groups was analyzed by a quantitative reverse transcription-polymerase chain reaction and western blot. Exosome labeling and uptake by SH-SY5Y cells were observed by confocal laser microscopy. Cell counting kit-8 assay and flow cytometry were used to determine the viability and apoptosis of SH-SY5Y cells, respectively. Results Exosomes were successfully isolated and identified from serum. The expression of GFAP and UCH-L1 was significantly higher in the serum-derived exosomes from MMD patients compared with the healthy controls (P < 0.05). Compared to the blank and control exosome group, serum-derived exosomes from MMD significantly suppress cellular vitality and promote apoptosis of SH-SY5Y cells, while the use of LDN-91946, a specific inhibitor of UCH-L1, could reverse the effects induced by serum-derived exosomes from MMD. Conclusion UCH-L1 inhibitor could reverse MMD-induced inhibition of SH-SY5Y cell viability and promotion of apoptosis. UCH-L1 may be a therapeutic target for the treatment of nerve damage caused by MMD.
Collapse
Affiliation(s)
- Minghua Xu
- Intensive-Care UnitPunan Branch of Renji HospitalShanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Xiaomin Zhao
- Intensive-Care UnitPunan Branch of Renji HospitalShanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Jiang Zhao
- Department of NeurosurgeryPunan Branch of Renji HospitalShanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Zhisheng Tan
- Geriatric Department920th Hospital of Joint Logistics Support Force, PLA, Kunming 650200, Yunnan, China
| | - Chengshi Zhang
- Department of RespiratoryPunan Branch of Renji HospitalShanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Yun Huang
- Department of Clinical LaboratoryPunan Branch of Renji HospitalShanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Huiping Zhong
- Intensive-Care UnitPunan Branch of Renji HospitalShanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Meifeng Guo
- Intensive-Care UnitPunan Branch of Renji HospitalShanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Chen Zhang
- Intensive-Care UnitPunan Branch of Renji HospitalShanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Ping Ye
- Intensive-Care UnitPunan Branch of Renji HospitalShanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Wentao Zheng
- Intensive-Care UnitPunan Branch of Renji HospitalShanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| |
Collapse
|
3
|
Zhang W, Pan Z, Zhu Y, Lv D, Zhang H, Li S, Liu C, Xiong X, Li Q, Yao G, Yang S, Song R, Yan S, Wang D, Li M, Liu H. Illness uncertainty, resilience, and perceived social support among patients with moyamoya disease: a cross-sectional study. Front Psychiatry 2024; 15. [DOI: 10.3389/fpsyt.2024.1405594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2024] Open
Abstract
ObjectiveThe present study aims to investigate the levels of illness uncertainty in patients with moyamoya disease and to determine the association of socio-demographic characteristics, perceived social support and resilience with illness uncertainty in patients with moyamoya disease.MethodA cross-sectional survey using convenience sampling was conducted in two hospitals in China from August to December 2023. A socio-demographic characteristics questionnaire, the Chinese versions of Mishel’s Unsurety in Disease Scale (MUIS), the Chinese version of Connor-Davidson Resilience Scale (CD-RISC), and the Chinese version of Multidimensional Scale of Perceived Social Support (MSPSS) were used to perform this research. The collected data were analyzed using SPSS 24.0 statistical software. The t-test, one-way analysis of variance (ANOVA), pearson correlation analysis and hierarchical regression analysis were used to identify associated factors.ResultA total of 263 patients with moyamoya disease were recruited in this survey. The score of illness uncertainty was at a moderate level of (100.03 ± 18.59). The present study identified a negative correlation between illness uncertainty with resilience perceived social support. Hierarchical regression analysis showed that gender, occupation, education level, resilience and perceived social support were the related factors of illness uncertainty.ConclusionPatients with moyamoya disease experienced moderate disease uncertainty on average, which was related to gender, occupation, education level, resilience and perceived social support. Future research is needed to better explore the complex relationships between illness uncertainty, resilience, and perceived social support with different types of moyamoya disease using longitudinal research.
Collapse
|
4
|
Cheng S, Xia IF, Wanner R, Abello J, Stratman AN, Nicoli S. Hemodynamics regulate spatiotemporal artery muscularization in the developing circle of Willis. eLife 2024; 13:RP94094. [PMID: 38985140 PMCID: PMC11236418 DOI: 10.7554/elife.94094] [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] [Indexed: 07/11/2024] Open
Abstract
Vascular smooth muscle cells (VSMCs) envelop vertebrate brain arteries and play a crucial role in regulating cerebral blood flow and neurovascular coupling. The dedifferentiation of VSMCs is implicated in cerebrovascular disease and neurodegeneration. Despite its importance, the process of VSMC differentiation on brain arteries during development remains inadequately characterized. Understanding this process could aid in reprogramming and regenerating dedifferentiated VSMCs in cerebrovascular diseases. In this study, we investigated VSMC differentiation on zebrafish circle of Willis (CoW), comprising major arteries that supply blood to the vertebrate brain. We observed that arterial specification of CoW endothelial cells (ECs) occurs after their migration from cranial venous plexus to form CoW arteries. Subsequently, acta2+ VSMCs differentiate from pdgfrb+ mural cell progenitors after they were recruited to CoW arteries. The progression of VSMC differentiation exhibits a spatiotemporal pattern, advancing from anterior to posterior CoW arteries. Analysis of blood flow suggests that earlier VSMC differentiation in anterior CoW arteries correlates with higher red blood cell velocity and wall shear stress. Furthermore, pulsatile flow induces differentiation of human brain PDGFRB+ mural cells into VSMCs, and blood flow is required for VSMC differentiation on zebrafish CoW arteries. Consistently, flow-responsive transcription factor klf2a is activated in ECs of CoW arteries prior to VSMC differentiation, and klf2a knockdown delays VSMC differentiation on anterior CoW arteries. In summary, our findings highlight blood flow activation of endothelial klf2a as a mechanism regulating initial VSMC differentiation on vertebrate brain arteries.
Collapse
Affiliation(s)
- Siyuan Cheng
- Department of Genetics, Yale School of Medicine, New Haven, United States
- Yale Cardiovascular Research Center, Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, New Haven, United States
- Vascular Biology & Therapeutics Program, Yale School of Medicine, New Haven, United States
| | - Ivan Fan Xia
- Department of Genetics, Yale School of Medicine, New Haven, United States
- Yale Cardiovascular Research Center, Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, New Haven, United States
- Vascular Biology & Therapeutics Program, Yale School of Medicine, New Haven, United States
| | - Renate Wanner
- Department of Genetics, Yale School of Medicine, New Haven, United States
- Yale Cardiovascular Research Center, Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, New Haven, United States
- Vascular Biology & Therapeutics Program, Yale School of Medicine, New Haven, United States
| | - Javier Abello
- Department of Cell Biology & Physiology, School of Medicine, Washington University in St. Louis, St. Louis, United States
| | - Amber N Stratman
- Department of Cell Biology & Physiology, School of Medicine, Washington University in St. Louis, St. Louis, United States
| | - Stefania Nicoli
- Department of Genetics, Yale School of Medicine, New Haven, United States
- Yale Cardiovascular Research Center, Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, New Haven, United States
- Vascular Biology & Therapeutics Program, Yale School of Medicine, New Haven, United States
| |
Collapse
|
5
|
Tchernychev B, Nitschke Y, Chu D, Sullivan C, Flaman L, O’Brien K, Howe J, Cheng Z, Thompson D, Ortiz D, Rutsch F, Sabbagh Y. Inhibition of Vascular Smooth Muscle Cell Proliferation by ENPP1: The Role of CD73 and the Adenosine Signaling Axis. Cells 2024; 13:1128. [PMID: 38994980 PMCID: PMC11240470 DOI: 10.3390/cells13131128] [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: 04/24/2024] [Revised: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024] Open
Abstract
The Ectonucleotide Pyrophosphatase/Phosphodiesterase 1 (ENPP1) ectoenzyme regulates vascular intimal proliferation and mineralization of bone and soft tissues. ENPP1 variants cause Generalized Arterial Calcification of Infancy (GACI), a rare genetic disorder characterized by ectopic calcification, intimal proliferation, and stenosis of large- and medium-sized arteries. ENPP1 hydrolyzes extracellular ATP to pyrophosphate (PPi) and AMP. AMP is the precursor of adenosine, which has been implicated in the control of neointimal formation. Herein, we demonstrate that an ENPP1-Fc recombinant therapeutic inhibits proliferation of vascular smooth muscle cells (VSMCs) in vitro and in vivo. Addition of ENPP1 and ATP to cultured VSMCs generated AMP, which was metabolized to adenosine. It also significantly decreased cell proliferation. AMP or adenosine alone inhibited VSMC growth. Inhibition of ecto-5'-nucleotidase CD73 decreased adenosine accumulation and suppressed the anti-proliferative effects of ENPP1/ATP. Addition of AMP increased cAMP synthesis and phosphorylation of VASP at Ser157. This AMP-mediated cAMP increase was abrogated by CD73 inhibitors or by A2aR and A2bR antagonists. Ligation of the carotid artery promoted neointimal hyperplasia in wild-type mice, which was exacerbated in ENPP1-deficient ttw/ttw mice. Prophylactic or therapeutic treatments with ENPP1 significantly reduced intimal hyperplasia not only in ttw/ttw but also in wild-type mice. These findings provide the first insight into the mechanism of the anti-proliferative effect of ENPP1 and broaden its potential therapeutic applications beyond enzyme replacement therapy.
Collapse
Affiliation(s)
- Boris Tchernychev
- Research and Development, Inozyme Pharma, 321 Summer St, Suite 400, Boston, MA 02201, USA; (B.T.); (D.C.); (C.S.); (L.F.); (K.O.); (J.H.); (Z.C.); (D.T.); (D.O.); (Y.S.)
| | - Yvonne Nitschke
- Department of General Pediatrics, Münster University Children’s Hospital, 48149 Münster, Germany;
- INTEC Network of Ectopic Calcification, Center for Medical Genetics Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Di Chu
- Research and Development, Inozyme Pharma, 321 Summer St, Suite 400, Boston, MA 02201, USA; (B.T.); (D.C.); (C.S.); (L.F.); (K.O.); (J.H.); (Z.C.); (D.T.); (D.O.); (Y.S.)
| | - Caitlin Sullivan
- Research and Development, Inozyme Pharma, 321 Summer St, Suite 400, Boston, MA 02201, USA; (B.T.); (D.C.); (C.S.); (L.F.); (K.O.); (J.H.); (Z.C.); (D.T.); (D.O.); (Y.S.)
| | - Lisa Flaman
- Research and Development, Inozyme Pharma, 321 Summer St, Suite 400, Boston, MA 02201, USA; (B.T.); (D.C.); (C.S.); (L.F.); (K.O.); (J.H.); (Z.C.); (D.T.); (D.O.); (Y.S.)
| | - Kevin O’Brien
- Research and Development, Inozyme Pharma, 321 Summer St, Suite 400, Boston, MA 02201, USA; (B.T.); (D.C.); (C.S.); (L.F.); (K.O.); (J.H.); (Z.C.); (D.T.); (D.O.); (Y.S.)
| | - Jennifer Howe
- Research and Development, Inozyme Pharma, 321 Summer St, Suite 400, Boston, MA 02201, USA; (B.T.); (D.C.); (C.S.); (L.F.); (K.O.); (J.H.); (Z.C.); (D.T.); (D.O.); (Y.S.)
| | - Zhiliang Cheng
- Research and Development, Inozyme Pharma, 321 Summer St, Suite 400, Boston, MA 02201, USA; (B.T.); (D.C.); (C.S.); (L.F.); (K.O.); (J.H.); (Z.C.); (D.T.); (D.O.); (Y.S.)
| | - David Thompson
- Research and Development, Inozyme Pharma, 321 Summer St, Suite 400, Boston, MA 02201, USA; (B.T.); (D.C.); (C.S.); (L.F.); (K.O.); (J.H.); (Z.C.); (D.T.); (D.O.); (Y.S.)
| | - Daniel Ortiz
- Research and Development, Inozyme Pharma, 321 Summer St, Suite 400, Boston, MA 02201, USA; (B.T.); (D.C.); (C.S.); (L.F.); (K.O.); (J.H.); (Z.C.); (D.T.); (D.O.); (Y.S.)
| | - Frank Rutsch
- Department of General Pediatrics, Münster University Children’s Hospital, 48149 Münster, Germany;
- INTEC Network of Ectopic Calcification, Center for Medical Genetics Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Yves Sabbagh
- Research and Development, Inozyme Pharma, 321 Summer St, Suite 400, Boston, MA 02201, USA; (B.T.); (D.C.); (C.S.); (L.F.); (K.O.); (J.H.); (Z.C.); (D.T.); (D.O.); (Y.S.)
| |
Collapse
|
6
|
Zhou Z, Wang Y, Zhang J, Liu Z, Hao X, Wang X, He S, Wang R. Characterization of PANoptosis-related genes and the immune landscape in moyamoya disease. Sci Rep 2024; 14:10278. [PMID: 38704490 PMCID: PMC11069501 DOI: 10.1038/s41598-024-61241-w] [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: 11/21/2023] [Accepted: 05/02/2024] [Indexed: 05/06/2024] Open
Abstract
Moyamoya disease (MMD) is a cerebrovascular narrowing and occlusive condition characterized by progressive stenosis of the terminal portion of the internal carotid artery and the formation of an abnormal network of dilated, fragile perforators at the base of the brain. However, the role of PANoptosis, an apoptotic mechanism associated with vascular disease, has not been elucidated in MMD. In our study, a total of 40 patients' genetic data were included, and a total of 815 MMD-related differential genes were screened, including 215 upregulated genes and 600 downregulated genes. Among them, DNAJA3, ESR1, H19, KRT18 and STK3 were five key genes. These five key genes were associated with a variety of immune cells and immune factors. Moreover, GSEA (gene set enrichment analysis) and GSVA (gene set variation analysis) showed that the different expression levels of the five key genes affected multiple signaling pathways associated with MMD. In addition, they were associated with the expression of MMD-related genes. Then, based on the five key genes, a transcription factor regulatory network was constructed. In addition, targeted therapeutic drugs against MMD-related genes were obtained by the Cmap drug prediction method: MST-312, bisacodyl, indirubin, and tropanyl-3,5-dimethylbenzoate. These results suggest that the PANoptosis-related genes may contribute to the pathogenesis of MMD through multiple mechanisms.
Collapse
Affiliation(s)
- Zhenyu Zhou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yanru Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Junze Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Ziqi Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xiaokuan Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xilong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Shihao He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.
- Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China.
| |
Collapse
|
7
|
Kijpaisalratana N, Ariyaprakai C, Sriamornrattanakul K, Wongsuriyanan S, Akharathammachote N, Susantitaphong P, Suwanwela NC. Antiplatelet Treatment in Moyamoya Disease: A Systematic Review. Cerebrovasc Dis Extra 2024; 14:76-85. [PMID: 38697036 PMCID: PMC11250630 DOI: 10.1159/000539025] [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: 02/16/2024] [Accepted: 04/11/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Moyamoya disease (MMD) is an uncommon cause of stroke. Antiplatelet treatment is commonly prescribed for patients with MMD despite the lack of strong evidence supporting its efficacy. We conducted a systematic review to evaluate evidence of antiplatelet treatment and clinical outcomes among patients with MMD. METHODS A systematic literature search was performed to identify studies that evaluated the association between antiplatelet treatment and clinical outcomes, including ischemic stroke, hemorrhagic stroke, functional outcome, survival, and bypass patency, in patients with MMD. The following databases were searched: PubMed, Embase, Scopus, and the Cochrane Library, from the inception date to February 2022. RESULTS Eight studies were included in this systematic review. Six studies evaluated antiplatelet treatment and ischemic stroke. Most studies did not demonstrate a protective effect of antiplatelet treatment against ischemic stroke. Five studies evaluated antiplatelet treatment and hemorrhagic stroke. All of them did not demonstrate an increased risk of hemorrhagic stroke. One study found the benefit of antiplatelet treatment in terms of survival. Regarding the effect of antiplatelet treatment on functional outcome and patency of surgical bypass, the results were inconclusive. CONCLUSION Current evidence suggests that antiplatelet treatment in patients with MMD did not demonstrate a protective effect against ischemic stroke. However, antiplatelet treatment did not increase the risk of hemorrhagic stroke in patients with MMD. The well-designed randomized controlled trial should be highlighted.
Collapse
Affiliation(s)
- Naruchorn Kijpaisalratana
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Division of Academic Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chanon Ariyaprakai
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Kitiporn Sriamornrattanakul
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Somkiat Wongsuriyanan
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Nasaeng Akharathammachote
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand
- Center of Excellence for Metabolic Bone Disease in CKD Patients, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nijasri C. Suwanwela
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| |
Collapse
|
8
|
Uygun GG, Darici D, Cil MG, Bastug Z, Misirli CH. Moyamoya Syndrome Secondary to Coinfection of Meningovascular Neurosyphilis and Acquired Immunodeficiency Syndrome. Cureus 2024; 16:e60579. [PMID: 38894803 PMCID: PMC11184355 DOI: 10.7759/cureus.60579] [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] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
Moyamoya angiopathy is a rare cerebrovascular condition characterized by insufficient cerebral blood flow resulting from arterial vessel narrowing or occlusion, potentially leading to cerebral ischemia due to inadequate oxygen and nutrient supply to the brain tissue. The development of collateral vessels in stenotic regions, inherently fragile and prone to rupture, may further precipitate intracerebral hemorrhage. Alongside focal neurological symptoms, the common clinical presentations of Moyamoya angiopathy encompass headaches, dizziness, cognitive impairments, seizures, and involuntary movements. When associated with an underlying systemic illness, including Down Syndrome, cranial radiation, neurofibromatosis type 1, or meningitis, the condition is termed Moyamoya syndrome; whereas when idiopathic and a genetic mutation are identified, it is referred to as Moyamoya disease. In this report, we present a case of the rare Moyamoya syndrome, which was attributed to syphilis and HIV infection and was identified during an investigation into the etiology of ischemic stroke in a young patient.
Collapse
Affiliation(s)
- Gursan G Uygun
- Department of Neurology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, TUR
| | - Didem Darici
- Department of Interventional Neurology, University of Health Sciences, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, TUR
| | - Melis G Cil
- Department of Neurology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, TUR
| | - Zeynep Bastug
- Department of Neurology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, TUR
| | - Cemile H Misirli
- Department of Neurology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, TUR
| |
Collapse
|
9
|
Cheng S, Xia IF, Wanner R, Abello J, Stratman AN, Nicoli S. Hemodynamics regulate spatiotemporal artery muscularization in the developing circle of Willis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.12.01.569622. [PMID: 38077062 PMCID: PMC10705471 DOI: 10.1101/2023.12.01.569622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Vascular smooth muscle cells (VSMCs) envelop vertebrate brain arteries, playing a crucial role in regulating cerebral blood flow and neurovascular coupling. The dedifferentiation of VSMCs is implicated in cerebrovascular diseases and neurodegeneration. Despite its importance, the process of VSMC differentiation on brain arteries during development remains inadequately characterized. Understanding this process could aid in reprogramming and regenerating differentiated VSMCs in cerebrovascular diseases. In this study, we investigated VSMC differentiation on the zebrafish circle of Willis (CoW), comprising major arteries that supply blood to the vertebrate brain. We observed that the arterial expression of CoW endothelial cells (ECs) occurs after their migration from the cranial venous plexus to form CoW arteries. Subsequently, acta2+ VSMCs differentiate from pdgfrb+ mural cell progenitors upon recruitment to CoW arteries. The progression of VSMC differentiation exhibits a spatiotemporal pattern, advancing from anterior to posterior CoW arteries. Analysis of blood flow suggests that earlier VSMC differentiation in anterior CoW arteries correlates with higher red blood cell velocity wall shear stress. Furthermore, pulsatile blood flow is required for differentiation of human brain pdgfrb+ mural cells into VSMCs as well as VSMC differentiation on zebrafish CoW arteries. Consistently, the flow-responsive transcription factor klf2a is activated in ECs of CoW arteries prior to VSMC differentiation, and klf2a knockdown delays VSMC differentiation on anterior CoW arteries. In summary, our findings highlight the role of blood flow activation of endothelial klf2a as a mechanism regulating the initial VSMC differentiation on vertebrate brain arteries.
Collapse
Affiliation(s)
- Siyuan Cheng
- Department of Genetics, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520, USA
- Yale Cardiovascular Research Center, Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, 300 George St, New Haven, CT 06511, USA
- Vascular Biology & Therapeutics Program, Yale School of Medicine, 10 Amistad St, New Haven, CT 06520, USA
| | - Ivan Fan Xia
- Department of Genetics, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520, USA
- Yale Cardiovascular Research Center, Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, 300 George St, New Haven, CT 06511, USA
- Vascular Biology & Therapeutics Program, Yale School of Medicine, 10 Amistad St, New Haven, CT 06520, USA
| | - Renate Wanner
- Department of Genetics, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520, USA
- Yale Cardiovascular Research Center, Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, 300 George St, New Haven, CT 06511, USA
- Vascular Biology & Therapeutics Program, Yale School of Medicine, 10 Amistad St, New Haven, CT 06520, USA
| | - Javier Abello
- Department of Cell Biology & Physiology, School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave, St. Louis, MO 63110, USA
| | - Amber N. Stratman
- Department of Cell Biology & Physiology, School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave, St. Louis, MO 63110, USA
| | - Stefania Nicoli
- Department of Genetics, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520, USA
- Yale Cardiovascular Research Center, Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, 300 George St, New Haven, CT 06511, USA
- Vascular Biology & Therapeutics Program, Yale School of Medicine, 10 Amistad St, New Haven, CT 06520, USA
| |
Collapse
|
10
|
Yang H, Huang G, Li X, Wu M, Zhou W, Yin X, Zhang M, Chen Z. High-resolution magnetic resonance vessel wall imaging provides new insights into Moyamoya disease. Front Neurosci 2024; 18:1375645. [PMID: 38665292 PMCID: PMC11043609 DOI: 10.3389/fnins.2024.1375645] [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: 01/24/2024] [Accepted: 03/13/2024] [Indexed: 04/28/2024] Open
Abstract
Moyamoya disease (MMD) is a rare condition that affects the blood vessels of the central nervous system. This cerebrovascular disease is characterized by progressive narrowing and blockage of the internal carotid, middle cerebral, and anterior cerebral arteries, which results in the formation of a compensatory fragile vascular network. Currently, digital subtraction angiography (DSA) is considered the gold standard in diagnosing MMD. However, this diagnostic technique is invasive and may not be suitable for all patients. Hence, non-invasive imaging methods such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are often used. However, these methods may have less reliable diagnostic results. Therefore, High-Resolution Magnetic Resonance Vessel Wall Imaging (HR-VWI) has emerged as the most accurate method for observing and analyzing arterial wall structure. It enhances the resolution of arterial walls and enables quantitative and qualitative analysis of plaque, facilitating the identification of atherosclerotic lesions, vascular entrapment, myofibrillar dysplasia, moyamoya vasculopathy, and other related conditions. Consequently, HR-VWI provides a new and more reliable evaluation criterion for diagnosing vascular lesions in patients with Moyamoya disease.
Collapse
Affiliation(s)
- Hui Yang
- Department of Neurology, Clinical Medical School of Jiujiang University, Jiujiang, China
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
- School of Basic Medicine, Jiujiang University, Jiujiang, China
| | - Guilan Huang
- Department of Neurology, Clinical Medical School of Jiujiang University, Jiujiang, China
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
| | - Xi Li
- Department of Neurology, University of California Irvine Medical Center, Irvine, CA, United States
| | - Moxin Wu
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
| | - Weixin Zhou
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
| | - Xiaoping Yin
- Department of Neurology, Clinical Medical School of Jiujiang University, Jiujiang, China
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
| | - Manqing Zhang
- School of Basic Medicine, Jiujiang University, Jiujiang, China
| | - Zhiying Chen
- Department of Neurology, Clinical Medical School of Jiujiang University, Jiujiang, China
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
| |
Collapse
|
11
|
Kim JH, Jeon H, Kim M, Byun J, Chung Y, Lee SU, Park W, Park JC, Ahn JS, Lee S. Chemical and perfusion markers as predictors of moyamoya disease progression and complication types. Sci Rep 2024; 14:56. [PMID: 38167529 PMCID: PMC10762200 DOI: 10.1038/s41598-023-47984-y] [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: 05/18/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024] Open
Abstract
To investigate the association between chemical markers (triglyceride, C-reactive protein (CRP), and inflammation markers) and perfusion markers (relative cerebral vascular reserve (rCVR)) with moyamoya disease progression and complication types. A total of 314 patients diagnosed with moyamoya disease were included. Triglyceride and CRP levels were assessed and categorized based on Korean guidelines for dyslipidemia and CDC/AHA guidelines, respectively. Perfusion markers were evaluated using Diamox SPECT. Cox proportional hazard analysis was performed to examine the relationship between these markers and disease progression, as well as complication types (ischemic stroke, hemorrhagic stroke, and rCVR deterioration). Elevated triglyceride levels (≥ 200) were significantly associated with higher likelihood of end-point events (HR: 2.292, CI 1.00-4.979, P = 0.03). Severe decreased rCVR findings on Diamox SPECT were also significantly associated with end-point events (HR: 3.431, CI 1.254-9.389, P = 0.02). Increased CRP levels and white blood cell (WBC) count were significantly associated with moyamoya disease progression. For hemorrhagic stroke, higher triglyceride levels were significantly associated with end-point events (HR: 5.180, CI 1.355-19.801, P = 0.02). For ischemic stroke, severe decreased rCVR findings on Diamox SPECT (HR: 5.939, CI 1.616-21.829, P < 0.01) and increased CRP levels (HR: 1.465, CI 1.009-2.127, P = 0.05) were significantly associated with end-point events. Elevated triglyceride, CRP, and inflammation markers, as well as decreased rCVR, are potential predictors of moyamoya disease progression and complication types. Further research is warranted to understand their role in disease pathophysiology and treatment strategies.
Collapse
Affiliation(s)
- Jae Hyun Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hanwool Jeon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Translational Biomedical Research Group, Asan Institute for Life Science, Asan Medical Center, Seoul, 05505, Republic of Korea
- Bio-Medical Institute of Technology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Moinay Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Joonho Byun
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Yeongu Chung
- Department of Neurosurgery, Kangbuk Samsung Medical Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Si Un Lee
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Seungjoo Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
- Translational Biomedical Research Group, Asan Institute for Life Science, Asan Medical Center, Seoul, 05505, Republic of Korea.
- Bio-Medical Institute of Technology, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
12
|
Krylov VV, Senko IV, Amiralieva MS, Staroverov MS, Grigoryev IV, Kordonskaya OO, Glotova NA. [Moyamoya disease in adults: treatment methods in modern era]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:75-82. [PMID: 38512098 DOI: 10.17116/jnevro202412403275] [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: 03/22/2024]
Abstract
Moyamoya angiopathy is a chronic progressive cerebrovascular disease characterized by stenosis and occlusion of the distal segments of the internal carotid arteries and/or proximal segments of the middle and anterior cerebral arteries, with a gradual compensatory restructuring of the cerebral circulation to the system of the external carotid arteries. Today, the main treatment method for Moyamoya angiopathy is surgical revascularization of the brain. A search and analysis of publications on the treatment of adult patients with Moyamoya angiopathy was carried out in the PubMed and Medscape databases over the past 10 years. We present a case of an adult female patient with a hemorrhagic form of Moyamoya angiopathy stage IV according to J. Suzuki, who underwent staged combined revascularization of both cerebral hemispheres. Surgical revascularization included the creation of a low-flow extra-intracranial shunt combined with a combination of indirect synangiosis. The combination of direct and indirect methods of surgical revascularization enables to achieve the development of an extensive network of collaterals and fully compensate for cerebral circulatory disorders both in the early and late postoperative periods, which is confirmed by instrumental diagnostic data. Combined revascularization is the most effective modern method of treating patients with Moyamoya angiopathy due to the complementary influence of direct and indirect components of revascularization.
Collapse
Affiliation(s)
- V V Krylov
- Federal Center of Brain Research and Neurotechnology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
- Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - I V Senko
- Federal Center of Brain Research and Neurotechnology, Moscow, Russia
| | - M Sh Amiralieva
- Federal Center of Brain Research and Neurotechnology, Moscow, Russia
| | - M S Staroverov
- Federal Center of Brain Research and Neurotechnology, Moscow, Russia
- Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
- Clinical City Hospital No. 4, Perm, Russia
| | - I V Grigoryev
- Federal Center of Brain Research and Neurotechnology, Moscow, Russia
| | - O O Kordonskaya
- Federal Center of Brain Research and Neurotechnology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - N A Glotova
- Federal Center of Brain Research and Neurotechnology, Moscow, Russia
| |
Collapse
|
13
|
Ott WP, Bellamy S, Onyali CB. A Rare Case of Moyamoya Disease in a Hispanic Woman: Unveiling Non-Asian Ethnicity and Atypical Risk Factors. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e940353. [PMID: 37528569 PMCID: PMC10405348 DOI: 10.12659/ajcr.940353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/28/2023] [Accepted: 06/07/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Moyamoya disease is a rare and progressive cerebrovascular disorder caused by narrowed or blocked arteries supplying the brain. First described in Japan, the disease's incidence is higher in Asian countries and primarily affects children, although adults can also be afflicted. Following a literature review, very little was found regarding non-Asian ethnicities and the lack of typically associated risk factors that are known correlates of Moyamoya disease. CASE REPORT We present the case of a 41-year-old Hispanic woman with a history of type 1 diabetes mellitus and asthma who presented to the Emergency Department with concerns of recurrent transient episodes of left upper extremity weakness and paresthesia followed by confusion. The patient's blood pressure on arrival was 215/134 mmHg, and heart rate was 124 beats per min. Computed tomography of the head was unremarkable, but a computed tomography angiogram of the head demonstrated several areas of severe and bilateral stenosis with radiographic appearances, suggestive of Moyamoya disease. Magnetic resonance imaging of the brain would later illustrate two 6×2-mm ischemic infarcts in the right posterior centrum semiovale. CONCLUSIONS Moyamoya disease in the non-Asian population is rarely reported. We present a case of this condition in a patient of Hispanic ethnicity. Although it is generally considered a non-atherosclerotic disease, some literature suggests that atherosclerotic disease may also contribute to the development and possible acceleration of clinical features of Moyamoya disease. Given our patient's risk factors, we postulated that our patient's presentation was likely multifactorial, with both non-sclerotic and atherosclerotic disease.
Collapse
|
14
|
Cao L, Ai Y, Dong Y, Li D, Wang H, Sun K, Wang C, Zhang M, Yan D, Li H, Liang G, Yang B. Bioinformatics analysis reveals the landscape of immune cell infiltration and novel immune-related biomarkers in moyamoya disease. Front Genet 2023; 14:1101612. [PMID: 37265961 PMCID: PMC10230076 DOI: 10.3389/fgene.2023.1101612] [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: 11/18/2022] [Accepted: 04/28/2023] [Indexed: 06/03/2023] Open
Abstract
Objective: This study aimed to identify immune infiltration characteristics and new immunological diagnostic biomarkers in the cerebrovascular tissue of moyamoya disease (MMD) using bioinformatics analysis. Methods: GSE189993 and GSE141022 were downloaded from the GEO database. Differentially expressed gene and PPI analysis were performed. After performing WGCNA, the most significant module associated with MMD was obtained. Next, functional pathways according to GSEA, GO, and KEGG were enriched for the aforementioned core genes obtained from PPI and WGCNA. Additionally, immune infiltration, using the CIBERSORT deconvolution algorithm, immune-related biomarkers, and the relationship between these genes, was further explored. Finally, diagnostic accuracy was verified with ROC curves in the validation dataset GSE157628. Results: A total of 348 DEGs were screened, including 89 downregulated and 259 upregulated genes. The thistlel module was detected as the most significant module associated with MMD. Functional analysis of the core genes was chiefly involved in the immune response, immune system process, protein tyrosine kinase activity, secretory granule, and so on. Among 13 immune-related overlapping genes, 4 genes (BTK, FGR, PTPN11, and SYK) were identified as potential diagnostic biomarkers, where PTPN11 showed the highest specificity and sensitivity. Meanwhile, a higher proportion of eosinophils, not T cells or B cells, was demonstrated in the specific immune infiltration landscape of MMD. Conclusion: Immune activities and immune cells were actively involved in the progression of MMD. BTK, FGR, PTPN11, and SYK were identified as potential immune diagnostic biomarkers. These immune-related genes and cells may provide novel insights for immunotherapy in the future.
Collapse
Affiliation(s)
- Lei Cao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yunzheng Ai
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Yang Dong
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongpeng Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hao Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kaiwen Sun
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chenchao Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Manxia Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongming Yan
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongwei Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guobiao Liang
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Bo Yang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
15
|
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: 0] [Impact Index Per Article: 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.
Collapse
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
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Lu M, Zhang H, Liu D, Hao F, Zhang L, Peng P, Yuan F, Liu S, Sheng F, Liu Y, Zhao X, He Y, Han C, Cai J. Vessel wall enhancement as a predictor of arterial stenosis progression and poor outcomes in moyamoya disease. Eur Radiol 2023; 33:2489-2499. [PMID: 36334103 DOI: 10.1007/s00330-022-09223-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/03/2022] [Accepted: 10/05/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study aimed to determine the association between vessel wall enhancement and progression of arterial stenosis and clinical outcomes in patients with moyamoya (MMD) using high-resolution magnetic resonance (HRMR) vessel wall imaging. METHODS Consecutive participants diagnosed with MMD were prospectively recruited and underwent HRMR at baseline and during follow-up, which had an interval period of ≥ 6 months and were clinically followed up for ≤ 24 months to record the occurrence of ischemic stroke. The relationship between vessel wall enhancement and arterial stenosis progression and stroke occurrence was evaluated. RESULTS HRMR vessel wall imaging was used to identify 309 stenotic lesions at the internal carotid artery (ICA) in 170 participants (mean age: 37.7 ± 11.3 years old, male: 44.1%). The baseline presence (adjusted odds ratio [aOR] = 3.57, 95% CI = 1.97-6.44, p < 0.001) and progression (aOR = 2.96, 95% CI = 1.29-6.80, p = 0.010) of vessel wall enhancement and middle cerebral artery (MCA) involvement (aOR = 4.98, 95% CI = 1.50-16.52, p = 0.009) were significantly associated with rapid progression of arterial stenosis. Furthermore, vessel wall enhancement (adjusted HR = 3.59, 95% CI = 1.33-9.70, p = 0.011) and rapid progression of arterial stenosis (adjusted HR = 4.52, 95% CI = 1.48-13.81, p = 0.008) were correlated with future stroke occurrence. CONCLUSION The baseline presence of vessel wall enhancement was associated with rapid progression of arterial stenosis and increased risk for stroke in MMD patients. Our findings suggest that vessel wall enhancement may serve as a predictor of disease progression and poor outcomes in MMD. KEY POINTS • The baseline presence of vessel wall enhancement was significantly associated with the rapid progression of arterial stenosis. • The baseline presence of vessel wall enhancement and rapid progression of arterial stenosis were both correlated with increased risk for future occurrence of stroke. • Our findings suggest that vessel wall enhancement may serve as a predictor of rapid progression of arterial stenosis and poor outcomes in MMD patients.
Collapse
Affiliation(s)
- Mingming Lu
- Institute of Geriatrics, State Key Laboratory of Kidney Disease, Beijing Key Laboratory of Aging and Geriatrics, the Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.,Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Hongtao Zhang
- Department of Radiology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Dongqing Liu
- Department of Radiology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Fangbin Hao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lichen Zhang
- Department of Radiology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Peng Peng
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Fei Yuan
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Shitong Liu
- Department of Radiology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Fugeng Sheng
- Department of Radiology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yuan Liu
- Department of Radiology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Yao He
- Institute of Geriatrics, State Key Laboratory of Kidney Disease, Beijing Key Laboratory of Aging and Geriatrics, the Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
| | - Cong Han
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Jianming Cai
- Department of Radiology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
| |
Collapse
|
18
|
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.
Collapse
|
19
|
Mertens R, Acker G, Kersting K, Lange C, Furth C, Beyaztas D, Truckenmueller P, Moedl L, Spruenken ED, Czabanka M, Vajkoczy P. Validation of the Berlin Grading System for moyamoya angiopathy with the use of [ 15O]H 2O PET. Neurosurg Rev 2022; 46:25. [PMID: 36574089 PMCID: PMC9794537 DOI: 10.1007/s10143-022-01920-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/05/2022] [Accepted: 11/30/2022] [Indexed: 12/28/2022]
Abstract
The Berlin Grading System assesses clinical severity of moyamoya angiopathy (MMA) by combining MRI, DSA, and cerebrovascular reserve capacity (CVRC). Our aim was to validate this grading system using [15O]H2O PET for CVRC. We retrospectively identified bilateral MMA patients who underwent [15O]H2O PET examination and were treated surgically at our department. Each hemisphere was classified using the Suzuki and Berlin Grading System. Preoperative symptoms and perioperative ischemias were collected, and a logistic regression analysis was performed. A total of 100 hemispheres in 50 MMA patients (36 women, 14 men) were included. Using the Berlin Grading System, 2 (2.8%) of 71 symptomatic hemispheres were categorized as grade I, 14 (19.7%) as grade II, and 55 (77.5%) as grade III. The 29 asymptomatic hemispheres were characterized as grade I in 7 (24.1%) hemispheres, grade II in 12 (41.4%), and grade III in 10 (34.5%) hemispheres. Berlin grades were independent factors for identifying hemispheres as symptomatic and higher grades correlated with increasing proportion of symptomatic hemispheres (p < 0.01). The Suzuki grading did not correlate with preoperative symptoms (p = 0.26). Perioperative ischemic complications occurred in 8 of 88 operated hemispheres. Overall, complications did not occur in any of the grade I hemispheres, but in 9.1% (n = 2 of 22) and 9.8% (n = 6 of 61) of grade II and III hemispheres, respectively. In this study, we validated the Berlin Grading System with the use of [15O]H2O PET for CVRC as it could stratify preoperative symptomatology. Furthermore, we highlighted its relevance for predicting perioperative ischemic complications.
Collapse
Affiliation(s)
- R Mertens
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin Institute of Health, BIH Academy, (Junior) Clinician Scientist Program, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - G Acker
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin Institute of Health, BIH Academy, (Junior) Clinician Scientist Program, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Kersting
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - C Lange
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - C Furth
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - D Beyaztas
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - P Truckenmueller
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - L Moedl
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - E D Spruenken
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - M Czabanka
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - P Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
| |
Collapse
|
20
|
Xu D, Zheng B, Wu Q, Yao J, Ilyasova T, Beilerli A, Shi H. Outcomes after superficial temporal artery–middle cerebral artery anastomosis combined with multiple burr hole surgery and dural inversion synangiosis for moyamoya disease in adults. Front Surg 2022; 9:1047727. [PMID: 36406349 PMCID: PMC9672457 DOI: 10.3389/fsurg.2022.1047727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Objective Several forms of cerebral revascularization have been carried out to treat moyamoya disease, however, the existing methods are accompanied by a variety of complications. In this study, the authors aimed to evaluate the clinical and angiographic outcomes of a new surgical procedure: superficial temporal artery–middle cerebral artery (STA-MCA) anastomosis combined with multiple burr hole (MBH) surgery and dural inversion synangiosis for the treatment of moyamoya disease in adults. Methods Patients treated for moyamoya disease from August 2019 to July 2021 were retrospectively reviewed. Clinical data, including perioperative complications and follow-up outcomes, were noted. Preoperative and postoperative angiograms were compared, and the diameters of the frontal branch of the superficial temporal artery (F-STA), the deep temporal artery (DTA), the distal superficial temporal artery (STA) before the bifurcation and the middle meningeal artery (MMA) were measured on preoperative and postoperative angiograms. Meanwhile, a Matsushima score was assigned from postoperative angiograms. Results This study included 66 patients (67 hemispheres). During the follow-up period, a median of 18 (IQR, 13–21) months, no stroke or death occurred in any of the patients. The clinical outcomes were excellent in 27 patients (40.9%), good in 34 patients (51.6%), fair in 4 patients (6.0%), and poor in 1 patient (1.5%); the overall rate of favorable clinical outcomes (excellent and good) was 92.5%. The modified Rankin Scale (mRS) score was significantly improved at follow-up (P < 0.001). There were 41 hemispheres imaged by cerebral angiography after the operation, at a median postoperative interval of 9 (IQR, 8–12) months; among them, 34 (82.9%) hemispheres had Matsushima scores of grade A and grade B. The average postoperative diameters in the STA, DTA and MMA were increased significantly in 41 hemispheres at follow-up (P < 0.001). Sixteen (24.2%) patients suffered from perioperative complications, including focal hyperperfusion syndrome (HS) in 8 (12.2%) patients, cerebral infarction in 3 (4.5%) patients (including one case accompanied by wound infection), cerebral hemorrhage in 2 (3.0%) patients, seizures in 2 (3.0%) patients, and subdural effusion in 1 (1.5%) patient. Conclusions The procedure of STA-MCA anastomosis combined with MBH surgery and dural inversion synangiosis may be a safe and effective treatment for adult patients with moyamoya disease.
Collapse
Affiliation(s)
- Dongxiao Xu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bingjie Zheng
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qiaowei Wu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jinbiao Yao
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tatiana Ilyasova
- Department of Internal Diseases, Bashkir State Medical University, Ufa, Russia
| | - Aferin Beilerli
- Department of Obstetrics and Gynecology, Tyumen State Medical University, Tyumen, Russia
| | - Huaizhang Shi
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- Correspondence: Huaizhang Shi
| |
Collapse
|
21
|
Xu S, Wei W, Zhang F, Chen T, Dong L, Shi J, Wu X, Zhang T, Li Z, Zhang J, Li X, Chen J. Transcriptomic Profiling of Intracranial Arteries in Adult Patients With Moyamoya Disease Reveals Novel Insights Into Its Pathogenesis. Front Mol Neurosci 2022; 15:881954. [PMID: 35711733 PMCID: PMC9197469 DOI: 10.3389/fnmol.2022.881954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/01/2022] [Indexed: 11/24/2022] Open
Abstract
Moyamoya disease (MMD) is a rare, progressively steno-occlusive cerebrovascular disorder of unknown etiology. Here, we revealed the gene expression profile of the intracranial arteries in MMD via the RNA-sequencing (RNA-seq). We identified 556 differentially expressed genes (DEGs) for MMD, including 449 and 107 significantly upregulated or downregulated genes. Compared with atherosclerosis-associated intracranial artery stenosis/occlusion (AS-ICASO) controls, upregulated genes were mainly involved in extracellular matrix (ECM) organization, whereas downregulated genes were primarily associated with mitochondrial function and oxidative phosphorylation in MMD. Moreover, we found that a separate sex analysis uncovers more DEGs (n = 1.022) compared to an combined sex analysis in MMD. We identified 133 and 439 sex-specific DEGs for men and women in MMD, respectively. About 95.6% of sex-specific DEGs were protein-coding genes and 3% of the genes belonged to long non-coding RNAs (lncRNA). Sex-specific DEGs were observed on all chromosomes, of which 95.49 and 96.59% were autosomal genes in men and women, respectively. These sex-specific DEGs, such as aquaporin-4 (AQP4), superoxide dismutase 3 (SOD3), and nuclear receptor subfamily 4 group A member 1 (NR4A1), may contribute to sex differences in MMD. This transcriptomic study highlighted that ECM and mitochondrial function are the central molecular mechanisms underlying MMD, and revealed sex differences in the gene expression in the intracranial arteries, thereby providing new insights into the pathogenesis of MMD.
Collapse
Affiliation(s)
- Shuangxiang Xu
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Wei Wei
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Feiyang Zhang
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Tongyu Chen
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Lixin Dong
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Jichun Shi
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Xiaolin Wu
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Tingbao Zhang
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Zhengwei Li
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Jianjian Zhang
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital, Wuhan University, Wuhan, China
- Jianjian Zhang
| | - Xiang Li
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital, Wuhan University, Wuhan, China
- Xiang Li
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital, Wuhan University, Wuhan, China
- *Correspondence: Jincao Chen
| |
Collapse
|