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Wang XP, Zou ZX, Bao XY, Wang QN, Ren B, Yu D, Zhang Q, Liu JQ, Hao FB, Gao G, Guo QB, Fu HG, Li JJ, Wang MJ, Liu SM, Duan L. Clinical and genetic factors associated with contralateral progression in unilateral moyamoya disease: Longitudinal and Cross-Sectional Study. Heliyon 2024; 10:e26108. [PMID: 38404780 PMCID: PMC10884840 DOI: 10.1016/j.heliyon.2024.e26108] [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: 07/28/2023] [Revised: 01/12/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024] Open
Abstract
Objective This study aimed to explore the long-term outcome of unilateral moyamoya disease and predict the clinical and genetic factors associated with contralateral progression in unilateral moyamoya disease. Methods We retrospectively recruited unilateral moyamoya disease patients with available genetic data who underwent encephaloduroarteriosynangiosis (EDAS) surgery at our institution from January 2009 to November 2017. Long-term follow-up data, including clinical outcomes, angiographic features, and genetic information, were analyzed. Results A total of 83 unilateral moyamoya disease patients with available genetic data were enrolled in our study. The mean duration of clinical follow-up was 7.9 ± 2.0 years. Among all patients, 19 patients demonstrated contralateral progression to bilateral disease. Heterozygous Ring Finger Protein 213 p.R4810K mutations occurred significantly more frequently in unilateral moyamoya disease patients with contralateral progression. Furthermore, patients with contralateral progression typically demonstrated an earlier age of onset than those with non-progressing unilateral moyamoya disease. In the contralateral progression group, posterior circulation involvement was observed in 11 (11/19, 57.9%) patients compared to 12 (12/64, 18.8%) in the non-contralateral progression group (P = 0.001). The time to peak of cerebral perfusion and neurological status showed significant postoperative improvement. Conclusion Long-term follow-up revealed that the EDAS procedure might provide benefits for unilateral moyamoya disease patients. Ring Finger Protein 213 p.R4810K mutations, younger age, and posterior circulation involvement might predict the contralateral progression of unilateral moyamoya disease.
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Affiliation(s)
- Xiao-Peng Wang
- Medical School of Chinese PLA, Beijing, 100039, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Zheng-Xing Zou
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Xiang-Yang Bao
- Medical School of Chinese PLA, Beijing, 100039, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Qian-Nan Wang
- Department of Neurosurgery, the Eighth Medical Center of Chinese PLA General Hospital, Beijing, 100000, China
| | - Bin Ren
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Dan Yu
- Department of Neurosurgery, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Qian Zhang
- Department of Neurosurgery, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Jia-Qi Liu
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Fang-Bin Hao
- Medical School of Chinese PLA, Beijing, 100039, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Gan Gao
- Medical School of Chinese PLA, Beijing, 100039, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Qing-Bao Guo
- Medical School of Chinese PLA, Beijing, 100039, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - He-Guan Fu
- Department of Neurosurgery, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Jing-Jie Li
- Medical School of Chinese PLA, Beijing, 100039, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Min-Jie Wang
- Medical School of Chinese PLA, Beijing, 100039, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Si-Meng Liu
- Medical School of Chinese PLA, Beijing, 100039, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Lian Duan
- Medical School of Chinese PLA, Beijing, 100039, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
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Fang J, Yang X, Ni J. RNF213 in moyamoya disease: Genotype-phenotype association and the underlying mechanism. Chin Med J (Engl) 2024:00029330-990000000-00928. [PMID: 38243713 DOI: 10.1097/cm9.0000000000002985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Indexed: 01/21/2024] Open
Abstract
ABSTRACT Moyamoya disease (MMD) is a cerebrovascular disorder characterized by a steno-occlusive internal carotid artery and compensatory vascular network formation. Although the precise pathogenic mechanism remains elusive, genetic association studies have identified RNF213 as the principal susceptibility gene for MMD, with the single nucleotide polymorphism p.R4810K recognized as the founder variant predominantly in the Asian populations. Distinct genotype-phenotype correlations are observable in RNF213-related MMD. The clinical manifestations linked to p.R4810K bear commonalities within Asian cohort, including familial predisposition, earlier age of onset, ischemic episodes, and involvement of the posterior cerebral artery (PCA). However, despite these shared phenotypic characteristics, there is significant heterogeneity in RNF213-related MMD presentations. This diversity manifests as variations across ethnic groups, inconsistent clinical symptoms and prognosis, and occurrence of other vasculopathies involving RNF213. This heterogeneity, in conjunction with the observed low disease penetrance of RNF213 mutations, suggests that the presence of these mutations may not be sufficient to cause MMD, underscoring the potential influence of other genetic or environmental factors. Although the current research might not have fully identified these additional contributors, experimental evidence points toward the involvement of RNF213 in angiogenesis, lipid metabolism, and the immune response. Future research is required to unveil the molecular mechanisms and identify the factors that synergize with RNF213 in the pathogenesis of MMD.
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Affiliation(s)
- Jianxun Fang
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xinzhuang Yang
- Medical Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jun Ni
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
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Gao G, Wang QN, Hao FB, Wang XP, Liu SM, Wang MJ, Han C, Bao XY, Duan L. To explore the effectiveness of atorvastatin in the postoperative formation of collateral blood vessels after encephaloduroarteriosynangiosis in patients with moyamoya disease: a prospective double-blind randomized controlled study. Front Neurol 2023; 14:1169253. [PMID: 37332989 PMCID: PMC10270285 DOI: 10.3389/fneur.2023.1169253] [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: 02/19/2023] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction The aim of this large, prospective, double-blind randomized controlled trial is to investigate the effect of atorvastatin on the formation of collateral blood vessels in patients after encephaloduroarteriosynangiosis (EDAS) and to provide a theoretical basis for clinical drug intervention. Specifically, we will determine whether atorvastatin has an effect on the development of collateral vascularization and on cerebral blood perfusion after revasculoplasty in patients with moyamoya disease (MMD). Methods and analysis Overall, 180 patients with moyamoya disease will be recruited and randomly assigned to the atorvastatin treatment group or the placebo control group in a 1:1 ratio. Before revascularization surgery, magnetic resonance imaging (MRI) scanning and digital subangiography (DSA) examination will be routinely performed on the enrolled patients. All patients will receive intervention via EDAS. According to the randomization results, patients in the experimental group will be treated with atorvastatin (20 mg/day, once a day, for 8 weeks) and patients in the control group will be treated with placebo (20 mg/day, once a day, for 8 weeks). All participants will return to the hospital for MRI scan and DSA examination 6 months after EDAS surgery. The primary outcome of this trial will be the difference in the formation of collateral blood vessels revealed by DSA examination at 6 months after EDAS surgery between the two groups. The secondary outcome will be an improvement in the dynamic susceptibility contrast sequence cerebral perfusion on MRI at 6 months after EDAS, compared to the preoperative baseline. Ethics and dissemination This study was approved by the Ethics Committee of the First Medical Center of the PLA General Hospital. All participates will voluntary provide written informed consent before participating in the trial. Clinical trial registration ClinicalTrials.gov, ChiCTR2200064976.
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Affiliation(s)
- Gan Gao
- Chinese PLA Medical School, Beijing, China
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Qian-Nan Wang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Fang-Bin Hao
- Chinese PLA Medical School, Beijing, China
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Peng Wang
- Chinese PLA Medical School, Beijing, China
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Si-Meng Liu
- Chinese PLA Medical School, Beijing, China
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Min-Jie Wang
- Chinese PLA Medical School, Beijing, China
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Cong Han
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Xiang-Yang Bao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Lian Duan
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
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