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Ibanez L, Heitsch L, Carrera C, Farias FHG, Del Aguila JL, Dhar R, Budde J, Bergmann K, Bradley J, Harari O, Phuah CL, Lemmens R, Viana Oliveira Souza AA, Moniche F, Cabezas-Juan A, Arenillas JF, Krupinksi J, Cullell N, Torres-Aguila N, Muiño E, Cárcel-Márquez J, Marti-Fabregas J, Delgado-Mederos R, Marin-Bueno R, Hornick A, Vives-Bauza C, Navarro RD, Tur S, Jimenez C, Obach V, Segura T, Serrano-Heras G, Chung JW, Roquer J, Soriano-Tarraga C, Giralt-Steinhauer E, Mola-Caminal M, Pera J, Lapicka-Bodzioch K, Derbisz J, Davalos A, Lopez-Cancio E, Muñoz L, Tatlisumak T, Molina C, Ribo M, Bustamante A, Sobrino T, Castillo-Sanchez J, Campos F, Rodriguez-Castro E, Arias-Rivas S, Rodríguez-Yáñez M, Herbosa C, Ford AL, Gutierrez-Romero A, Uribe-Pacheco R, Arauz A, Lopes-Cendes I, Lowenkopf T, Barboza MA, Amini H, Stamova B, Ander BP, Sharp FR, Kim GM, Bang OY, Jimenez-Conde J, Slowik A, Stribian D, Tsai EA, Burkly LC, Montaner J, Fernandez-Cadenas I, Lee JM, Cruchaga C. Multi-ancestry GWAS reveals excitotoxicity associated with outcome after ischaemic stroke. Brain 2022; 145:2394-2406. [PMID: 35213696 PMCID: PMC9890452 DOI: 10.1093/brain/awac080] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 01/14/2022] [Accepted: 02/06/2022] [Indexed: 02/05/2023] Open
Abstract
During the first hours after stroke onset, neurological deficits can be highly unstable: some patients rapidly improve, while others deteriorate. This early neurological instability has a major impact on long-term outcome. Here, we aimed to determine the genetic architecture of early neurological instability measured by the difference between the National Institutes of Health Stroke Scale (NIHSS) within 6 h of stroke onset and NIHSS at 24 h. A total of 5876 individuals from seven countries (Spain, Finland, Poland, USA, Costa Rica, Mexico and Korea) were studied using a multi-ancestry meta-analyses. We found that 8.7% of NIHSS at 24 h of variance was explained by common genetic variations, and also that early neurological instability has a different genetic architecture from that of stroke risk. Eight loci (1p21.1, 1q42.2, 2p25.1, 2q31.2, 2q33.3, 5q33.2, 7p21.2 and 13q31.1) were genome-wide significant and explained 1.8% of the variability suggesting that additional variants influence early change in neurological deficits. We used functional genomics and bioinformatic annotation to identify the genes driving the association from each locus. Expression quantitative trait loci mapping and summary data-based Mendelian randomization indicate that ADAM23 (log Bayes factor = 5.41) was driving the association for 2q33.3. Gene-based analyses suggested that GRIA1 (log Bayes factor = 5.19), which is predominantly expressed in the brain, is the gene driving the association for the 5q33.2 locus. These analyses also nominated GNPAT (log Bayes factor = 7.64) ABCB5 (log Bayes factor = 5.97) for the 1p21.1 and 7p21.1 loci. Human brain single-nuclei RNA-sequencing indicates that the gene expression of ADAM23 and GRIA1 is enriched in neurons. ADAM23, a presynaptic protein and GRIA1, a protein subunit of the AMPA receptor, are part of a synaptic protein complex that modulates neuronal excitability. These data provide the first genetic evidence in humans that excitotoxicity may contribute to early neurological instability after acute ischaemic stroke.
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Affiliation(s)
- Laura Ibanez
- Department of Psychiatry, School of Medicine, Washington University, Saint Louis 63110, MO, USA
- NeuroGenomics and Informatics, School of Medicine, Washington University, Saint Louis 63110, MO, USA
| | - Laura Heitsch
- Department of Neurology, School of Medicine, Washington University, Saint Louis 63110, MO, USA
- Department of Emergency Medicine, School of Medicine, Washington University, Saint Louis 63110, MO, USA
| | - Caty Carrera
- Stroke Unit, Vall d’Hebron University Hospital, Universitat de Barcelona, Barcelona 08035, Spain
| | - Fabiana H G Farias
- Department of Psychiatry, School of Medicine, Washington University, Saint Louis 63110, MO, USA
- NeuroGenomics and Informatics, School of Medicine, Washington University, Saint Louis 63110, MO, USA
| | - Jorge L Del Aguila
- Department of Psychiatry, School of Medicine, Washington University, Saint Louis 63110, MO, USA
- NeuroGenomics and Informatics, School of Medicine, Washington University, Saint Louis 63110, MO, USA
| | - Rajat Dhar
- Department of Neurology, School of Medicine, Washington University, Saint Louis 63110, MO, USA
| | - John Budde
- Department of Psychiatry, School of Medicine, Washington University, Saint Louis 63110, MO, USA
- NeuroGenomics and Informatics, School of Medicine, Washington University, Saint Louis 63110, MO, USA
| | - Kristy Bergmann
- Department of Psychiatry, School of Medicine, Washington University, Saint Louis 63110, MO, USA
- NeuroGenomics and Informatics, School of Medicine, Washington University, Saint Louis 63110, MO, USA
| | - Joseph Bradley
- Department of Psychiatry, School of Medicine, Washington University, Saint Louis 63110, MO, USA
- NeuroGenomics and Informatics, School of Medicine, Washington University, Saint Louis 63110, MO, USA
| | - Oscar Harari
- Department of Psychiatry, School of Medicine, Washington University, Saint Louis 63110, MO, USA
- NeuroGenomics and Informatics, School of Medicine, Washington University, Saint Louis 63110, MO, USA
- Hope Center for Neurological Disorders, School of Medicine, Washington University, Saint Louis 63110, MO, USA
- The Charles F. and Joanne Knight Alzheimer Disease Research Center, School of Medicine, Washington University, Saint Louis 63110, MO, USA
| | - Chia Ling Phuah
- Department of Neurology, School of Medicine, Washington University, Saint Louis 63110, MO, USA
| | - Robin Lemmens
- Department of Neuroscience, Katholieke Universiteit Leuven, Campus Gasthuisberg O&N2, Leuven BE-3000, Belgium
| | - Alessandro A Viana Oliveira Souza
- Department of Neurology, School of Medical Sciences, University of Campinas (UNICAMP), Cidade Universitaria, Campinas 13083-887, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), R. Tessalia Viera de Camargo, Campinas 13083-887, Brazil
| | - Francisco Moniche
- Department of Neurology, Hospital Virgen del Rocio, University of Seville, Seville 41013, Spain
| | - Antonio Cabezas-Juan
- Department of Neurology, Hospital Virgen del Rocio, University of Seville, Seville 41013, Spain
- Hospital Virgen de la Macarena, University of Seville, Seville 41009, Spain
| | - Juan Francisco Arenillas
- Department of Neurology, Hospital Clinico Universitario Valladolid, Valladolid University, Valladolid 47003, Spain
| | - Jerzy Krupinksi
- Department of Neurology, Mutua Terrassa University Hospital, Universitat de Barcelona, Terrassa 08221, Spain
- Fundacio Docencia i Recerca Mutua Terrassa, Universitat de Barcelona, Terrassa 08221, Spain
| | - Natalia Cullell
- Fundacio Docencia i Recerca Mutua Terrassa, Universitat de Barcelona, Terrassa 08221, Spain
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona 08041, Spain
| | - Nuria Torres-Aguila
- Fundacio Docencia i Recerca Mutua Terrassa, Universitat de Barcelona, Terrassa 08221, Spain
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona 08041, Spain
| | - Elena Muiño
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona 08041, Spain
| | - Jara Cárcel-Márquez
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona 08041, Spain
| | - Joan Marti-Fabregas
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona 08041, Spain
| | - Raquel Delgado-Mederos
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona 08041, Spain
| | - Rebeca Marin-Bueno
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona 08041, Spain
| | - Alejandro Hornick
- Department of Neurology, Southern Illinois Healthcare Memorial Hospital of Carbondale, Carbondale 62901, IL, USA
| | | | - Rosa Diaz Navarro
- Department of Neurology, Hospital Universitari Son Espases, Universitat de les Illes Balears, Palma 07120, Spain
| | - Silvia Tur
- Department of Neurology, Hospital Universitari Son Espases, Universitat de les Illes Balears, Palma 07120, Spain
| | - Carmen Jimenez
- Department of Neurology, Hospital Universitari Son Espases, Universitat de les Illes Balears, Palma 07120, Spain
| | - Victor Obach
- Department of Neurology, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona 08036, Spain
| | - Tomas Segura
- Research Unit, Complejo Hospitalario Universitario de Albacete, Albacete 02008, Spain
| | - Gemma Serrano-Heras
- Research Unit, Complejo Hospitalario Universitario de Albacete, Albacete 02008, Spain
| | - Jong Won Chung
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| | - Jaume Roquer
- Neurovascular Research Group, Institut Hospital del Mar de Investigacions Mediques, Barcelona 08003, Spain
| | - Carol Soriano-Tarraga
- Department of Psychiatry, School of Medicine, Washington University, Saint Louis 63110, MO, USA
- NeuroGenomics and Informatics, School of Medicine, Washington University, Saint Louis 63110, MO, USA
- Neurovascular Research Group, Institut Hospital del Mar de Investigacions Mediques, Barcelona 08003, Spain
| | - Eva Giralt-Steinhauer
- Neurovascular Research Group, Institut Hospital del Mar de Investigacions Mediques, Barcelona 08003, Spain
| | - Marina Mola-Caminal
- Neurovascular Research Group, Institut Hospital del Mar de Investigacions Mediques, Barcelona 08003, Spain
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala 75185, Sweden
| | - Joanna Pera
- Department of Neurology, Jagiellonian University, Krakow 31-007, Poland
| | | | - Justyna Derbisz
- Department of Neurology, Jagiellonian University, Krakow 31-007, Poland
| | - Antoni Davalos
- Department of Neurology, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona 08916, Spain
| | - Elena Lopez-Cancio
- Department of Neurology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Lucia Muñoz
- Department of Neurology, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona 08916, Spain
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg 413 45, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Carlos Molina
- Stroke Unit, Vall d’Hebron University Hospital, Universitat de Barcelona, Barcelona 08035, Spain
| | - Marc Ribo
- Stroke Unit, Vall d’Hebron University Hospital, Universitat de Barcelona, Barcelona 08035, Spain
| | - Alejandro Bustamante
- Department of Neurology, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona 08916, Spain
| | - Tomas Sobrino
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain
| | - Jose Castillo-Sanchez
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain
| | - Emilio Rodriguez-Castro
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain
| | - Susana Arias-Rivas
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain
| | - Manuel Rodríguez-Yáñez
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela 15706, Spain
| | - Christina Herbosa
- Department of Neurology, School of Medicine, Washington University, Saint Louis 63110, MO, USA
| | - Andria L Ford
- Department of Neurology, School of Medicine, Washington University, Saint Louis 63110, MO, USA
- Hope Center for Neurological Disorders, School of Medicine, Washington University, Saint Louis 63110, MO, USA
- Department of Radiology, School of Medicine, Washington University, Saint Louis 63110, MO, USA
| | | | - Rodrigo Uribe-Pacheco
- Instituto Nacional de Neurologia y Neurocirurgia de Mexico, Ciudad de Mexico 14269, Mexico
| | - Antonio Arauz
- Instituto Nacional de Neurologia y Neurocirurgia de Mexico, Ciudad de Mexico 14269, Mexico
| | - Iscia Lopes-Cendes
- Department of Neurology, School of Medical Sciences, University of Campinas (UNICAMP), Cidade Universitaria, Campinas 13083-887, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), R. Tessalia Viera de Camargo, Campinas 13083-887, Brazil
| | - Theodore Lowenkopf
- Department of Neurology, Providence St. Vincent Medical Center, Portland 97225, OR, USA
| | - Miguel A Barboza
- Neurosciences Department, Hospital Rafael A. Calderon Guardia, Aranjuez, San José, Costa Rica
| | - Hajar Amini
- Department of Neurology and MIND Institute, University of California at Davis, Sacramento 95817, CA, USA
| | - Boryana Stamova
- Department of Neurology and MIND Institute, University of California at Davis, Sacramento 95817, CA, USA
| | - Bradley P Ander
- Department of Neurology and MIND Institute, University of California at Davis, Sacramento 95817, CA, USA
| | - Frank R Sharp
- Department of Neurology and MIND Institute, University of California at Davis, Sacramento 95817, CA, USA
| | - Gyeong Moon Kim
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| | - Jordi Jimenez-Conde
- Neurovascular Research Group, Institut Hospital del Mar de Investigacions Mediques, Barcelona 08003, Spain
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University, Krakow 31-007, Poland
| | - Daniel Stribian
- Department of Neurology, Helsinki University Hospital, Helsinki 00290, Finland
| | - Ellen A Tsai
- Translational Biology, Biogen, Inc., Cambridge 02142, MA, USA
| | - Linda C Burkly
- Genetics and Neurodevelopmental Disease Research Unit, Biogen, Inc., Cambridge 02142, MA, USA
| | - Joan Montaner
- Stroke Unit, Vall d’Hebron University Hospital, Universitat de Barcelona, Barcelona 08035, Spain
- Department of Neurology, Hospital Virgen del Rocio, University of Seville, Seville 41013, Spain
- Hospital Virgen de la Macarena, University of Seville, Seville 41009, Spain
| | - Israel Fernandez-Cadenas
- Stroke Unit, Vall d’Hebron University Hospital, Universitat de Barcelona, Barcelona 08035, Spain
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona 08041, Spain
| | - Jin Moo Lee
- Correspondence may also be addressed to: Jin-Moo Lee School of Medicine, Washington University 660 South Euclid Avenue Campus Box 8111 St. Louis, MO 63110, USA E-mail:
| | - Carlos Cruchaga
- Correspondence to: Carlos Cruchaga School of Medicine, Washington University 660 South Euclid Avenue Campus Box 8134 Saint Louis, MO 63110, USA E-mail:
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