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Rutten JW, Cerfontaine MN, Dijkstra KL, Mulder AA, Vreijling J, Kruit M, Koning RI, de Bot ST, van Nieuwenhuizen KM, Baelde HJ, Berendse HW, Mei LH, Ruijter GJG, Baas F, Jost CR, van Duinen SG, Nibbeling EAR, Gravesteijn G, Lesnik Oberstein SAJ. Bi-allelic NIT1 variants cause a brain small vessel disease characterized by movement disorders, massively dilated perivascular spaces, and intracerebral hemorrhage. Genet Med 2024; 26:101105. [PMID: 38430071 DOI: 10.1016/j.gim.2024.101105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
PURPOSE To describe a recessively inherited cerebral small vessel disease, caused by loss-of-function variants in Nitrilase1 (NIT1). METHODS We performed exome sequencing, brain magnetic resonance imaging, neuropathology, electron microscopy, western blotting, and transcriptomic and metabolic analyses in 7 NIT1-small vessel disease patients from 5 unrelated pedigrees. RESULTS The first identified patients were 3 siblings, compound heterozygous for the NIT1 c.727C>T; (p.Arg243Trp) variant and the NIT1 c.198_199del; p.(Ala68∗) variant. The 4 additional patients were single cases from 4 unrelated pedigrees and were all homozygous for the NIT1 c.727C>T; p.(Arg243Trp) variant. Patients presented in mid-adulthood with movement disorders. All patients had striking abnormalities on brain magnetic resonance imaging, with numerous and massively dilated basal ganglia perivascular spaces. Three patients had non-lobar intracerebral hemorrhage between age 45 and 60, which was fatal in 2 cases. Western blotting on patient fibroblasts showed absence of NIT1 protein, and metabolic analysis in urine confirmed loss of NIT1 enzymatic function. Brain autopsy revealed large electron-dense deposits in the vessel walls of small and medium sized cerebral arteries. CONCLUSION NIT1-small vessel disease is a novel, autosomal recessively inherited cerebral small vessel disease characterized by a triad of movement disorders, massively dilated basal ganglia perivascular spaces, and intracerebral hemorrhage.
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Affiliation(s)
- Julie W Rutten
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Minne N Cerfontaine
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Kyra L Dijkstra
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Aat A Mulder
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen Vreijling
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark Kruit
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roman I Koning
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Susanne T de Bot
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Hans J Baelde
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Henk W Berendse
- Department of Neurology, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Leon H Mei
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - George J G Ruijter
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frank Baas
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Carolina R Jost
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sjoerd G van Duinen
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther A R Nibbeling
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Gido Gravesteijn
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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2
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van Slobbe M, van Haeringen A, Vissers LELM, Bijlsma EK, Rutten JW, Suerink M, Nibbeling EAR, Ruivenkamp CAL, Koene S. Reanalysis of whole-exome sequencing (WES) data of children with neurodevelopmental disorders in a standard patient care context. Eur J Pediatr 2024; 183:345-355. [PMID: 37889289 PMCID: PMC10858114 DOI: 10.1007/s00431-023-05279-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/20/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
This study aims to inform future genetic reanalysis management by evaluating the yield of whole-exome sequencing (WES) reanalysis in standard patient care in the Netherlands. Single-center data of 159 patients with a neurodevelopmental disorder (NDD), in which WES analysis and reanalysis were performed between January 1, 2014, and December 31, 2021, was retrospectively collected. Patients were included if they were under the age of 18 years at initial analysis and if this initial analysis did not result in a diagnosis. Demographic, phenotypic, and genotypic characteristics of patients were collected and analyzed. The primary outcomes of our study were (i) diagnostic yield at reanalysis, (ii) reasons for detecting a new possibly causal variant at reanalysis, (iii) unsolicited findings, and (iv) factors associated with positive result of reanalysis. In addition, we conducted a questionnaire study amongst the 7 genetic department in the Netherlands creating an overview of used techniques, yield, and organization of WES reanalysis. The single-center data show that in most cases, WES reanalysis was initiated by the clinical geneticist (65%) or treating physician (30%). The mean time between initial WES analysis and reanalysis was 3.7 years. A new (likely) pathogenic variant or VUS with a clear link to the phenotype was found in 20 initially negative cases, resulting in a diagnostic yield of 12.6%. In 75% of these patients, the diagnosis had clinical consequences, as for example, a screening plan for associated signs and symptoms could be devised. Most (32%) of the (likely) causal variants identified at WES reanalysis were discovered due to a newly described gene-disease association. In addition to the 12.6% diagnostic yield based on new diagnoses, reclassification of a variant of uncertain significance found at initial analysis led to a definite diagnosis in three patients. Diagnostic yield was higher in patients with dysmorphic features compared to patients without clear dysmorphic features (yield 27% vs. 6%; p = 0.001). CONCLUSIONS Our results show that WES reanalysis in patients with NDD in standard patient care leads to a substantial increase in genetic diagnoses. In the majority of newly diagnosed patients, the diagnosis had clinical consequences. Knowledge about the clinical impact of WES reanalysis, clinical characteristics associated with higher yield, and the yield per year after a negative WES in larger clinical cohorts is warranted to inform guidelines for genetic reanalysis. These guidelines will be of great value for pediatricians, pediatric rehabilitation specialists, and pediatric neurologists in daily care of patients with NDD. WHAT IS KNOWN • Whole exome sequencing can cost-effectively identify a genetic cause of intellectual disability in about 30-40% of patients. • WES reanalysis in a research setting can lead to a definitive diagnosis in 10-20% of previously exome negative cases. WHAT IS NEW • WES reanalysis in standard patient care resulted in a diagnostic yield of 13% in previously exome negative children with NDD. • The presence of dysmorphic features is associated with an increased diagnostic yield of WES reanalysis.
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Affiliation(s)
- Michelle van Slobbe
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Arie van Haeringen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Lisenka E L M Vissers
- Department of Human Genetics, Donders Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Emilia K Bijlsma
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Julie W Rutten
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Manon Suerink
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Esther A R Nibbeling
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Claudia A L Ruivenkamp
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Saskia Koene
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands.
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3
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Hack RJ, Gravesteijn G, Cerfontaine MN, Santcroos MA, Gatti L, Kopczak A, Bersano A, Duering M, Rutten JW, Lesnik Oberstein SAJ. Three-tiered EGFr domain risk stratification for individualized NOTCH3-small vessel disease prediction. Brain 2023; 146:2913-2927. [PMID: 36535904 PMCID: PMC10316769 DOI: 10.1093/brain/awac486] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 06/28/2022] [Revised: 11/23/2022] [Accepted: 11/27/2022] [Indexed: 02/10/2024] Open
Abstract
Cysteine-altering missense variants (NOTCH3cys) in one of the 34 epidermal growth-factor-like repeat (EGFr) domains of the NOTCH3 protein are the cause of NOTCH3-associated small vessel disease (NOTCH3-SVD). NOTCH3-SVD is highly variable, ranging from cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) at the severe end of the spectrum to non-penetrance. The strongest known NOTCH3-SVD modifier is NOTCH3cys variant position: NOTCH3cys variants located in EGFr domains 1-6 are associated with a more severe phenotype than NOTCH3cys variants located in EGFr domains 7-34. The objective of this study was to further improve NOTCH3-SVD genotype-based risk prediction by using relative differences in NOTCH3cys variant frequencies between large CADASIL and population cohorts as a starting point. Scientific CADASIL literature, cohorts and population databases were queried for NOTCH3cys variants. For each EGFr domain, the relative difference in NOTCH3cys variant frequency (NVFOR) was calculated using genotypes of 2574 CADASIL patients and 1647 individuals from population databases. Based on NVFOR cut-off values, EGFr domains were classified as either low (LR-EGFr), medium (MR-EGFr) or high risk (HR-EGFr). The clinical relevance of this new three-tiered EGFr risk classification was cross-sectionally validated by comparing SVD imaging markers and clinical outcomes between EGFr risk categories using a genotype-phenotype data set of 434 CADASIL patients and 1003 NOTCH3cys positive community-dwelling individuals. CADASIL patients and community-dwelling individuals harboured 379 unique NOTCH3cys variants. Nine EGFr domains were classified as an HR-EGFr, which included EGFr domains 1-6, but additionally also EGFr domains 8, 11 and 26. Ten EGFr domains were classified as MR-EGFr and 11 as LR-EGFr. In the population genotype-phenotype data set, HR-EGFr individuals had the highest risk of stroke [odds ratio (OR) = 10.81, 95% confidence interval (CI): 5.46-21.37], followed by MR-EGFr individuals (OR = 1.81, 95% CI: 0.84-3.88) and LR-EGFr individuals (OR = 1 [reference]). MR-EGFr individuals had a significantly higher normalized white matter hyperintensity volume (nWMHv; P = 0.005) and peak width of skeletonized mean diffusivity (PSMD; P = 0.035) than LR-EGFr individuals. In the CADASIL genotype-phenotype data set, HR-EGFr domains 8, 11 and 26 patients had a significantly higher risk of stroke (P = 0.002), disability (P = 0.041), nWMHv (P = 1.8 × 10-8), PSMD (P = 2.6 × 10-8) and lacune volume (P = 0.006) than MR-EGFr patients. SVD imaging marker load and clinical outcomes were similar between HR-EGFr 1-6 patients and HR-EGFr 8, 11 and 26 patients. NVFOR was significantly associated with vascular NOTCH3 aggregation load (P = 0.006), but not with NOTCH3 signalling activity (P = 0.88). In conclusion, we identified three clinically distinct NOTCH3-SVD EGFr risk categories based on NFVOR cut-off values, and identified three additional HR-EGFr domains located outside of EGFr domains 1-6. This EGFr risk classification will provide an important key to individualized NOTCH3-SVD disease prediction.
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Affiliation(s)
- Remco J Hack
- Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Gido Gravesteijn
- Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Minne N Cerfontaine
- Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Mark A Santcroos
- Department of Human Genetics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Laura Gatti
- Laboratory of Neurobiology, Fondazione IRCSS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Anna Kopczak
- Institute for Stroke and Dementia Research, LMU University Hospital Munich, 81377 Munich, Germany
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Marco Duering
- Institute for Stroke and Dementia Research, LMU University Hospital Munich, 81377 Munich, Germany
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, 4051 Basel, Switzerland
| | - Julie W Rutten
- Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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4
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Oliveira DV, Coupland KG, Shao W, Jin S, Del Gaudio F, Wang S, Fox R, Rutten JW, Sandin J, Zetterberg H, Lundkvist J, Lesnik Oberstein SAJ, Lendahl U, Karlström H. Active immunotherapy reduces NOTCH3 deposition in brain capillaries in a CADASIL mouse model. EMBO Mol Med 2022; 15:e16556. [PMID: 36524456 PMCID: PMC9906330 DOI: 10.15252/emmm.202216556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/14/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common monogenic form of familial small vessel disease; no preventive or curative therapy is available. CADASIL is caused by mutations in the NOTCH3 gene, resulting in a mutated NOTCH3 receptor, with aggregation of the NOTCH3 extracellular domain (ECD) around vascular smooth muscle cells. In this study, we have developed a novel active immunization therapy specifically targeting CADASIL-like aggregated NOTCH3 ECD. Immunizing CADASIL TgN3R182C150 mice with aggregates composed of CADASIL-R133C mutated and wild-type EGF1-5 repeats for a total of 4 months resulted in a marked reduction (38-48%) in NOTCH3 deposition around brain capillaries, increased microglia activation and lowered serum levels of NOTCH3 ECD. Active immunization did not impact body weight, general behavior, the number and integrity of vascular smooth muscle cells in the retina, neuronal survival, or inflammation or the renal system, suggesting that the therapy is tolerable. This is the first therapeutic study reporting a successful reduction of NOTCH3 accumulation in a CADASIL mouse model supporting further development towards clinical application for the benefit of CADASIL patients.
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Affiliation(s)
- Daniel V Oliveira
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden,Department of Cell Biology, Faculty of ScienceCharles UniversityPragueCzech Republic
| | - Kirsten G Coupland
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Wenchao Shao
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Shaobo Jin
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden,Department of Cell and Molecular BiologyKarolinska InstitutetStockholmSweden
| | | | - Sailan Wang
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Rhys Fox
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden,Department of Cell and Molecular BiologyKarolinska InstitutetStockholmSweden
| | - Julie W Rutten
- Department of Clinical GeneticsLeiden University Medical CenterLeidenThe Netherlands
| | - Johan Sandin
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden,Alzecure FoundationHuddingeSweden,Alzecure PharmaHuddingeSweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and PhysiologyThe Sahlgrenska Academy at the University of GothenburgMölndalSweden,Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden,Department of Neurodegenerative DiseaseUCL Institute of Neurology, Queen SquareLondonUK,UK Dementia Research Institute at UCLLondonUK,Hong Kong Center for Neurodegenerative Diseases, Clear Water BayHong KongChina
| | - Johan Lundkvist
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden,Alzecure FoundationHuddingeSweden,Sinfonia BiotherapeuticsHuddingeSweden
| | | | - Urban Lendahl
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden,Department of Cell and Molecular BiologyKarolinska InstitutetStockholmSweden
| | - Helena Karlström
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
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5
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Hack RJ, Cerfontaine MN, Gravesteijn G, Tap S, Hafkemeijer A, van der Grond J, Witjes-Ané MN, Baas F, Rutten JW, Lesnik Oberstein SA. Effect of
NOTCH3
EGFr Group, Sex, and Cardiovascular Risk Factors on CADASIL Clinical and Neuroimaging Outcomes. Stroke 2022; 53:3133-3144. [PMID: 35862191 PMCID: PMC9508953 DOI: 10.1161/strokeaha.122.039325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A retrospective study has shown that EGFr (epidermal growth factor–like repeat) group in the NOTCH3 gene is an important cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) disease modifier of age at first stroke and white matter hyperintensity (WMH) volume. No study has yet assessed the effect of other known CADASIL modifiers, that is, cardiovascular risk factors and sex, in the context of NOTCH3 EGFr group. In this study, we determined the relative disease-modifying effects of NOTCH3 EGFr group, sex and cardiovascular risk factor on disease severity in the first genotype-driven, large prospective CADASIL cohort study, using a comprehensive battery of CADASIL clinical outcomes and neuroimaging markers.
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Affiliation(s)
- Remco J. Hack
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Minne N. Cerfontaine
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Gido Gravesteijn
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Stephan Tap
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Anne Hafkemeijer
- Department of Radiology, Leiden University Medical Center, the Netherlands. (A.H., J.v.d.G.)
- Institute of Psychology, Leiden University, the Netherlands. (A.H.)
- Leiden Institute for Brain and Cognition, Leiden University, the Netherlands. (A.H.)
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, the Netherlands. (A.H., J.v.d.G.)
| | - Marie-Noëlle Witjes-Ané
- Department of Geriatrics and Psychiatrics, Leiden University Medical Center, the Netherlands. (M.N.W.-A.)
| | - Frank Baas
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Julie W. Rutten
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Saskia A.J. Lesnik Oberstein
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
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6
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Hack RJ, Gravesteijn G, Cerfontaine MN, Hegeman IM, Mulder AA, Lesnik Oberstein SA, Rutten JW. Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy Family Members With a Pathogenic NOTCH3 Variant Can Have a Normal Brain Magnetic Resonance Imaging and Skin Biopsy Beyond Age 50 Years. Stroke 2022; 53:1964-1974. [PMID: 35300531 PMCID: PMC9126263 DOI: 10.1161/strokeaha.121.036307] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/16/2021] [Accepted: 12/15/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND To determine whether extremely mild small vessel disease (SVD) phenotypes can occur in NOTCH3 variant carriers from Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) pedigrees using clinical, genetic, neuroimaging, and skin biopsy findings. METHODS Individuals from CADASIL pedigrees fulfilling criteria for extremely mild NOTCH3-associated SVD (mSVDNOTCH3) were selected from the cross-sectional Dutch CADASIL cohort (n=200), enrolled between 2017 and 2020. Brain magnetic resonance imaging were quantitatively assessed for SVD imaging markers. Immunohistochemistry and electron microscopy was used to quantitatively assess and compare NOTCH3 ectodomain (NOTCH3ECD) aggregation and granular osmiophilic material deposits in the skin vasculature of mSVDNOTCH3 cases and symptomatic CADASIL patients. RESULTS Seven cases were identified that fulfilled the mSVDNOTCH3 criteria, with a mean age of 56.6 years (range, 50-72). All of these individuals harbored a NOTCH3 variant located in one of EGFr domains 7-34 and had a normal brain magnetic resonance imaging, except the oldest individual, aged 72, who had beginning confluence of WMH (Fazekas score 2) and 1 cerebral microbleed. mSVDNOTCH3 cases had very low levels of NOTCH3ECD aggregation in skin vasculature, which was significantly less than in symptomatic EGFr 7-34 CADASIL patients (P=0.01). Six mSVDNOTCH3 cases had absence of granular osmiophilic material deposits. CONCLUSIONS Our findings demonstrate that extremely mild SVD phenotypes can occur in individuals from CADASIL pedigrees harboring NOTCH3 EGFr 7-34 variants with normal brain magnetic resonance imaging up to age 58 years. Our study has important implications for CADASIL diagnosis, disease prediction, and the counseling of individuals from EGFr 7-34 CADASIL pedigrees.
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Affiliation(s)
- Remco J. Hack
- Department of Clinical Genetics (R.J.H., G.G., M.N.C., S.A.J.L.O., J.W.R.), Leiden University Medical Center, the Netherlands
| | - Gido Gravesteijn
- Department of Clinical Genetics (R.J.H., G.G., M.N.C., S.A.J.L.O., J.W.R.), Leiden University Medical Center, the Netherlands
| | - Minne N. Cerfontaine
- Department of Clinical Genetics (R.J.H., G.G., M.N.C., S.A.J.L.O., J.W.R.), Leiden University Medical Center, the Netherlands
| | - Ingrid M. Hegeman
- Department of Pathology (I.M.H.), Leiden University Medical Center, the Netherlands
| | - Aat A. Mulder
- Department of Cell and Chemical Biology (A.A.M.), Leiden University Medical Center, the Netherlands
| | - Saskia A.J. Lesnik Oberstein
- Department of Clinical Genetics (R.J.H., G.G., M.N.C., S.A.J.L.O., J.W.R.), Leiden University Medical Center, the Netherlands
| | - Julie W. Rutten
- Department of Clinical Genetics (R.J.H., G.G., M.N.C., S.A.J.L.O., J.W.R.), Leiden University Medical Center, the Netherlands
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7
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Richardson R, Baralle D, Bennett C, Briggs T, Bijlsma EK, Clayton-Smith J, Constantinou P, Foulds N, Jarvis J, Jewell R, Johnson DS, McEntagart M, Parker MJ, Radley JA, Robertson L, Ruivenkamp C, Rutten JW, Tellez J, Turnpenny PD, Wilson V, Wright M, Balasubramanian M. Further delineation of phenotypic spectrum of SCN2A-related disorder. Am J Med Genet A 2022; 188:867-877. [PMID: 34894057 DOI: 10.1002/ajmg.a.62595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/26/2021] [Revised: 09/28/2021] [Accepted: 11/20/2021] [Indexed: 01/12/2023]
Abstract
SCN2A-related disorders include intellectual disability, autism spectrum disorder, seizures, episodic ataxia, and schizophrenia. In this study, the phenotype-genotype association in SCN2A-related disorders was further delineated by collecting detailed clinical and molecular characteristics. Using previously proposed genotype-phenotype hypotheses based on variant function and position, the potential of phenotype prediction from the variants found was examined. Patients were identified through the Deciphering Developmental Disorders study and gene matching strategies. Phenotypic information and variant interpretation evidence were collated. Seventeen previously unreported patients and five patients who had been previously reported (but with minimal phenotypic and segregation data) were included (10 males, 12 females; median age 10.5 years). All patients had developmental delays and the majority had intellectual disabilities. Seizures were reported in 15 of 22 (68.2%), four of 22 (18.2%) had autism spectrum disorder and no patients were reported with episodic ataxia. The majority of variants were de novo. One family had presumed gonadal mosaicism. The correlation of the use of sodium channel-blocking antiepileptic drugs with phenotype or genotype was variable. These data suggest that variant type and position alone can provide some predictive information about the phenotype in a proportion of cases, but more precise assessment of variant function is needed for meaningful phenotype prediction.
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Affiliation(s)
- Ruth Richardson
- Northern Genetics Service, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle, UK
| | - Diana Baralle
- University Hospital of Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Christopher Bennett
- Yorkshire Regional Genetics Service, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Tracy Briggs
- NW Genomic Laboratory Hub, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Emilia K Bijlsma
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jill Clayton-Smith
- NW Genomic Laboratory Hub, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | | | - Nicola Foulds
- University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Joanna Jarvis
- Clinical Genetics Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Rosalyn Jewell
- Yorkshire Regional Genetics Service, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Diana S Johnson
- Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Meriel McEntagart
- South West Thames Regional Genetics Centre, St. George's Healthcare NHS Trust, St. George's, University of London, London, UK
| | - Michael J Parker
- Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Jessica A Radley
- London North West Regional Genetics Service, St. Mark's and Northwick Park Hospitals, London, UK
| | | | - Claudia Ruivenkamp
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Julie W Rutten
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - James Tellez
- Northern Genetics Service, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle, UK
| | - Peter D Turnpenny
- Clinical Genetics Department, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Valerie Wilson
- Northern Genetics Service, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle, UK
| | - Michael Wright
- Northern Genetics Service, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle, UK
| | - Meena Balasubramanian
- Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Gravesteijn G, Hack RJ, Mulder AA, Cerfontaine MN, van Doorn R, Hegeman IM, Jost CR, Rutten JW, Lesnik Oberstein SAJ. NOTCH3 variant position is associated with NOTCH3 aggregation load in CADASIL vasculature. Neuropathol Appl Neurobiol 2021; 48:e12751. [PMID: 34297860 PMCID: PMC9291091 DOI: 10.1111/nan.12751] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/15/2021] [Accepted: 07/17/2021] [Indexed: 12/02/2022]
Abstract
Aims CADASIL, the most prevalent hereditary cerebral small vessel disease, is caused by cysteine‐altering NOTCH3 variants (NOTCH3cys) leading to vascular NOTCH3 protein aggregation. It has recently been shown that variants located in one of NOTCH3 protein epidermal growth‐factor like repeat (EGFr) domains 1–6, are associated with a more severe phenotype than variants located in one of the EGFr domains 7–34. The underlying mechanism for this genotype–phenotype correlation is unknown. The aim of this study was to analyse whether NOTCH3cys variant position is associated with NOTCH3 protein aggregation load. Methods We quantified vascular NOTCH3 aggregation in skin biopsies (n = 25) and brain tissue (n = 7) of CADASIL patients with a NOTCH3cys EGFr 1–6 variant or a EGFr 7–34 variant, using NOTCH3 immunohistochemistry (NOTCH3 score) and ultrastructural analysis of granular osmiophilic material (GOM count). Disease severity was assessed by neuroimaging (lacune count and white matter hyperintensity volume) and disability (modified Rankin scale). Results Patients with NOTCH3cys EGFr 7–34 variants had lower NOTCH3 scores (P = 1.3·10−5) and lower GOM counts (P = 8.2·10−5) than patients with NOTCH3cys EGFr 1–6 variants in skin vessels. A similar trend was observed in brain vasculature. In the EGFr 7–34 group, NOTCH3 aggregation levels were associated with lacune count (P = 0.03) and white matter hyperintensity volume (P = 0.02), but not with disability. Conclusions CADASIL patients with an EGFr 7–34 variant have significantly less vascular NOTCH3 aggregation than patients with an EGFr 1–6 variant. This may be one of the factors underlying the difference in disease severity between NOTCH3cys EGFr 7–34 and EGFr 1–6 variants.
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Affiliation(s)
- Gido Gravesteijn
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Remco J Hack
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Aat A Mulder
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Minne N Cerfontaine
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Remco van Doorn
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ingrid M Hegeman
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Carolina R Jost
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Julie W Rutten
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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Gravesteijn G, Hack RJ, Opstal AMV, van Eijsden BJ, Middelkoop HAM, Rodriguez Girondo MDM, Aartsma-Rus A, Grond JVD, Rutten JW, Oberstein SAJL. Eighteen-Year Disease Progression and Survival in CADASIL. J Stroke 2021; 23:132-134. [PMID: 33600711 PMCID: PMC7900403 DOI: 10.5853/jos.2020.04112] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/18/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Gido Gravesteijn
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Remco J Hack
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Anna M van Opstal
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Bastian J van Eijsden
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Huub A M Middelkoop
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | | | - Annemieke Aartsma-Rus
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen van de Grond
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Julie W Rutten
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands.,Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
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10
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Hack RJ, Rutten JW, Person TN, Li J, Khan A, Griessenauer CJ, Abedi V, Lesnik Oberstein SAJ, Zand R. Cysteine-Altering NOTCH3 Variants Are a Risk Factor for Stroke in the Elderly Population. Stroke 2020; 51:3562-3569. [PMID: 33161844 PMCID: PMC7678653 DOI: 10.1161/strokeaha.120.030343] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Supplemental Digital Content is available in the text. Cysteine altering NOTCH3 variants, which have previously been exclusively associated with the rare hereditary small vessel disease cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, have a population frequency of 1:300 worldwide. Using a large population database, and taking genotype as a starting point, we aimed to determine whether individuals harboring a NOTCH3 cysteine altering variant have a higher load of small vessel disease markers on brain magnetic resonance imaging than controls, as well as a higher risk of stroke and cognitive impairment.
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Affiliation(s)
- Remco J Hack
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands (R.J.H., J.W.R., S.A.J.L.O.)
| | - Julie W Rutten
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands (R.J.H., J.W.R., S.A.J.L.O.)
| | | | - Jiang Li
- Department of Molecular and Functional Genomics, Geisinger, Danville, PA (J.L., V.A.)
| | - Ayesha Khan
- Neuroscience Institute, Geisinger, Danville, PA (A.K., C.J.G., R.Z.)
| | - Christoph J Griessenauer
- Neuroscience Institute, Geisinger, Danville, PA (A.K., C.J.G., R.Z.).,Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria (C.J.G.). Regeneron Genetics Center, Tarrytown, New York
| | | | - Vida Abedi
- Department of Molecular and Functional Genomics, Geisinger, Danville, PA (J.L., V.A.)
| | - Saskia A J Lesnik Oberstein
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands (R.J.H., J.W.R., S.A.J.L.O.)
| | - Ramin Zand
- Neuroscience Institute, Geisinger, Danville, PA (A.K., C.J.G., R.Z.)
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11
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Rutten JW, Hack RJ, Duering M, Gravesteijn G, Dauwerse JG, Overzier M, van den Akker EB, Slagboom E, Holstege H, Nho K, Saykin A, Dichgans M, Malik R, Lesnik Oberstein SAJ. Broad phenotype of cysteine-altering NOTCH3 variants in UK Biobank: CADASIL to nonpenetrance. Neurology 2020; 95:e1835-e1843. [PMID: 32732295 PMCID: PMC7682826 DOI: 10.1212/wnl.0000000000010525] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/07/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the small vessel disease spectrum associated with cysteine-altering NOTCH3 variants in community-dwelling individuals by analyzing the clinical and neuroimaging features of UK Biobank participants harboring such variants. METHODS The exome and genome sequencing datasets of the UK Biobank (n = 50,000) and cohorts of cognitively healthy elderly (n = 751) were queried for cysteine-altering NOTCH3 variants. Brain MRIs of individuals harboring such variants were scored according to Standards for Reporting Vascular Changes on Neuroimaging criteria, and clinical information was extracted with ICD-10 codes. Clinical and neuroimaging data were compared to age- and sex-matched UK Biobank controls and clinically diagnosed patients from the Dutch cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) registry. RESULTS We identified 108 individuals harboring a cysteine-altering NOTCH3 variant (2.2 of 1,000), of whom 75% have a variant that has previously been reported in CADASIL pedigrees. Almost all variants were located in 1 of the NOTCH3 protein epidermal growth factor-like repeat domains 7 to 34. White matter hyperintensity lesion load was higher in individuals with NOTCH3 variants than in controls (p = 0.006) but lower than in patients with CADASIL with the same variants (p < 0.001). Almost half of the 24 individuals with brain MRI had a Fazekas score of 0 or 1 up to age 70 years. There was no increased risk of stroke. CONCLUSIONS Although community-dwelling individuals harboring a cysteine-altering NOTCH3 variant have a higher small vessel disease MRI burden than controls, almost half have no MRI abnormalities up to age 70 years. This shows that NOTCH3 cysteine altering variants are associated with an extremely broad phenotypic spectrum, ranging from CADASIL to nonpenetrance.
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Affiliation(s)
- Julie W Rutten
- From the Center for Hereditary Small Vessel Disease, Department of Clinical Genetics (J.W.R., R.J.H., G.G., J.G.D., S.A.J.L.O.), Department of Human Genetics (M.O.), Department of Biomedical Data Sciences (E.B.v.d.A.), and Department of Biomedical Data Sciences (E.S.), Leiden University Medical Center, the Netherlands; Institute for Stroke and Dementia Research (M.D., M.D., R.M.), University Hospital, LMU Munich, Germany; Pattern Recognition & Bioinformatics (E.B.v.d.A., H.H.), Delft University of Technology; Alzheimer Center Amsterdam (H.H.), Department of Neurology, Amsterdam Neuroscience, and Department of Clinical Genetics (H.H.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; and Department of Radiology and Imaging Sciences (K.N., A.S.), Indiana Alzheimer Disease Center, Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis.
| | - Remco J Hack
- From the Center for Hereditary Small Vessel Disease, Department of Clinical Genetics (J.W.R., R.J.H., G.G., J.G.D., S.A.J.L.O.), Department of Human Genetics (M.O.), Department of Biomedical Data Sciences (E.B.v.d.A.), and Department of Biomedical Data Sciences (E.S.), Leiden University Medical Center, the Netherlands; Institute for Stroke and Dementia Research (M.D., M.D., R.M.), University Hospital, LMU Munich, Germany; Pattern Recognition & Bioinformatics (E.B.v.d.A., H.H.), Delft University of Technology; Alzheimer Center Amsterdam (H.H.), Department of Neurology, Amsterdam Neuroscience, and Department of Clinical Genetics (H.H.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; and Department of Radiology and Imaging Sciences (K.N., A.S.), Indiana Alzheimer Disease Center, Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis
| | - Marco Duering
- From the Center for Hereditary Small Vessel Disease, Department of Clinical Genetics (J.W.R., R.J.H., G.G., J.G.D., S.A.J.L.O.), Department of Human Genetics (M.O.), Department of Biomedical Data Sciences (E.B.v.d.A.), and Department of Biomedical Data Sciences (E.S.), Leiden University Medical Center, the Netherlands; Institute for Stroke and Dementia Research (M.D., M.D., R.M.), University Hospital, LMU Munich, Germany; Pattern Recognition & Bioinformatics (E.B.v.d.A., H.H.), Delft University of Technology; Alzheimer Center Amsterdam (H.H.), Department of Neurology, Amsterdam Neuroscience, and Department of Clinical Genetics (H.H.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; and Department of Radiology and Imaging Sciences (K.N., A.S.), Indiana Alzheimer Disease Center, Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis
| | - Gido Gravesteijn
- From the Center for Hereditary Small Vessel Disease, Department of Clinical Genetics (J.W.R., R.J.H., G.G., J.G.D., S.A.J.L.O.), Department of Human Genetics (M.O.), Department of Biomedical Data Sciences (E.B.v.d.A.), and Department of Biomedical Data Sciences (E.S.), Leiden University Medical Center, the Netherlands; Institute for Stroke and Dementia Research (M.D., M.D., R.M.), University Hospital, LMU Munich, Germany; Pattern Recognition & Bioinformatics (E.B.v.d.A., H.H.), Delft University of Technology; Alzheimer Center Amsterdam (H.H.), Department of Neurology, Amsterdam Neuroscience, and Department of Clinical Genetics (H.H.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; and Department of Radiology and Imaging Sciences (K.N., A.S.), Indiana Alzheimer Disease Center, Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis
| | - Johannes G Dauwerse
- From the Center for Hereditary Small Vessel Disease, Department of Clinical Genetics (J.W.R., R.J.H., G.G., J.G.D., S.A.J.L.O.), Department of Human Genetics (M.O.), Department of Biomedical Data Sciences (E.B.v.d.A.), and Department of Biomedical Data Sciences (E.S.), Leiden University Medical Center, the Netherlands; Institute for Stroke and Dementia Research (M.D., M.D., R.M.), University Hospital, LMU Munich, Germany; Pattern Recognition & Bioinformatics (E.B.v.d.A., H.H.), Delft University of Technology; Alzheimer Center Amsterdam (H.H.), Department of Neurology, Amsterdam Neuroscience, and Department of Clinical Genetics (H.H.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; and Department of Radiology and Imaging Sciences (K.N., A.S.), Indiana Alzheimer Disease Center, Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis
| | - Maurice Overzier
- From the Center for Hereditary Small Vessel Disease, Department of Clinical Genetics (J.W.R., R.J.H., G.G., J.G.D., S.A.J.L.O.), Department of Human Genetics (M.O.), Department of Biomedical Data Sciences (E.B.v.d.A.), and Department of Biomedical Data Sciences (E.S.), Leiden University Medical Center, the Netherlands; Institute for Stroke and Dementia Research (M.D., M.D., R.M.), University Hospital, LMU Munich, Germany; Pattern Recognition & Bioinformatics (E.B.v.d.A., H.H.), Delft University of Technology; Alzheimer Center Amsterdam (H.H.), Department of Neurology, Amsterdam Neuroscience, and Department of Clinical Genetics (H.H.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; and Department of Radiology and Imaging Sciences (K.N., A.S.), Indiana Alzheimer Disease Center, Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis
| | - Erik B van den Akker
- From the Center for Hereditary Small Vessel Disease, Department of Clinical Genetics (J.W.R., R.J.H., G.G., J.G.D., S.A.J.L.O.), Department of Human Genetics (M.O.), Department of Biomedical Data Sciences (E.B.v.d.A.), and Department of Biomedical Data Sciences (E.S.), Leiden University Medical Center, the Netherlands; Institute for Stroke and Dementia Research (M.D., M.D., R.M.), University Hospital, LMU Munich, Germany; Pattern Recognition & Bioinformatics (E.B.v.d.A., H.H.), Delft University of Technology; Alzheimer Center Amsterdam (H.H.), Department of Neurology, Amsterdam Neuroscience, and Department of Clinical Genetics (H.H.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; and Department of Radiology and Imaging Sciences (K.N., A.S.), Indiana Alzheimer Disease Center, Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis
| | - Eline Slagboom
- From the Center for Hereditary Small Vessel Disease, Department of Clinical Genetics (J.W.R., R.J.H., G.G., J.G.D., S.A.J.L.O.), Department of Human Genetics (M.O.), Department of Biomedical Data Sciences (E.B.v.d.A.), and Department of Biomedical Data Sciences (E.S.), Leiden University Medical Center, the Netherlands; Institute for Stroke and Dementia Research (M.D., M.D., R.M.), University Hospital, LMU Munich, Germany; Pattern Recognition & Bioinformatics (E.B.v.d.A., H.H.), Delft University of Technology; Alzheimer Center Amsterdam (H.H.), Department of Neurology, Amsterdam Neuroscience, and Department of Clinical Genetics (H.H.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; and Department of Radiology and Imaging Sciences (K.N., A.S.), Indiana Alzheimer Disease Center, Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis
| | - Henne Holstege
- From the Center for Hereditary Small Vessel Disease, Department of Clinical Genetics (J.W.R., R.J.H., G.G., J.G.D., S.A.J.L.O.), Department of Human Genetics (M.O.), Department of Biomedical Data Sciences (E.B.v.d.A.), and Department of Biomedical Data Sciences (E.S.), Leiden University Medical Center, the Netherlands; Institute for Stroke and Dementia Research (M.D., M.D., R.M.), University Hospital, LMU Munich, Germany; Pattern Recognition & Bioinformatics (E.B.v.d.A., H.H.), Delft University of Technology; Alzheimer Center Amsterdam (H.H.), Department of Neurology, Amsterdam Neuroscience, and Department of Clinical Genetics (H.H.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; and Department of Radiology and Imaging Sciences (K.N., A.S.), Indiana Alzheimer Disease Center, Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis
| | - Kwangsik Nho
- From the Center for Hereditary Small Vessel Disease, Department of Clinical Genetics (J.W.R., R.J.H., G.G., J.G.D., S.A.J.L.O.), Department of Human Genetics (M.O.), Department of Biomedical Data Sciences (E.B.v.d.A.), and Department of Biomedical Data Sciences (E.S.), Leiden University Medical Center, the Netherlands; Institute for Stroke and Dementia Research (M.D., M.D., R.M.), University Hospital, LMU Munich, Germany; Pattern Recognition & Bioinformatics (E.B.v.d.A., H.H.), Delft University of Technology; Alzheimer Center Amsterdam (H.H.), Department of Neurology, Amsterdam Neuroscience, and Department of Clinical Genetics (H.H.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; and Department of Radiology and Imaging Sciences (K.N., A.S.), Indiana Alzheimer Disease Center, Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis
| | - Andrew Saykin
- From the Center for Hereditary Small Vessel Disease, Department of Clinical Genetics (J.W.R., R.J.H., G.G., J.G.D., S.A.J.L.O.), Department of Human Genetics (M.O.), Department of Biomedical Data Sciences (E.B.v.d.A.), and Department of Biomedical Data Sciences (E.S.), Leiden University Medical Center, the Netherlands; Institute for Stroke and Dementia Research (M.D., M.D., R.M.), University Hospital, LMU Munich, Germany; Pattern Recognition & Bioinformatics (E.B.v.d.A., H.H.), Delft University of Technology; Alzheimer Center Amsterdam (H.H.), Department of Neurology, Amsterdam Neuroscience, and Department of Clinical Genetics (H.H.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; and Department of Radiology and Imaging Sciences (K.N., A.S.), Indiana Alzheimer Disease Center, Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis
| | - Martin Dichgans
- From the Center for Hereditary Small Vessel Disease, Department of Clinical Genetics (J.W.R., R.J.H., G.G., J.G.D., S.A.J.L.O.), Department of Human Genetics (M.O.), Department of Biomedical Data Sciences (E.B.v.d.A.), and Department of Biomedical Data Sciences (E.S.), Leiden University Medical Center, the Netherlands; Institute for Stroke and Dementia Research (M.D., M.D., R.M.), University Hospital, LMU Munich, Germany; Pattern Recognition & Bioinformatics (E.B.v.d.A., H.H.), Delft University of Technology; Alzheimer Center Amsterdam (H.H.), Department of Neurology, Amsterdam Neuroscience, and Department of Clinical Genetics (H.H.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; and Department of Radiology and Imaging Sciences (K.N., A.S.), Indiana Alzheimer Disease Center, Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis
| | - Rainer Malik
- From the Center for Hereditary Small Vessel Disease, Department of Clinical Genetics (J.W.R., R.J.H., G.G., J.G.D., S.A.J.L.O.), Department of Human Genetics (M.O.), Department of Biomedical Data Sciences (E.B.v.d.A.), and Department of Biomedical Data Sciences (E.S.), Leiden University Medical Center, the Netherlands; Institute for Stroke and Dementia Research (M.D., M.D., R.M.), University Hospital, LMU Munich, Germany; Pattern Recognition & Bioinformatics (E.B.v.d.A., H.H.), Delft University of Technology; Alzheimer Center Amsterdam (H.H.), Department of Neurology, Amsterdam Neuroscience, and Department of Clinical Genetics (H.H.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; and Department of Radiology and Imaging Sciences (K.N., A.S.), Indiana Alzheimer Disease Center, Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis
| | - Saskia A J Lesnik Oberstein
- From the Center for Hereditary Small Vessel Disease, Department of Clinical Genetics (J.W.R., R.J.H., G.G., J.G.D., S.A.J.L.O.), Department of Human Genetics (M.O.), Department of Biomedical Data Sciences (E.B.v.d.A.), and Department of Biomedical Data Sciences (E.S.), Leiden University Medical Center, the Netherlands; Institute for Stroke and Dementia Research (M.D., M.D., R.M.), University Hospital, LMU Munich, Germany; Pattern Recognition & Bioinformatics (E.B.v.d.A., H.H.), Delft University of Technology; Alzheimer Center Amsterdam (H.H.), Department of Neurology, Amsterdam Neuroscience, and Department of Clinical Genetics (H.H.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; and Department of Radiology and Imaging Sciences (K.N., A.S.), Indiana Alzheimer Disease Center, Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis
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Gravesteijn G, Dauwerse JG, Overzier M, Brouwer G, Hegeman I, Mulder AA, Baas F, Kruit MC, Terwindt GM, van Duinen SG, Jost CR, Aartsma-Rus A, Lesnik Oberstein SAJ, Rutten JW. Naturally occurring NOTCH3 exon skipping attenuates NOTCH3 protein aggregation and disease severity in CADASIL patients. Hum Mol Genet 2020; 29:1853-1863. [PMID: 31960911 PMCID: PMC7372551 DOI: 10.1093/hmg/ddz285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/15/2019] [Accepted: 11/26/2019] [Indexed: 11/21/2022] Open
Abstract
CADASIL is a vascular protein aggregation disorder caused by cysteine-altering NOTCH3 variants, leading to mid-adult-onset stroke and dementia. Here, we report individuals with a cysteine-altering NOTCH3 variant that induces exon 9 skipping, mimicking therapeutic NOTCH3 cysteine correction. The index came to our attention after a coincidental finding on a commercial screening MRI, revealing white matter hyperintensities. A heterozygous NOTCH3 c.1492G>T, p.Gly498Cys variant, was identified using a gene panel, which was also present in four first- and second-degree relatives. Although some degree of white matter hyperintensities was present on MRI in all family members with the NOTCH3 variant, the CADASIL phenotype was mild, as none had lacunes on MRI and there was no disability or cognitive impairment above the age of 60 years. RT-PCR and Sanger sequencing analysis on patient fibroblast RNA revealed that exon 9 was absent from the majority of NOTCH3 transcripts of the mutant allele, effectively excluding the mutation. NOTCH3 aggregation was assessed in skin biopsies using electron microscopy and immunohistochemistry and did not show granular osmiophilic material and only very mild NOTCH3 staining. For purposes of therapeutic translatability, we show that, in cell models, exon 9 exclusion can be obtained using antisense-mediated exon skipping and CRISPR/Cas9-mediated genome editing. In conclusion, this study provides the first in-human evidence that cysteine corrective NOTCH3 exon skipping is associated with less NOTCH3 aggregation and an attenuated phenotype, justifying further therapeutic development of NOTCH3 cysteine correction for CADASIL.
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Affiliation(s)
- Gido Gravesteijn
- Department of Clinical Genetics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Johannes G Dauwerse
- Department of Human Genetics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Maurice Overzier
- Department of Human Genetics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Gwendolyn Brouwer
- Department of Human Genetics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Ingrid Hegeman
- Department of Pathology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Aat A Mulder
- Department of Cell and Chemical Biology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Frank Baas
- Department of Clinical Genetics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Mark C Kruit
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Sjoerd G van Duinen
- Department of Pathology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Carolina R Jost
- Department of Cell and Chemical Biology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Annemieke Aartsma-Rus
- Department of Human Genetics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Saskia A J Lesnik Oberstein
- Department of Clinical Genetics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Julie W Rutten
- Department of Clinical Genetics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
- Department of Human Genetics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
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Gravesteijn G, Munting LP, Overzier M, Mulder AA, Hegeman I, Derieppe M, Koster AJ, van Duinen SG, Meijer OC, Aartsma-Rus A, van der Weerd L, Jost CR, van den Maagdenberg AMJM, Rutten JW, Lesnik Oberstein SAJ. Progression and Classification of Granular Osmiophilic Material (GOM) Deposits in Functionally Characterized Human NOTCH3 Transgenic Mice. Transl Stroke Res 2019; 11:517-527. [PMID: 31667734 PMCID: PMC7235067 DOI: 10.1007/s12975-019-00742-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/12/2019] [Accepted: 09/23/2019] [Indexed: 11/26/2022]
Abstract
CADASIL is a NOTCH3-associated cerebral small vessel disease. A pathological ultrastructural disease hallmark is the presence of NOTCH3-protein containing deposits called granular osmiophilic material (GOM), in small arteries. How these GOM deposits develop over time and what their role is in disease progression is largely unknown. Here, we studied the progression of GOM deposits in humanized transgenic NOTCH3Arg182Cys mice, compared them to GOM deposits in patient material, and determined whether GOM deposits in mice are associated with a functional CADASIL phenotype. We found that GOM deposits are not static, but rather progress in ageing mice, both in terms of size and aspect. We devised a GOM classification system, reflecting size, morphology and electron density. Six-month-old mice showed mostly early stage GOM, whereas older mice and patient vessels showed predominantly advanced stage GOM, but also early stage GOM. Mutant mice did not develop the most severe GOM stage seen in patient material. This absence of end-stage GOM in mice was associated with an overall lack of histological vascular pathology, which may explain why the mice did not reveal functional deficits in cerebral blood flow, cognition and motor function. Taken together, our data indicate that GOM progress over time, and that new GOM deposits are continuously being formed. The GOM staging system we introduce here allows for uniform GOM deposit classification in future mouse and human studies, which may lead to more insight into a potential association between GOM stage and CADASIL disease severity, and the role of GOM in disease progression.
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Affiliation(s)
- Gido Gravesteijn
- Department of Clinical Genetics, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Leon P Munting
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Maurice Overzier
- Department of Human Genetics, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Aat A Mulder
- Department of Cell and Chemical Biology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Ingrid Hegeman
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Marc Derieppe
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
- Department of Pediatric Neuro-Oncology, Prinses Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Abraham J Koster
- Department of Cell and Chemical Biology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Sjoerd G van Duinen
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Onno C Meijer
- Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Annemieke Aartsma-Rus
- Department of Human Genetics, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Louise van der Weerd
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
- Department of Human Genetics, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Carolina R Jost
- Department of Cell and Chemical Biology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Arn M J M van den Maagdenberg
- Department of Human Genetics, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Julie W Rutten
- Department of Clinical Genetics, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
- Department of Human Genetics, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Saskia A J Lesnik Oberstein
- Department of Clinical Genetics, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
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van der Sluijs PJ, Aten E, Barge-Schaapveld DQ, Bijlsma EK, Bökenkamp-Gramann R, Kaat LD, van Doorn R, van de Putte DF, van Haeringen A, ten Harkel AD, Hilhorst-Hofstee Y, Hoffer MJ, den Hollander NS, van Ierland Y, Koopmans M, Kriek M, Moghadasi S, Nibbeling EA, Peeters-Scholte CM, Potjer TP, van Rij M, Ruivenkamp CA, Rutten JW, Steggerda SJ, Suerink M, Tan RN, van der Tuin K, Visser R, van der Werf –’t Lam AS, Williams M, Witlox R, Santen GW. Correction: Putting genome-wide sequencing in neonates into perspective. Genet Med 2019; 21:2159-2164. [DOI: 10.1038/s41436-018-0363-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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15
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Rutten JW, van den Akker EB, Lesnik Oberstein SAJ. Commentary to: Masoli et al. Clinical Outcomes of CADASIL-Associated NOTCH3 mutations in 451,424 European Ancestry Community Volunteers. (Translational Stroke Research Oct 2018). Transl Stroke Res 2018; 10:458-459. [PMID: 30565089 PMCID: PMC6733833 DOI: 10.1007/s12975-018-0681-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 12/06/2018] [Indexed: 11/27/2022]
Affiliation(s)
- J W Rutten
- Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA, Leiden, The Netherlands.
| | - E B van den Akker
- Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - S A J Lesnik Oberstein
- Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA, Leiden, The Netherlands
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16
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Gravesteijn G, Rutten JW, Verberk IMW, Böhringer S, Liem MK, van der Grond J, Aartsma-Rus A, Teunissen CE, Lesnik Oberstein SAJ. Serum Neurofilament light correlates with CADASIL disease severity and survival. Ann Clin Transl Neurol 2018; 6:46-56. [PMID: 30656183 PMCID: PMC6331956 DOI: 10.1002/acn3.678] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/01/2018] [Indexed: 12/12/2022] Open
Abstract
Objective To validate whether serum Neurofilament Light‐chain (NfL) levels correlate with disease severity in CADASIL, and to determine whether serum NfL predicts disease progression and survival. Methods Fourty‐one (pre‐) manifest individuals with CADASIL causing NOTCH3 mutations and 22 healthy controls were recruited from CADASIL families. At baseline, MRI‐lesion load and clinical severity was determined and serum was stored. Disease progression was measured in 30/41 patients at 7‐year follow‐up, and survival of all individuals was determined at 17‐year follow‐up. Serum NfL levels were quantified using an ultra‐sensitive molecule array. Generalized estimated equation regression (GEE) was used to analyze association between serum NfL, MRI‐lesion load, disease severity, and disease progression. With GEE‐based Cox regression, survival was analyzed. Results At baseline, serum NfL levels correlated with MRI‐lesion load [lacune count (s = 0.64, P = 0.002), brain atrophy (r = −0.50, P = 0.001), and microbleed count (s = 0.48, P = 0.044)], cognition [CAMCOG (s = −0.45, P = 0.010), MMSE (r = −0.61, P = 0.003), GIT (r = −0.61, P < 0.001), TMT‐A (r = 0.70, P < 0.001)) and disability (mRS (r = 0.70, P = 0.002)]. Baseline serum NfL predicted 7‐year changes in disability (B = 0.34, P < 0.001) and cognition (CAMCOG B = −4.94, P = 0.032), as well as 17‐year survival. Higher NfL levels were associated with increased mortality (HR=1.8 per twofold increase in NfL levels, P = 0.006). Interpretation Serum NfL levels correlate with disease severity, disease progression and 17‐year survival in CADASIL patients. Serum NfL is a promising biomarker to monitor and predict disease course in CADASIL, as well as potentially assessing therapeutic response in future clinical trials.
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Affiliation(s)
- Gido Gravesteijn
- Department of Clinical Genetics Leiden University Medical Center Leiden the Netherlands
| | - Julie W Rutten
- Department of Clinical Genetics Leiden University Medical Center Leiden the Netherlands
| | - Inge M W Verberk
- Neurochemistry lab and Biobank Department of Clinical Chemistry Amsterdam Neuroscience VU University Medical Center Amsterdam the Netherlands
| | - Stefan Böhringer
- Department of Biomedical Data Sciences Leiden University Medical Center Leiden the Netherlands
| | - Michael K Liem
- Department of Radiology Leiden University Medical Center Leiden the Netherlands.,Department of Radiology Lange Land Ziekenhuis Zoetermeer the Netherlands
| | | | - Annemieke Aartsma-Rus
- Department of Human Genetics Leiden University Medical Center Leiden the Netherlands
| | - Charlotte E Teunissen
- Neurochemistry lab and Biobank Department of Clinical Chemistry Amsterdam Neuroscience VU University Medical Center Amsterdam the Netherlands
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Rutten JW, Van Eijsden BJ, Duering M, Jouvent E, Opherk C, Pantoni L, Federico A, Dichgans M, Markus HS, Chabriat H, Oberstein SAJL. Correction: The effect of NOTCH3 pathogenic variant position on CADASIL disease severity: NOTCH3 EGFr 1-6 pathogenic variant are associated with a more severe phenotype and lower survival compared with EGFr 7-34 pathogenic variant. Genet Med 2018; 21:1895. [PMID: 30237574 PMCID: PMC7608265 DOI: 10.1038/s41436-018-0306-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This Article was originally published under Nature Research's License to Publish, but has now been made available under a [CC BY 4.0] license. The PDF and HTML versions of the Article have been modified accordingly.
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Affiliation(s)
- Julie W Rutten
- CADASIL Research Group, Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands. .,Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Bastian J Van Eijsden
- CADASIL Research Group, Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marco Duering
- Institute for Stroke and Dementia Research, University Hospital (LMU), Munich, Germany
| | - Eric Jouvent
- Department of Neurology, AP-HP, Lariboisière Hospital, Paris, France
| | - Christian Opherk
- Department of Neurology, SLK-Kliniken Heilbronn, Heilbronn, Germany
| | - Leonardo Pantoni
- "L. Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Antonio Federico
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Siena, Italy
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital (LMU), Munich, Germany
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Hugues Chabriat
- Department of Neurology, AP-HP, Lariboisière Hospital, Paris, France
| | - Saskia A J Lesnik Oberstein
- CADASIL Research Group, Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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18
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Hainsworth AH, Allan SM, Boltze J, Cunningham C, Farris C, Head E, Ihara M, Isaacs JD, Kalaria RN, Lesnik Oberstein SAMJ, Moss MB, Nitzsche B, Rosenberg GA, Rutten JW, Salkovic-Petrisic M, Troen AM. Translational models for vascular cognitive impairment: a review including larger species. BMC Med 2017; 15:16. [PMID: 28118831 PMCID: PMC5264492 DOI: 10.1186/s12916-017-0793-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 01/12/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Disease models are useful for prospective studies of pathology, identification of molecular and cellular mechanisms, pre-clinical testing of interventions, and validation of clinical biomarkers. Here, we review animal models relevant to vascular cognitive impairment (VCI). A synopsis of each model was initially presented by expert practitioners. Synopses were refined by the authors, and subsequently by the scientific committee of a recent conference (International Conference on Vascular Dementia 2015). Only peer-reviewed sources were cited. METHODS We included models that mimic VCI-related brain lesions (white matter hypoperfusion injury, focal ischaemia, cerebral amyloid angiopathy) or reproduce VCI risk factors (old age, hypertension, hyperhomocysteinemia, high-salt/high-fat diet) or reproduce genetic causes of VCI (CADASIL-causing Notch3 mutations). CONCLUSIONS We concluded that (1) translational models may reflect a VCI-relevant pathological process, while not fully replicating a human disease spectrum; (2) rodent models of VCI are limited by paucity of white matter; and (3) further translational models, and improved cognitive testing instruments, are required.
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Affiliation(s)
- Atticus H Hainsworth
- Clinical Neurosciences (J-0B) Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK. .,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Stuart M Allan
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, UK
| | - Johannes Boltze
- Department of Translational Medicine and Cell Technology, University of Lübeck, Lübeck, Germany.,Neurovascular Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Catriona Cunningham
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, UK
| | - Chad Farris
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Elizabeth Head
- Department of Pharmacology & Nutritional Sciences, Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Masafumi Ihara
- Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Jeremy D Isaacs
- Clinical Neurosciences (J-0B) Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Raj N Kalaria
- Institute of Neuroscience, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, UK
| | | | - Mark B Moss
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Björn Nitzsche
- Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany.,Clinic for Nuclear Medicine, University of Leipzig, Leipzig, Germany.,Institute for Anatomy, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Gary A Rosenberg
- Department of Neurology, Health Sciences Center, University of New Mexico, Albuquerque, NM, USA
| | - Julie W Rutten
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands.,Department of Human Genetics, Leiden University Medical Center, Leiden, Netherlands
| | - Melita Salkovic-Petrisic
- Department of Pharmacology, Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Aron M Troen
- Institute of Biochemistry Food and Nutrition Science, Hebrew University of Jerusalem, Rehovot, Israel
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19
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Rutten JW, Dauwerse HG, Gravesteijn G, van Belzen MJ, van der Grond J, Polke JM, Bernal-Quiros M, Lesnik Oberstein SAJ. Archetypal NOTCH3 mutations frequent in public exome: implications for CADASIL. Ann Clin Transl Neurol 2016; 3:844-853. [PMID: 27844030 PMCID: PMC5099530 DOI: 10.1002/acn3.344] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/01/2016] [Accepted: 08/01/2016] [Indexed: 11/21/2022] Open
Abstract
Objective To determine the frequency of distinctive EGFr cysteine altering NOTCH3 mutations in the 60,706 exomes of the exome aggregation consortium (ExAC) database. Methods ExAC was queried for mutations distinctive for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), namely mutations leading to a cysteine amino acid change in one of the 34 EGFr domains of NOTCH3. The genotype‐phenotype correlation predicted by the ExAC data was tested in an independent cohort of Dutch CADASIL patients using quantified MRI lesions. The Dutch CADASIL registry was probed for paucisymptomatic individuals older than 70 years. Results We identified 206 EGFr cysteine altering NOTCH3 mutations in ExAC, with a total prevalence of 3.4/1000. More than half of the distinct mutations have been previously reported in CADASIL patients. Despite the clear overlap, the mutation distribution in ExAC differs from that in reported CADASIL patients, as mutations in ExAC are predominantly located outside of EGFr domains 1–6. In an independent Dutch CADASIL cohort, we found that patients with a mutation in EGFr domains 7–34 have a significantly lower MRI lesion load than patients with a mutation in EGFr domains 1–6. Interpretation The frequency of EGFr cysteine altering NOTCH3 mutations is 100‐fold higher than expected based on estimates of CADASIL prevalence. This challenges the current CADASIL disease paradigm, and suggests that certain mutations may more frequently cause a much milder phenotype, which may even go clinically unrecognized. Our data suggest that individuals with a mutation located in EGFr domains 1–6 are predisposed to the more severe “classical” CADASIL phenotype, whereas individuals with a mutation outside of EGFr domains 1–6 can remain paucisymptomatic well into their eighth decade.
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Affiliation(s)
- Julie W Rutten
- Department of Clinical Genetics Leiden University Medical Center Leiden The Netherlands; Department of Human Genetics Leiden University Medical Center Leiden The Netherlands
| | - Hans G Dauwerse
- Department of Clinical Genetics Leiden University Medical Center Leiden The Netherlands; Department of Human Genetics Leiden University Medical Center Leiden The Netherlands
| | - Gido Gravesteijn
- Department of Clinical Genetics Leiden University Medical Center Leiden The Netherlands
| | - Martine J van Belzen
- Department of Clinical Genetics Leiden University Medical Center Leiden The Netherlands
| | | | - James M Polke
- Neurogenetics Unit National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Manuel Bernal-Quiros
- Neurogenetics Unit National Hospital for Neurology and Neurosurgery London United Kingdom
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20
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Rutten JW, Dauwerse HG, Peters DJM, Goldfarb A, Venselaar H, Haffner C, van Ommen GJB, Aartsma-Rus AM, Lesnik Oberstein SAJ. Therapeutic NOTCH3 cysteine correction in CADASIL using exon skipping:in vitroproof of concept. Brain 2016; 139:1123-35. [DOI: 10.1093/brain/aww011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 12/27/2015] [Indexed: 12/12/2022] Open
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21
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Switzar L, Nicolardi S, Rutten JW, Oberstein SAJL, Aartsma-Rus A, van der Burgt YEM. In-Depth Characterization of Protein Disulfide Bonds by Online Liquid Chromatography-Electrochemistry-Mass Spectrometry. J Am Soc Mass Spectrom 2016; 27:50-8. [PMID: 26369777 PMCID: PMC4686567 DOI: 10.1007/s13361-015-1258-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/14/2015] [Accepted: 08/20/2015] [Indexed: 05/04/2023]
Abstract
Disulfide bonds are an important class of protein post-translational modifications, yet this structurally crucial modification type is commonly overlooked in mass spectrometry (MS)-based proteomics approaches. Recently, the benefits of online electrochemistry-assisted reduction of protein S-S bonds prior to MS analysis were exemplified by successful characterization of disulfide bonds in peptides and small proteins. In the current study, we have combined liquid chromatography (LC) with electrochemistry (EC) and mass analysis by Fourier transform ion cyclotron resonance (FTICR) MS in an online LC-EC-MS platform to characterize protein disulfide bonds in a bottom-up proteomics workflow. A key advantage of a LC-based strategy is the use of the retention time in identifying both intra- and interpeptide disulfide bonds. This is demonstrated by performing two sequential analyses of a certain protein digest, once without and once with electrochemical reduction. In this way, the "parent" disulfide-linked peptide detected in the first run has a retention time-based correlation with the EC-reduced peptides detected in the second run, thus simplifying disulfide bond mapping. Using this platform, both inter- and intra-disulfide-linked peptides were characterized in two different proteins, ß-lactoglobulin and ribonuclease B. In order to prevent disulfide reshuffling during the digestion process, proteins were digested at a relatively low pH, using (a combination of) the high specificity proteases trypsin and Glu-C. With this approach, disulfide bonds in ß-lactoglobulin and ribonuclease B were comprehensively identified and localized, showing that online LC-EC-MS is a useful tool for the characterization of protein disulfide bonds.
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Affiliation(s)
- Linda Switzar
- Department of Human Genetics, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
- Center for Proteomics and Metabolomics, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
- , Albinusdreef 2, Postzone S3, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Simone Nicolardi
- Center for Proteomics and Metabolomics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Julie W Rutten
- Department of Human Genetics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Department of Clinical Genetics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | | | - Annemieke Aartsma-Rus
- Department of Human Genetics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Yuri E M van der Burgt
- Center for Proteomics and Metabolomics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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22
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Rutten JW, Klever RR, Hegeman IM, Poole DS, Dauwerse HG, Broos LAM, Breukel C, Aartsma-Rus AM, Verbeek JS, van der Weerd L, van Duinen SG, van den Maagdenberg AMJM, Lesnik Oberstein SAJ. The NOTCH3 score: a pre-clinical CADASIL biomarker in a novel human genomic NOTCH3 transgenic mouse model with early progressive vascular NOTCH3 accumulation. Acta Neuropathol Commun 2015; 3:89. [PMID: 26715087 PMCID: PMC4696336 DOI: 10.1186/s40478-015-0268-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/14/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) is a hereditary small vessel disease caused by mutations in the NOTCH3 gene, leading to toxic NOTCH3 protein accumulation in the small- to medium sized arterioles. The accumulation is systemic but most pronounced in the brain vasculature where it leads to clinical symptoms of recurrent stroke and dementia. There is no therapy for CADASIL, and therapeutic development is hampered by a lack of feasible clinical outcome measures and biomarkers, both in mouse models and in CADASIL patients. To facilitate pre-clinical therapeutic interventions for CADASIL, we aimed to develop a novel, translational CADASIL mouse model. RESULTS We generated transgenic mice in which we overexpressed the full length human NOTCH3 gene from a genomic construct with the archetypal c.544C > T, p.Arg182Cys mutation. The four mutant strains we generated have respective human NOTCH3 RNA expression levels of 100, 150, 200 and 350 % relative to endogenous mouse Notch3 RNA expression. Immunohistochemistry on brain sections shows characteristic vascular human NOTCH3 accumulation in all four mutant strains, with human NOTCH3 RNA expression levels correlating with age at onset and progression of NOTCH3 accumulation. This finding was the basis for developing the 'NOTCH3 score', a quantitative measure for the NOTCH3 accumulation load. This score proved to be a robust and sensitive method to assess the progression of NOTCH3 accumulation, and a feasible biomarker for pre-clinical therapeutic testing. CONCLUSIONS This novel, translational CADASIL mouse model is a suitable model for pre-clinical testing of therapeutic strategies aimed at delaying or reversing NOTCH3 accumulation, using the NOTCH3 score as a biomarker.
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23
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Rutten JW, Haan J, Terwindt GM, van Duinen SG, Boon EMJ, Lesnik Oberstein SAJ. Interpretation ofNOTCH3mutations in the diagnosis of CADASIL. Expert Rev Mol Diagn 2014; 14:593-603. [DOI: 10.1586/14737159.2014.922880] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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24
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Rutten JW, Boon EMJ, Liem MK, Dauwerse JG, Pont MJ, Vollebregt E, Maat-Kievit AJ, Ginjaar HB, Lakeman P, van Duinen SG, Terwindt GM, Lesnik Oberstein SAJ. Hypomorphic NOTCH3 alleles do not cause CADASIL in humans. Hum Mutat 2013; 34:1486-9. [PMID: 24000151 DOI: 10.1002/humu.22432] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 08/22/2013] [Indexed: 11/07/2022]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is caused by stereotyped missense mutations in NOTCH3. Whether these mutations lead to the CADASIL phenotype via a neomorphic effect, or rather by a hypomorphic effect, is subject of debate. Here, we report two novel NOTCH3 mutations, both leading to a premature stop codon with predicted loss of NOTCH3 function. The first mutation, c.307C>T, p.Arg103*, was detected in two brothers aged 50 and 55 years, with a brain MRI and skin biopsy incompatible with CADASIL. The other mutation was found in a 40-year-old CADASIL patient compound heterozygous for a pathogenic NOTCH3 mutation (c.2129A>G, p.Tyr710Cys) and an intragenic frameshift deletion. The deletion was inherited from his father, who did not have the skin biopsy abnormalities seen in CADASIL patients. These individuals with rare NOTCH3 mutations indicate that hypomorphic NOTCH3 alleles do not cause CADASIL.
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Affiliation(s)
- Julie W Rutten
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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