伴皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病的临床特点(附1家系报告)

目的 探讨伴皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病(CADASIL)的临床特点.方法 对1例CADASIL患者及其家系的临床资料进行回顾性分析.结果 先证者以大脑皮质下梗死起病,伴有渐进性认知功能障碍.头颅MRI示皮质下多发梗死灶,脑白质疏松.NOTHC3基因检测为第3号外显子Arg110Cys突变,家系调查显示为常染色体显性遗传.结论 CADASIL临床表现主要为缺血性卒中、认知障碍、偏头痛及精神症状.MRI特征性改变是颞极白质T2的异常高信号.NOTCH3基因检查发现突变.     

1例CADASIL家系的临床特征与基因突变分析

目的 分析1例皖江地区CADASIL家系的临床表现及基因突变特征.方法 随访记录1例CADASIL家系先证者的临床表现、实验室检查及影像学检查,对其NOTCH3基因突变热点区行基因检测.结果 先证者为1例53岁男性患者,病程中反复发作脑卒中并有家族发病史,另表现假性球麻痹、情绪障碍、冷漠和轻度认知功能障碍,无偏头痛史.其头颅核磁共振显示对称性双侧颞极及外囊区白质高信号病变.患者NOTCH3基因突变分析发现4号外显子区已知致病突变（c.580T〉C）和常见核苷酸多态性（rs1043994）.结论 c.580T〉C突变是中国人CADASIL病例首次报道,基因检测是确诊CADASIL的金标准.     

携带非半胱氨酸NOTCH3基因突变的伴有皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病患者五例临床及影像学特征分析

目的总结5例携带非半胱氨酸NOTCH3基因错义突变的伴有皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病(CADASIL)患者的临床及影像学特征,并探讨其基因突变的潜在致病性。方法收集2017年3月至2018年11月就诊于郑州大学人民医院,经基因检测发现携带非半胱氨酸突变且病理确诊的5例CADASIL患者的临床资料。这些患者分别为5个无关家系的先证者,均进行了全外显子基因组测序和皮肤活体组织检查。结果经基因检测发现5例患者共有5种不同的NOTCH3基因突变,分别是:p.R75Q、p.D80G、p.V237M、p.S1418L和p.R1761H。前3种突变位于胞外域EGFr区,后2种突变位于跨膜结构域附近。5例患者皮肤活体组织检查均显示嗜锇颗粒沉积。5例患者发病年龄为22~58岁,其中3例合并脑血管危险因素。临床表现包括偏头痛1例,脑卒中3例,情感障碍4例,认知障碍5例,步态障碍、假性球麻痹、癫痫发作分别只占1例。5例患者头颅磁共振成像均显示皮质下白质病变和腔隙性脑梗死,白质病变累及颞极、外囊分别占3例。根据Mui?o等提出的非半胱氨酸NOTCH3突变致病性的评估标准,该5种突变均具有潜在致病性。结论非半胱氨酸NOTCH3基因突变的CADASIL患者也可表现出典型CADASIL的临床症状和影像学特点。非EGFr区的NOTCH3突变也可能具有潜在致病性,具体机制仍需进一步研究。     

结节性硬化症TSC2基因5238-5255 del 18 bp及2713 C>T基因突变分析

目的检测并分析2例中国汉族结节性硬化症(tuberous sclerosis complex,TSC)患者TSC2基因突变特点。方法采用直接测序法对31个家系的34例TSC患者及其父母33名进行TSC1基因和TSC2基因全长编码外显子基因检测。测序后发现第25家系先证者为TSC2基因外显子40的框内移码突变5238-5255 del 18 bp,第11家系先证者为TSC2基因外显子23错义突变Arg905Trp。进一步采用变性凝胶电泳及内切酶技术在患者与120名正常对照中检测这两种突变。结果第25家系先证者外显子40出现5238-5255d el CATCAAGCGGCTCCGCCA突变,导致6个氨基酸缺失的框内移码突变(1746-1751del His-Ile-Lys-Arg-Leu-Gly),第11家系先证者外显子23出现2713 C>T(Arg905Trp)错义突变,2713位碱基由胞嘧啶(C)改变为胸腺嘧啶(T),导致第905位氨基酸精氨酸被色氨酸替代。120名正常对照未检测到这两种突变。结论TSC2基因5238-5255 del 18 bp及2713 C>T突变为两种致病性突变。     

NOTCH3基因Cys206*无义突变所致的伴皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病患者二例

目的探讨NOTCH3 Cys206~*无义突变所致的伴皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病(CADASIL)的临床及影像学特征。方法分析河北省邢台市第三医院两例携带有新型NOTCH3基因突变患者的临床资料、家系发病情况、影像资料及基因检测情况。结果两例患者既往有卒中病史且伴有进行性认知功能减退,但没有常见的血管危险因素,头颅MRI提示脑室周围、外囊及颞极存在广泛的白质病变。NOTCH3基因检测结果提示两例均为c.618CA p.(Cys206~*)突变,该突变位点在CADASIL病例中尚未被报道。结论本文两例提示Noth3基因的无义突变(4号外显子,c.618CA,p.Cys206~*)患者也可表现出典型CADASIL的临床症状和影像学特点。     

遗传性痉挛性截瘫SPG4和SPG3A基因突变和多态分析

目的 筛查并分析遗传性痉挛性截瘫(HSP)SPG4和SPG3A基因突变,了解中国人群这2个基因的突变特点.方法 联合应用变性高效液相色谱分析(DHPLC)和DNA序列分析方法对24例常染色体显性遗传的HSP(AD-HSP)家系的先证者和32例散发性HSP患者进行SPG4和SPG3A基因突变筛查,对24例AD-HSP家系的先证者进一步直接测序筛查这2个基因的突变.结果 在1个AD-HSP家系中发现1个位于SPG4基因上的新犁突变1616+1g→t杂合突变.在此家系中,共发现了3例现症患者和2例症状前患者.本组病例未检出SPG3A基因突变.此外,共发现了8种新的SPG4多态和3种新的SPG3A多态.结论 本组检测结果 丰富了SPG4和SPG3A基因的突变和多态库.这2个基因突变在本组病例中较少见,需要继续分析其他基因.     

变性高效液相色谱在检测肝豆状核变性基因突变中的作用

目的　建立变性高效液相色谱 (denaturinghighperformanceliquidchromatography,DHPLC)技术检测肝豆状核变性 (WD)基因第 8外显子突变。方法　利用聚合酶链式反应 (PCR)扩增WD基因第 8外显子片段 ,扩增产物直接进行DHPLC分析 ;对峰型有改变的样品经测序分析确认突变。结果　在 5 1例WD先证者中共发现两种错义突变 (Arg778Leu和Arg778Gln)、一种插入突变 (Ins2 30 2C)和一种多态性位点 (C2 310G)。其中 12例先证者带有Arg778Leu杂合错义突变 ,3例为Arg778Leu纯合错义突变 ,1例为Arg778Gln杂合错义突变 ,1例为杂合 2 30 2C插入突变。多态位点C2 310G与Arg778Leu突变完全连锁。结论　WD基因第 8外显子阳性检出率为 33 3% (17/ 5 1) ,说明DHPLC技术是一种可用于临床WD基因诊断的高效、灵敏和操作简便的方法     

腓骨肌萎缩症CMTX1型的间隙连接蛋白32基因突变检测

目的检测无基因重复的腓骨肌萎缩症患者间隙连接蛋白32(connexin32,Cx32)基因的突变情况。方法应用变性高效液相色谱(DHPLC)结合混合样品池法和脱氧核糖核酸(DNA)序列测定对1个临床可疑的X连锁显性遗传的腓骨肌萎缩症CMTX1型家系的先证者和15名家庭成员及60名家系外健康对照者进行Cx32基因外显子2的基因编码区突变检测,分3个片段扩增其基因编码区全长。结果先证者在片段2的DHPLC中发现杂合双峰,经DNA序列测定证实其Cx32外显子2发生Leu89Pro(266T→C)错义突变;家系内其他4例发病者和5名未发病者Cx32外显子2都有与先证者一致的DHPLC杂合双峰。60名健康对照者中未发现上述改变。结论Leu89Pro是该家系的致病性突变。该突变体的致病机制如何,有待于做进一步研究。     

西洛他唑治疗CADASIL临床研究

伴有皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病(CADASIL)是一种由第19号染色体上的NOTCH3基因突变引起显性遗传性脑血管病.目前国内外尚无有效的治疗方法,本文选择两确诊CADASIL家系,两位先证者试服用西洛他唑治疗,观察其临床疗效.     

NOTCH3基因14号外显子基因突变的伴皮质下梗死和白质脑病的常染色体显性遗传性脑病的临床特征(附1家系报告)

目的探讨NOTCH3基因14号外显子基因突变的伴皮质下梗死和白质脑病的常染色体显性遗传性脑病(CADASIL)的临床特征。方法对1例NOTCH3基因14号外显子基因突变的CADASIL患者及其家系的临床资料进行回顾性分析。结果先证者20多岁起出现剧烈的偏头痛样发作,近2年来反复出现头晕、双下肢无力,并伴有兴趣减退、焦虑不安,无明显智能减退。头颅MRI显示双侧基底节区、皮质下及脑干多发缺血梗死灶,并在基底节区和丘脑可见多发微出血病灶。皮肤活检见真皮小血管基底膜增厚及嗜锇颗粒物质。NOTCH3基因突变分析发现14号外显子C2182T突变。家族中有类似患者多例,另有4名亲属检出同样位点的基因突变。结论 14号外显子C2182T突变CADASIL的临床表现主要为偏头痛、情感障碍和反复皮质下脑缺血发作,认知功能减退可能出现较晚。MRI特征为颅内多发白质高信号及微出血病灶,皮肤活检可见嗜锇颗粒物质。NOTCH3基因检测可发现突变。     

Arg332Cys mutation of NOTCH3 gene in the first known Taiwanese family with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy

The phenotype and genotype of cerebral autosomal dominant arteriopathy and subcortical infarcts and leukoencephalopathy (CADASIL) in Caucasians have been well characterized, but CADASIL is less recognized in Asian populations. Here we investigated the first known Taiwanese family affected by CADASIL and identified an uncommon NOTCH3 mutation. The family had clinical manifestations in affected members including recurrent strokes, early dementia, and depression, but not migraine. A skin biopsy in the proband patient showed characteristic pathological findings of CADASIL on electron microscopy. Afterward, genetic analysis found an Arg332Cys mutation at exon 6 of NOTCH3. Neuropsychological evaluation showed vascular dementia in two of four affected people. Head MRI showed multiple infarcts in bilateral basal ganglia, thalami, periventricular white matter, external capsules, and brainstem, but involvement of the anterior temporal pole was found only in two people with milder symptoms. To our knowledge, the Arg332Cys NOTCH3 mutation at exon 6, which was identified in the studied family, has not been reported in Asian populations. Our findings emphasize the importance of genetic analysis of NOTCH3 for Asians with a phenotype typical of CADASIL.     

Genotypic and phenotypic spectrum of CADASIL in Japan: the experience at a referral center in Kumamoto University from 1997 to 2014

This study elucidates the genotypic and phenotypic spectrum and histopathological findings related to cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) in Japan. For this single-center retrospective observational study, we enrolled 215 patients who were clinically suspected of having CADASIL and were examined at Kumamoto University from 1997 to 2014, and we diagnosed CADASIL in 70 patients. We found 19 different NOTCH3 mutations in the patients, with the NOTCH3 Arg133Cys mutation being found most frequently. We also found the Arg75Pro mutation, a cysteine-sparing NOTCH3 mutation. CADASIL patients with this Arg75Pro mutation were frequently found throughout Japan, and fewer patients with the Arg75Pro mutation showed MRI hyperintensity in the anterior temporal pole compared with patients with other NOTCH3 mutations. Significantly more CADASIL patients with the NOTCH3 Arg133Cys mutation had hyperintensity in the external capsule compared with CADASIL patients with the other mutations not including the NOTCH3 Arg75Pro mutation. We also showed postmortem pathological findings of the first Japanese CADASIL case with the NOTCH3 Arg133Cys mutation, and histopathological findings of fresh frozen skin biopsy specimens of CADASIL patients. In conclusions, the spectrum of NOTCH3 mutations in Japanese CADASIL patients may be partially explained by founder effects. Genotype–phenotype correlations may exist in CADASIL, which should be considered so as to make an accurate diagnosis of CADASIL in each population. Fresh frozen skin biopsy specimens may aid detection of Notch3 deposits on vascular walls for an improved diagnosis of CADASIL.     

Mutations of the notch3 gene in non-caucasian patients with suspected CADASIL syndrome

The Notch3 gene has been recently identified as a causative gene for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). To investigate the genetic contribution of Notch mutations in familial cases with vascular leukoencephalopathy, we screened 13 patients from 11 unrelated families, which were selected on the basis of magnetic resonance imaging findings and positive family history. We identified three different missense mutations in 5 patients from 4 families. Two (Arg90Cys and Arg133Cys) are the same as previously reported in Caucasian patients, the other (Cys174Phe) is a novel mutation causing a loss of a cysteine in epidermal-growth-factor-like repeats of Notch3. These data indicate that the CADASIL Notch3 mutations were found in approximately 35% of familial cases with leukoencephalopathy, suggesting genetic heterogeneity of the disease.     

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy: two novel mutations in the NOTCH3 gene in Chinese

BACKGROUND: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary disorder caused by NOTCH3 mutations, usually localized to exons 3 and 4, and characterized by recurrent subcortical infarctions, dementia and leukoencephalopathy. So far, there has been only limited information about CADASIL in Chinese population. OBJECTIVES: To analyze the NOTCH3 mutations in ethnic Chinese in Taiwan with clinically suspected CADASIL and to characterize their clinical and molecular features. METHODS: Mutation analysis of NOTCH3 by direct nucleotide sequencing was performed in eight unrelated Chinese patients with clinically suspected CADASIL. Skin biopsy with ultrastructural studies by electronic microscopy was performed in four patients. RESULTS: Five NOTCH3 mutations, S118C, R141C, R332C, R544C and C977S, respectively, were identified from five patients, of which S118C and C977S are novel. None of these nucleotide sequence variations could be found among 50 healthy controls. Among the five mutations, two were in exon 4, and the other three were in exons 6, 11 and 18, respectively. Skin biopsy showed the presence of characteristic granular osmiophilic material only in the patient with the NOTCH3 mutation of R332C. CONCLUSION: Our study demonstrated the clinical and molecular features of CADASIL in Chinese patients and broadened the spectrum of NOTCH3 mutations. Lack of evidence of a strong clustering of mutations in a particular exon tentatively suggests that a comprehensive screening of NOTCH3 mutation is still necessary for molecular diagnosis of CADASIL in Chinese population.     

Identification of a Notch3 mutation in a Japanese CADASIL family. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary disease that is characterized by recurrent stroke episodes and focal neurologic deficits progressing to pseudobulbar palsy and dementia. The causative gene is the Notch3 gene on chromosome 19, and 22 missense mutations have been identified in Caucasian patients to date. To perform mutational analysis of the Notch3 gene, we identified its exon intron boundaries and prepared sets of primers for amplification of each exon. Using these primers, we determined the Notch3 gene in a Japanese family with CADASIL symptoms and found a missense mutation (Arg133Cys) in exon 4. The mutation was heterozygous and cosegregated with the disease. Thus, the Notch3 gene is responsible for CADASIL in patients across different ethnic groups.     

A case of CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and lekoencephalopathy) with Notch 3 (Arg169Cys) mutation and typical granular osmiophilic materials in peripheral small arteries]

We report a 64-year-old Japanese woman with recurrent ischemic strokes and progressive dementia without any cardiovascular risk factors. Her first stroke was at 45 years old, and she has a family history of ischemic strokes compatible with an autosomal dominant trait. Marked leukoaraiosis and multiple lacunar infarcts were shown on brain MR images, and no atherosclerotic changes were observed in her extra- and intra-cranial arteries by cervical arterial echography and intracranial MR angiography. Excluded other inherited or metabolic diseases causing leukodystrophy by examination of her blood samples, her disease was diagnosed as CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and lekoencephalopathy). We demonstrated granular osmiophilic materials (GOM) on the wall of small arteries from a biopsied peripheral nerve tissue specimen and detected a mutation Arg169Cys of Notch 3 gene. Many CADASIL patients have been reported and over 28 kinds of mutations of the Notch 3 were identified in western countries, while few CADASIL patients have been reported in Japanese people. Among them, eleven CADASIL families have been reported and only five mutations (Arg133Cys, Cys174Phe, Arg213Lys, Arg90Cys and Arg141Cys) have been determined so far. The mutation of Notch 3 in our patient was determined as Arg169Cys, and this is the first report on a Japanese patient with CADASIL due to this mutation.     

Denaturing high-performance liquid chromatography to diagnose cerebral autosomal dominant arteriopathy in Chinese patients with subcortical infarcts and leukoencephalopathy*★

BACKGROUND： Notch3 mutations are the molecular genetic foundation for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy （CADASIL）. Of all currently available detection methods, direct sequencing or restriction enzymes are frequently used, but the cost is relatively high, because the Notch3 gene is composed of many exons and mutational sites are widely distributed. Denaturing high-performance liquid chromatography （DHPLC） exhibits high efficiency and specificity and has been applied to gene detection. To date, there has no report regarding DHPLC in gene detection of large-scale CADASIL families in China. OBJECTIVE： To explore the application and value of DHPLC in the diagnosis of CADASIL by a mutation screening for Notch3 gene in CADASIL probands and their family members. DESIGN, TIME AND SETTING： A comparative observation was performed at the Genetic Diagnosis Laboratory of Institute of Geriatrics, Xuanwu Hospital of Capital Medical University and the Key Laboratory for Neurodegenerative Disease of the Ministry of Education between August 2003 and May 2004. PARTICIPANTS： Fourteen CADASIL patients and their family members, comprising eight males and six females, aged 38-62 years, were included. Their key features included recurrent sub-cortical ischemic events and vascular dementia. In addition, 100 healthy physical examinees were selected as controls, including 52 males and 48 females, aged 56-72 years, who had no neurodegenerative disease or psychosis, and no history or high risk for cerebrovascular disease. METHODS： DNA was extracted from white blood cells. Ten hotspots of the Notch3 gene for sequence variation were first amplified by PCR, and the products were detected using DHPLC, Exons exhibiting a variant in the DHPLC profile underwent another PCR amplification, followed by DNA sequencing to identify the mutation type, In addition, patients with normal DHPLC peak profiles underwent PCR amplification for the remaining 13 exons, DNA sequencing was per     

Novel heterozygous NOTCH3 pathogenic variant found in two Chinese patients with CADASIL

NOTCH3 mutations have been described to cause cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Here, we report 2 CADASIL patients from a Chinese family. Whole genome sequencing was performed on the two CADASIL patients. The novel variant c.128G>C in exon 2 of NOTCH3 was identified and confirmed through PCR-Sanger sequencing (Human Genome Variation Society nomenclature: HGVS: NOTCH3 c.128G>C; p.Cys43Ser). The heterozygous NOTCH3 variant cause a cysteine to serine substitution at codon 43. According to the variant interpretation guideline of American College of Medical Genetics and Genomics (ACMG), this variant was classified as “pathogenic”. Other variants in HTRA1, COL4A1 and COL4A2 were also found, they were classified as “benign”.     

A novel report of Cys1298Gly mutation in exon 24 of NOTCH3 gene in a Chinese family with CADASIL

ObjectivesCerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is the most common monogenic hereditary small cerebral vessel disease, which is caused by mutation of the neurogenic locus notch homolog protein 3 gene (NOTCH3). The exon 24 encodes EGF-like repeats, variants on this exon are rare. Here, we report a novel heterozygous variant c.3892 T >G (p. Cys1298Gly) on exon 24 of NOTCH3 gene in a 57-year-old Chinese woman.Materials and MethodsWe present a patient with clinical manifestations, laboratory examination and imaging reveal suspicion of CADASIL. The family and genetic test and pathological examination were performed.ResultsMagnetic resonance imaging revealed diffuse leukoencephalopathy with hyperintense signals in the bilateral temporal poles, periventricular white matter, centrum semiovale, basal ganglia, frontal and parietal cortex and subcortical areas bilaterally. Molecular Genetic testing identified a heterozygous variant c.3892 T >G (p. Cys1298Gly) on exon 24 of NOTCH3 gene. Her brother and his son were confirmed as subclinical carriers of the variant. The skin biopsy was negative, but the pathologic role of this mutation is predicted by using the DynaMut database and results showed the stability of the NOTCH gene is decreased.ConclusionsTo the best of our knowledge, this is the second case of exon 24 mutations reported from China and the variant of c.3892 T >G (p. Cys1298Gly) on exon 24 of NOTCH3 has not been reported so far. Our report broadens the mutation spectrum of the NOTCH3 gene in CADASIL.