伴有皮层下梗死和白质脑病的常染色体显性遗传脑动脉病一家系

先证者男，42岁，因“右侧肢体无力1年余”于2005年4月8日就诊于我院门诊。患者于2004年3月20号晨醒后感右侧肢体无力，讲话不清楚，无饮水呛咳。在当地医院诊断脑梗死，给予疏血通等治疗，于发病第6天完全恢复正常，其后继续服用阿司匹林100mg／d和中药3个月。2004年11月30日晨醒后再次感右侧肢体无力，并头昏、恶心，右手麻木。当地医院诊断脑梗死，给予阿司匹林及其他治疗后头昏及右侧肢体无力明显好转，右手麻木未见明显改善。     

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一家系八例

先证者(Ⅲ5)男,41岁,于10年前无明显诱因出现左下肢无力,走路拖拉,伴有左大腿后侧麻木.8年前当地行CT及MRI检查示"腔隙性脑梗塞".6年前左下肢无力加重,走路不稳,伴有臀部至足跟放射性麻木,呈持续状,同时感右下肢也稍力弱伴有麻木,并感排尿费力.     

伴有皮层下梗死和白质脑病的常染色体显性遗传脑动脉病两家系

家系1) 先证者(Ⅲ1),女,51岁,因"双下肢无力6年,构音不清、饮水呛咳半年"入院.患者6年前,开始感到左下肢麻木无力,走路发僵,以后逐渐好转,5年前症状又有加重,行走时左下肢拖行,3年前右下肢行走也无力,双上肢活动不灵活,1年前因行走不能需用轮椅代步,半年前出现饮水呛咳,反应迟钝,记忆力、计算能力明显下降.无高血压、糖尿病、高脂血症家族史.     

伴有皮层下梗死和白质脑病的常染色体显性遗传性脑动脉病一家系的临床及基因研究

目的 探讨伴有皮层下梗死和白质脑病的常染色体显性遗传性脑动脉病(cerebral autosomaldominant arteriopathy with subcortical infarcts and leukoencephalopathy,CADASIL)患者的临床特征及基因诊断.方法 对1个CADASIL先证者及其家族的发病情况、遗传方式、临床表现、影像学特征、分子遗传学及治疗等方面进行研究.结果 患者均有记忆力减退、乏力、脑卒中样发作等特点,没有高血压、动脉硬化证据,有家族聚集性,头颅CT、MRI示多发性梗死灶、脑白质变性,临床符合CADASIL的诊断.存活者中基因测序显示NOTCH3基因第3、4外显子突变,可确诊为CADASIL.该家系4代中有3代10人呈临床或亚临床发病,符合常染色体显性遗传.结论 该家系的临床及分子遗传学特征符合CADASIL诊断.     

Notch3基因突变引起遗传性脑动脉病CADASIL的研究进展

近年来研究发现Notch3基因是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)的首选致病基因。170多种Notch3基因突变类型显示Notch3基因的突变与CADASIL发病机制有关,但机理不明。CADASIL基因突变类型筛查显示可能存在其它类型的Notch3基因突变。对CADASIL的特点、CADASIL的Notch3基因突变类型、Notch3基因和CADASIL与认知功能障碍之间的关系等方面进行综述,以期为突变筛查、致病机理和临床治疗研究提供参考。     

常染色体显性遗传视网膜色素变性的研究概况

视网膜色素变性是视网膜感光细胞和色素上皮细胞变性导致夜盲和进行性视野缺损的一类眼底遗传病。常染色体显性遗传视网膜色素变性占视网膜色素变性的20％～25％，已克隆至少11个常染色体显性遗传基因。本文就常染色体显性遗传视网膜色素变性临床分型、基因定位、克隆和治疗等方面研究进展作一综述。     

常染色体显性视网膜色素变性的相关基因研究进展

常染色体显性视网膜色素变性 (autosomal dominant retinitis pigmentosa,ad RP)属视网膜色素变性的一种类型 ,是单基因遗传病 ,具有遗传异质性和临床异质性。目前已克隆了 8个致病基因 ,包括 RHO、Peripherin/ RDS、RP1、NRL、CRX等 ,现简介如下。     

一个常染色体显性非综合征型耳聋DFNA15家系的基因检测

目的:探究一个常染色体显性非综合征型语后聋家系的致病基因变异类型,明确可能的遗传学病因。方法:应用高通量测序方法对先证者进行415个遗传性耳聋相关基因的序列检测,应用Sanger测序法对高通量测序结果进行验证并对家系成员进行基因变异位点检测。结果:先证者基因组DNA中检测到一个与非综合征型常染色体显性耳聋15(auto...     

常染色体显性遗传视网膜色素变性的研究概况

视网膜色素变性是视网膜感光细胞和色素上皮细胞变性导致夜盲和进行性视野缺损的一类眼底遗传病。常染色体显性遗传视网膜色素变性占视网膜色素变性的 2 0 %～ 2 5 %,已克隆至少 11个常染色体显性遗传基因。本文就常染色体显性遗传视网膜色素变性临床分型、基因定位、克隆和治疗等方面研究进展作一综述     

High recurrence of the R1006C NOTCH3 mutation in central Italian patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a heritable small-vessel disease caused by mutations in NOTCH3 gene and clinically characterized by recurrent ischemic strokes, migraine with aura, psychiatric symptoms, cognitive decline and dementia. Direct sequencing of NOTCH3 gene in 90 Italian patients of sixty-three unrelated families identified four heterozygous mutations (R141C and C144F in exon 4, G528C in exon 10 and R1006C in exon 19) in fifteen probands and sixteen relatives. We detected seventeen heterozygous/homozygous polymorphisms, four of them novel. Here we report the high recurrence of R1006C mutation in ten families all originate from a restricted area of central Italy, the town of Ascoli Piceno and same neighbour villages. We also developed a PCR–Restriction Fragment Length Polymorphism (RFLP) assay to analyze the R1006C mutation. Our findings might suggest, for this mutation, the presence of a common ancestor.     

CADASIL研究新进展

伴有皮层下梗死和白质脑病的常染色体显性遗传性脑动脉病(cerebral autosome dominant arteriopathy with subcortical Infarcts and leukoencephalopathy,CADASIL)是近年来证实遗传因素参与脑血管病发病的重要进展之一.其主要临床特点为家族遗传方式起病、中年发病、逐渐进展的缺血样卒中样病程、进行性血管性痴呆、先兆症状的偏头痛发作和精神症状.MRI、CT检查可见多发性梗死、脑白质变性.脑组织活检示小血管玻璃样变、噬锇颗粒.分子遗传学研究发现19号染色体Notch3基因突变与本病有关.     

CADASIL and CARASIL

CADASIL and CARASIL are hereditary small vessel diseases leading to vascular dementia. CADASIL commonly begins with migraine followed by minor strokes in mid‐adulthood. Dominantly inherited CADASIL is caused by mutations (n > 230) in NOTCH3 gene, which encodes Notch3 receptor expressed in vascular smooth muscle cells (VSMC). Notch3 extracellular domain (N3ECD) accumulates in arterial walls followed by VSMC degeneration and subsequent fibrosis and stenosis of arterioles, predominantly in cerebral white matter, where characteristic ischemic MRI changes and lacunar infarcts emerge. The likely pathogenesis of CADASIL is toxic gain of function related to mutation‐induced unpaired cysteine in N3ECD. Definite diagnosis is made by molecular genetics but is also possible by electron microscopic demonstration of pathognomonic granular osmiophilic material at VSMCs or by positive immunohistochemistry for N3ECD in dermal arteries. In rare, recessively inherited CARASIL the clinical picture and white matter changes are similar as in CADASIL, but cognitive decline begins earlier. In addition, gait disturbance, low back pain and alopecia are characteristic features. CARASIL is caused by mutations (presently n = 10) in high‐temperature requirement. A serine peptidase 1 (HTRA1) gene, which result in reduced function of HTRA1 as repressor of transforming growth factor‐β (TGF β) ‐signaling. Cerebral arteries show loss of VSMCs and marked hyalinosis, but not stenosis.     

Hypomorphic NOTCH3 Alleles Do Not Cause CADASIL in Humans

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.     

Mechanisms regulating cerebral hypoperfusion in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy

Cerebral small vessel disease (CSVD) is a leading cause of stroke and dementia. As the most common type of inherited CSVD, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is characterized by the NOTCH3 gene mutation which leads to Notch3 ectodomain deposition and extracellular matrix aggregation around the small vessels. It further causes smooth muscle cell degeneration and small vessel arteriopathy in the central nervous system. Compromised cerebral blood flow occurs in the early stage of CADASIL and is associated with white matter hyperintensity, the typical neuroimaging pathology of CADASIL. This suggests that cerebral hypoperfusion may play an important role in the pathogenesis of CADASIL. However, the mechanistic linkage between NOTCH3 mutation and cerebral hypoperfusion remains unknown. Therefore, in this mini-review, it examines the cellular and molecular mechanisms contributing to cerebral hypoperfusion in CADASIL.     

免疫性血小板减少性紫癜的发病机制与临床研究进展

免疫性血小板减少性紫癜(Immune thrombocytopenic purpura,ITP)是自身抗体介导的血小板减少综合征,自身抗原的主要成分是血小板一种或多种糖蛋白;细胞免疫也是血小板破坏的一个重要原因.目前ITP的诊断仍是临床排除性诊断,分为原发性与继发性两种.ITP治疗的目的是使患者血小板计数提高到安全水平.肾上腺糖皮质激素仍是ITP的首选药物,静脉输注丙种球蛋白(IVIg)用于控制严重出血与重度血小板减少,脾切除仍是治疗慢性ITP的主要手段.血小板生成素(TPO)类似物可能成为新的治疗方法.对成人慢性ITP患者应常规进行幽门螺杆菌(Hp)筛查,阳性患者应根除Hp.     

Machado--Joseph的研究进展病基因检测及新突变位点

马查多-约瑟夫病（Machado—Josephdisease,MJD）也被称为脊髓小脑性共济失调3型（spinocerebellarataxia3,SCA3）,是最常见的遗传性脊髓小脑性共济失调亚型。发病机制尚不清楚,复杂的病情一直是临床工作者极大的挑战。得益于分子细胞遗传学迅猛发展,MJD症状前诊断及基因诊断成为现实并还在继续向前发展。逐步用于疾病诊断、鉴别诊断及治疗中,同时为遗传咨询提供科学依据。为寻求新突破,该文集中总结该疾病ATXN3突变致病机制及基因检测应用研究现状。更好地理解这些复杂的分子机制,探讨基因检测以及新基因突变位点的发现对这一致命性疾病的诊断及治疗意义。     

Putative role of specific JAG1 gene exons in modulating clinical features in patients with leukoencephalopathy

The aim of this study was to investigate the possible role of JAG1 gene mutations in modulating clinical features in patients with CADASIL-like phenotype which resulted negative for NOTCH3 gene mutations. Sixty-six CADASIL-like patients without NOTCH3 gene mutations were investigated for 5 out of 26 exons of the JAG1 gene, whose mutations were implicated in central nervous system vascular abnormalities. PCR was performed with primers specific for exons 3, 4, 13, 23 and 24 comprising the intron-exon boundaries. Amplicons were then analyzed by denaturing high performance liquid chromatography (DHPLC). The exons showing a variant DHPLC profile were directly sequenced. The sequence of exons 3, 4 and 23 revealed the presence of four already described polymorphisms in JAG1. 1001C/T (g.16015 C>T) in exon 4 was found in 9 patients, IVS23+18delT (g.33147 delT) in 29 patients, IVS3-15T/C (g.15852 T>C) in 17 patients, IVS2-43C/T (g.10532 C>T) in 1 patient; both the polymorphism 1001C/T and IVS3-15T/C were found in 3 patients. No mutations were found. These data demonstrate absence of correlation between mutations in specific JAG1 gene exons and clinical features in patients with CADASIL-like phenotype.