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      CCM1 and CCM2 variants in patients with cerebral cavernous malformation in an ethnically Chinese population in Taiwan

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          Abstract

          Cerebral cavernous malformation (CCM) is a vascular malformation characterized by clustered enlarged capillary-like channels in the central nervous system. The genes harboring variants in patients with CCM include CCM1/Krev interaction trapped-1, CCM2/MGC4607, and CCM3/programmed cell death protein 10. We aimed to identify pathogenic variants in an ethnic Chinese population in Taiwan. We recruited 95 patients with multiple CCMs or a single lesion with a relevant family history. Sanger sequencing was performed for 41 patients. Variants were identified using sequence alignment tools, and the clinical significance of these variants was determined using American College of Medical Genetics and Genomics standards and guidelines. Several pathogenic variants were found in six patients, including three unrelated patients and three affected members of one family. Two novel pathogenic variants leading to early truncation comprised a deletion variant in exon 18 of CCM1 (c.1846delA; p.Glu617LysfsTer44) and an insertion variant in exon 4 of CCM2 (c.401_402insGCCC; p.Ile136AlafsTer4). One novel pathogenic splice site variant was c.485 + 1G > C at the beginning of intron 8 of CCM1. In this study, we identified novel variants related to CCM in an ethnically Chinese population in Taiwan.

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          Natural history of the cavernous angioma.

          The incidence and natural history of the cavernous angioma have remained unclear in part because of the difficulty of diagnosing and following this lesion prior to surgical excision. The introduction of magnetic resonance (MR) imaging has improved the sensitivity and specificity of diagnosing and following this vascular malformation. Seventy-six lesions with an MR appearance typical of a presumed cavernous angioma were discovered in 66 patients among 14,035 consecutive MR images performed at the Cleveland Clinic between 1984 and 1989. Follow-up studies in 86% of the cases over a mean period of 26 months provided 143 lesion-years of clinical survey of this condition. The most frequent presenting features were seizure, focal neurological deficit, and headache. While most lesions exhibited evidence of occult bleeding on MR imaging, there was overt hemorrhage in seven of the 57 symptomatic patients and only one overt hemorrhage occurred during the follow-up interval. The annualized bleeding rate was 0.7%. Analysis of the hemorrhage group revealed a significantly greater risk of overt hemorrhage in females. Pathological confirmation of cavernous angioma was obtained in all 14 surgical cases. This information assists in rational therapeutic planning and prognosis in patients with MR images showing lesions suggestive of cavernous angioma.
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            Novel CCM1, CCM2, and CCM3 mutations in patients with cerebral cavernous malformations: in-frame deletion in CCM2 prevents formation of a CCM1/CCM2/CCM3 protein complex.

            Cerebral cavernous malformations (CCM) are prevalent cerebrovascular lesions predisposing to chronic headaches, epilepsy, and hemorrhagic stroke. Using a combination of direct sequencing and MLPA analyses, we identified 15 novel and eight previously published CCM1 (KRIT1), CCM2, and CCM3 (PDCD10) mutations. The mutation detection rate was >90% for familial cases and >60% for isolated cases with multiple malformations. Splice site mutations constituted almost 20% of all CCM mutations identified. One of these proved to be a de novo mutation of the most 3' acceptor splice site of the CCM1 gene resulting in retention of intron 19. A further mutation affected the 3' splice site of CCM2 intron 2 leading to cryptic splice site utilization in both CCM2 and its transcript variant lacking exon 2. With the exception of one in-frame deletion of CCM2 exon 2, which corresponds to the naturally occurring splice variant of CCM2 on the RNA level and is predicted to result in the omission of 58 amino acids (CCM2:p.P11_K68del), all mutations lead to the introduction of premature stop codons. To gain insight into the likely mechanisms underlying the only known CCM2 in-frame deletion, we analyzed the functional consequences of loss of CCM2 exon 2. The CCM2:p.P11_K68del protein could be expressed in cell culture and complexed with CCM3. However, its ability to interact with CCM1 and to form a CCM1/CCM2/CCM3 complex was lost. These data are in agreement with a loss-of-function mechanism for CCM mutations, uncover an N-terminal CCM2 domain required for CCM1 binding, and demonstrate full-length CCM2 as the essential core protein in the CCM1/CCM2/CCM3 complex.
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              Susceptibility-weighted imaging for the evaluation of patients with familial cerebral cavernous malformations: a comparison with t2-weighted fast spin-echo and gradient-echo sequences.

              The T2-weighted gradient-echo (GRE) imaging is currently the gold standard MR imaging sequence for the evaluation of patients with cerebral cavernous malformation (CCM) lesions. We aimed to compare the sensitivity of susceptibility-weighted imaging (SWI) with T2-weighted fast spin-echo (FSE) and GRE imaging in assigning the number of CCM lesions in patients with the familial form of the disease. We studied 15 patients (8 men, 7 women; mean age, 34 years) with familial CCM. All patients underwent MR imaging with the following sequences: T1-weighted spin echo, T2-weighted FSE, T2-weighted GRE, and SWI. Two neuroradiologists read the images regarding the number of lesions seen on each sequence. The final decisions were reached by consensus. The number of lesions on the different sequences was compared with analysis of variance, followed by a nonparametric Wilcoxon matched-pairs signed rank test. The number of lesions was higher on T2-weighted GRE than on T2-weighted FSE (P = .001). In addition, more lesions were seen on SWI than on T2-weighted GRE (P = .001) and FSE (P = .001) sequences. The sensitivity of SWI in assigning the number of CCM lesions in patients with the familial form of the disease is significantly higher than that of T2-weighted FSE and GRE sequences.
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                Author and article information

                Contributors
                yihruwu@cgmh.org.tw
                chen0050@cgmh.org.tw
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                27 August 2019
                27 August 2019
                2019
                : 9
                : 12387
                Affiliations
                [1 ]Department of Neurology, Chang Gung Memorial Hospital - Linkou Medical Center, Taoyuan, Taiwan
                [2 ]Department of Neurosurgery, Chang Gung Memorial Hospital - Linkou Medical Center, Taoyuan, Taiwan
                [3 ]GRID grid.145695.a, College of Medicine, , Chang Gung University, ; Taoyuan, Taiwan
                [4 ]Department of Neurosurgery, Xiamen Chang Gung Memorial Hospital, Xiamen, China
                [5 ]GRID grid.145695.a, Department of Medical Imaging and Radiological Sciences, , Chang Gung University, ; Taoyuan, Taiwan
                [6 ]GRID grid.145695.a, Healthy Ageing Research Center, , Chang Gung University, ; Taoyuan, Taiwan
                Author information
                http://orcid.org/0000-0003-3384-0199
                Article
                48448
                10.1038/s41598-019-48448-y
                6712018
                31455779
                dc894870-bb55-4213-9a37-e350d6078e92
                © The Author(s) 2019

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 19 January 2018
                : 11 July 2019
                Funding
                Funded by: FundRef https://doi.org/10.13039/501100005795, Chang Gung Memorial Hospital, Linkou (Linkou Chang Gung Memorial Hospital);
                Award ID: CMRPG371273
                Award Recipient :
                Categories
                Article
                Custom metadata
                © The Author(s) 2019

                Uncategorized
                cerebrovascular disorders,clinical genetics
                Uncategorized
                cerebrovascular disorders, clinical genetics

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