prognostic-analysis-butylphthalide-therapy-guided-cyp2c19-genotype

Prognostic Analysis of Butylphthalide Therapy Guided by CYP2C19 Genotype in Patients with Acute Cerebral Infarction

To investigate the prognosis of patients with acute-phase cerebral infarction treated with butylphthalide based on cytochrome P450 2C19 (CYP2C19) ...

Shaoxing University

 Homozygous and compound heterozygous mutations in  cause cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL). Recently, heterozygous pathogenic variants in  were described in patients with autosomal dominant cerebral small vessel disease (CSVD). Here, we investigated the genetic variants in a cohort of Chinese patients with CSVD.  A total of 95 Chinese index patients with typical characteristics of CSVD were collected. Whole exome sequencing was performed in the probands, followed by Sanger sequencing. Pathogenicity prediction software was applied to evaluate the pathogenicity of the identified variants.  We detected five heterozygous  pathogenic variants in five index patients. These pathogenic variants included four known variants (c.543delT, c.854C>T, c.889G>A, and c.824C>T) and one novel variant (c.472 + 1G>A). Among them, c.854C>T, c.824C>T, and c.472 + 1G>A have never been reported in China and c.889G>A was once reported in homozygous but never in heterozygous. Three of them were distributed in exon 4, one in exon 2, and another splicing variant in intron 1. Four out of five probands presented typical features of CARASIL but less severe. The common clinical features included lacunar infarction, cognitive decline, alopecia, and spondylosis. All of them showed leukoencephalopathy, and the main involved cerebral area include periventricular and frontal area, centrum semiovale, thalamus, and corpus callosum. Anterior temporal lobes and external capsule involvement were also observed. Three probands had intracranial microbleeds.  Our study expanded the mutation spectrum of , especially in Chinese populations, and provided further evidence for "hot regions" in exon 1-4, especially in exon 4, in heterozygous  pathogenic variants Our work further supported that patients with heterozygous  pathogenic variants presented with similar but less-severe features than CARASIL but in an autosomal dominantly inherited pattern.

Qiqi Ruan

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