Sex differences and risk factors for bleeding in Alagille syndrome

Abstract Spontaneous bleeds are a leading cause of death in the pediatric JAG1‐related liver disease Alagille syndrome (ALGS). We asked whether there are sex differences in bleeding events in patients, whether Jag1Ndr/Ndr mice display bleeds or vascular defects, and whether discovered vascular patho...

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Main Authors: Simona Hankeova, Noemi Van Hul, Jakub Laznovsky, Elisabeth Verboven, Katrin Mangold, Naomi Hensens, Csaba Adori, Elvira Verhoef, Tomas Zikmund, Feven Dawit, Michaela Kavkova, Jakub Salplachta, Marika Sjöqvist, Bengt R Johansson, Mohamed G Hassan, Linda Fredriksson, Karsten Baumgärtel, Vitezslav Bryja, Urban Lendahl, Andrew Jheon, Florian Alten, Kristina Teär Fahnehjelm, Björn Fischler, Jozef Kaiser, Emma R Andersson
Format: Article
Language:English
Published: Springer Nature 2022-11-01
Series:EMBO Molecular Medicine
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Online Access:https://doi.org/10.15252/emmm.202215809
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author Simona Hankeova
Noemi Van Hul
Jakub Laznovsky
Elisabeth Verboven
Katrin Mangold
Naomi Hensens
Csaba Adori
Elvira Verhoef
Tomas Zikmund
Feven Dawit
Michaela Kavkova
Jakub Salplachta
Marika Sjöqvist
Bengt R Johansson
Mohamed G Hassan
Linda Fredriksson
Karsten Baumgärtel
Vitezslav Bryja
Urban Lendahl
Andrew Jheon
Florian Alten
Kristina Teär Fahnehjelm
Björn Fischler
Jozef Kaiser
Emma R Andersson
author_facet Simona Hankeova
Noemi Van Hul
Jakub Laznovsky
Elisabeth Verboven
Katrin Mangold
Naomi Hensens
Csaba Adori
Elvira Verhoef
Tomas Zikmund
Feven Dawit
Michaela Kavkova
Jakub Salplachta
Marika Sjöqvist
Bengt R Johansson
Mohamed G Hassan
Linda Fredriksson
Karsten Baumgärtel
Vitezslav Bryja
Urban Lendahl
Andrew Jheon
Florian Alten
Kristina Teär Fahnehjelm
Björn Fischler
Jozef Kaiser
Emma R Andersson
author_sort Simona Hankeova
collection DOAJ
description Abstract Spontaneous bleeds are a leading cause of death in the pediatric JAG1‐related liver disease Alagille syndrome (ALGS). We asked whether there are sex differences in bleeding events in patients, whether Jag1Ndr/Ndr mice display bleeds or vascular defects, and whether discovered vascular pathology can be confirmed in patients non‐invasively. We performed a systematic review of patients with ALGS and vascular events following PRISMA guidelines, in the context of patient sex, and found significantly more girls than boys reported with spontaneous intracranial hemorrhage. We investigated vascular development, homeostasis, and bleeding in Jag1Ndr/Ndr mice, using retina as a model. Jag1Ndr/Ndr mice displayed sporadic brain bleeds, a thin skull, tortuous blood vessels, sparse arterial smooth muscle cell coverage in multiple organs, which could be aggravated by hypertension, and sex‐specific venous defects. Importantly, we demonstrated that retinographs from patients display similar characteristics with significantly increased vascular tortuosity. In conclusion, there are clinically important sex differences in vascular disease in ALGS, and retinography allows non‐invasive vascular analysis in patients. Finally, Jag1Ndr/Ndr mice represent a new model for vascular compromise in ALGS.
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spelling doaj-art-06eb0c1933c14c07a0211bd34884636e2025-08-20T03:05:54ZengSpringer NatureEMBO Molecular Medicine1757-46761757-46842022-11-01141212310.15252/emmm.202215809Sex differences and risk factors for bleeding in Alagille syndromeSimona Hankeova0Noemi Van Hul1Jakub Laznovsky2Elisabeth Verboven3Katrin Mangold4Naomi Hensens5Csaba Adori6Elvira Verhoef7Tomas Zikmund8Feven Dawit9Michaela Kavkova10Jakub Salplachta11Marika Sjöqvist12Bengt R Johansson13Mohamed G Hassan14Linda Fredriksson15Karsten Baumgärtel16Vitezslav Bryja17Urban Lendahl18Andrew Jheon19Florian Alten20Kristina Teär Fahnehjelm21Björn Fischler22Jozef Kaiser23Emma R Andersson24Department of Cell and Molecular Biology, Karolinska InstitutetDepartment of Cell and Molecular Biology, Karolinska InstitutetCEITEC – Central European Institute of Technology, Brno University of TechnologyDepartment of Cell and Molecular Biology, Karolinska InstitutetDepartment of Cell and Molecular Biology, Karolinska InstitutetDepartment of Cell and Molecular Biology, Karolinska InstitutetDepartment of Neuroscience, Karolinska InstitutetDepartment of Cell and Molecular Biology, Karolinska InstitutetCEITEC – Central European Institute of Technology, Brno University of TechnologyDepartment of Pediatrics, Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University HospitalCEITEC – Central European Institute of Technology, Brno University of TechnologyCEITEC – Central European Institute of Technology, Brno University of TechnologyDepartment of Cell and Molecular Biology, Karolinska InstitutetEM Unit, Institute of Biomedicine, University of GothenburgUniversity of San FranciscoDepartment of Medical Biochemistry and Biophysics, Karolinska InstitutetTravere TherapeuticsDepartment of Experimental Biology, Masaryk UniversityDepartment of Cell and Molecular Biology, Karolinska InstitutetUniversity of San FranciscoDepartment of Ophthalmology, University of Muenster Medical CenterDepartment of Pediatric Ophthalmology, Strabismus, Electrophysiology and Ocular Oncology, St. Erik Eye Hospital, Karolinska InstitutetDepartment of Pediatrics, Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University HospitalCEITEC – Central European Institute of Technology, Brno University of TechnologyDepartment of Cell and Molecular Biology, Karolinska InstitutetAbstract Spontaneous bleeds are a leading cause of death in the pediatric JAG1‐related liver disease Alagille syndrome (ALGS). We asked whether there are sex differences in bleeding events in patients, whether Jag1Ndr/Ndr mice display bleeds or vascular defects, and whether discovered vascular pathology can be confirmed in patients non‐invasively. We performed a systematic review of patients with ALGS and vascular events following PRISMA guidelines, in the context of patient sex, and found significantly more girls than boys reported with spontaneous intracranial hemorrhage. We investigated vascular development, homeostasis, and bleeding in Jag1Ndr/Ndr mice, using retina as a model. Jag1Ndr/Ndr mice displayed sporadic brain bleeds, a thin skull, tortuous blood vessels, sparse arterial smooth muscle cell coverage in multiple organs, which could be aggravated by hypertension, and sex‐specific venous defects. Importantly, we demonstrated that retinographs from patients display similar characteristics with significantly increased vascular tortuosity. In conclusion, there are clinically important sex differences in vascular disease in ALGS, and retinography allows non‐invasive vascular analysis in patients. Finally, Jag1Ndr/Ndr mice represent a new model for vascular compromise in ALGS.https://doi.org/10.15252/emmm.202215809Alagille syndromeBleedingJagged1NotchVasculature
spellingShingle Simona Hankeova
Noemi Van Hul
Jakub Laznovsky
Elisabeth Verboven
Katrin Mangold
Naomi Hensens
Csaba Adori
Elvira Verhoef
Tomas Zikmund
Feven Dawit
Michaela Kavkova
Jakub Salplachta
Marika Sjöqvist
Bengt R Johansson
Mohamed G Hassan
Linda Fredriksson
Karsten Baumgärtel
Vitezslav Bryja
Urban Lendahl
Andrew Jheon
Florian Alten
Kristina Teär Fahnehjelm
Björn Fischler
Jozef Kaiser
Emma R Andersson
Sex differences and risk factors for bleeding in Alagille syndrome
EMBO Molecular Medicine
Alagille syndrome
Bleeding
Jagged1
Notch
Vasculature
title Sex differences and risk factors for bleeding in Alagille syndrome
title_full Sex differences and risk factors for bleeding in Alagille syndrome
title_fullStr Sex differences and risk factors for bleeding in Alagille syndrome
title_full_unstemmed Sex differences and risk factors for bleeding in Alagille syndrome
title_short Sex differences and risk factors for bleeding in Alagille syndrome
title_sort sex differences and risk factors for bleeding in alagille syndrome
topic Alagille syndrome
Bleeding
Jagged1
Notch
Vasculature
url https://doi.org/10.15252/emmm.202215809
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