Analyses of NOTCH3 variants in Chinese patients with clinically diagnosed Alzheimer's disease and frontotemporal dementia

Abstract Background A pathogenic variant in the NOTCH3 gene has been identified as the cause of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Studies focusing on variants in NOTCH3 in Alzheimer's disease (AD) and frontotemporal dementia (F...

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Main Authors: Haitian Nan, Min Chu, Ailing Yue, Qianqian He, Jieying Li, Yanchen Liu, Lijun Chi, Xiaoyan Liu, Guoping Peng, Liyong Wu
Format: Article
Language:English
Published: BMC 2025-08-01
Series:Alzheimer’s Research & Therapy
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Online Access:https://doi.org/10.1186/s13195-025-01836-1
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author Haitian Nan
Min Chu
Ailing Yue
Qianqian He
Jieying Li
Yanchen Liu
Lijun Chi
Xiaoyan Liu
Guoping Peng
Liyong Wu
author_facet Haitian Nan
Min Chu
Ailing Yue
Qianqian He
Jieying Li
Yanchen Liu
Lijun Chi
Xiaoyan Liu
Guoping Peng
Liyong Wu
author_sort Haitian Nan
collection DOAJ
description Abstract Background A pathogenic variant in the NOTCH3 gene has been identified as the cause of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Studies focusing on variants in NOTCH3 in Alzheimer's disease (AD) and frontotemporal dementia (FTD) cohorts have been limited. We aim to screen clinically diagnosed AD and FTD patients with unknown etiology for pathogenic variants in NOTCH3 in the Chinese population. Methods This study included early-onset AD and FTD patients consecutively recruited from Xuanwu Hospital. We performed the whole exome sequencing of genomic DNA from the patients screened for rare, nonsynonymous, predicted deleterious NOTCH3 variants. The clinical characteristics of dementia patients with likely pathogenic NOTCH3 variants were described in detail. Results Three hundred four AD and 261 FTD patients were screened for variants in the NOTCH3 gene. Four cysteine-altering NOTCH3 variants—c.1630C > T,p.(R544C); c.1672C > T,p.(R558C); c.1759C > T,p.(R587C); and c.1918C > T,p.(R640C)—were identified as likely pathogenic variants according to ACMG guidelines. All four patients with cysteine-altering variants were clinically diagnosed with AD or FTD and presented with characteristic clinical manifestations and neuroimaging profiles. Notably, they also showed mild periventricular and deep white matter signal changes on neuroimaging. Our study showed a 0.7% (4/565) occurrence of NOTCH3 pathogenic variants in Chinese early-onset dementia patients. Conclusions Our findings expand the mutational and phenotypic spectrum associated with NOTCH3. NOTCH3 pathogenic variants are present in clinically diagnosed AD and FTD patients. However, the absence of biomarkers to confirm AD or FTD diagnoses limits the interpretation of whether these cases represent comorbid conditions or phenotypic overlaps with CADASIL. Clinical identification of dementia patients with these variants at an early stage is challenging.
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spelling doaj-art-d139e313951946f69ec379ace53308ea2025-08-20T03:04:22ZengBMCAlzheimer’s Research & Therapy1758-91932025-08-0117111210.1186/s13195-025-01836-1Analyses of NOTCH3 variants in Chinese patients with clinically diagnosed Alzheimer's disease and frontotemporal dementiaHaitian Nan0Min Chu1Ailing Yue2Qianqian He3Jieying Li4Yanchen Liu5Lijun Chi6Xiaoyan Liu7Guoping Peng8Liyong Wu9Department of Neurology, Xuanwu Hospital, Capital Medical UniversityDepartment of Neurology, Xuanwu Hospital, Capital Medical UniversityDepartment of Neurology, Xuanwu Hospital, Capital Medical UniversityDepartment of Neurology, Xuanwu Hospital, Capital Medical UniversitySichuan Provincial Center for Mental Health, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of ChinaDepartment of Neurology, The First Affiliated Hospital of Harbin Medical UniversityDepartment of Neurology, The First Affiliated Hospital of Harbin Medical UniversityDepartment of Neurology, The 1st Affiliated Hospital of Zhejiang University School of MedicineDepartment of Neurology, The 1st Affiliated Hospital of Zhejiang University School of MedicineDepartment of Neurology, Xuanwu Hospital, Capital Medical UniversityAbstract Background A pathogenic variant in the NOTCH3 gene has been identified as the cause of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Studies focusing on variants in NOTCH3 in Alzheimer's disease (AD) and frontotemporal dementia (FTD) cohorts have been limited. We aim to screen clinically diagnosed AD and FTD patients with unknown etiology for pathogenic variants in NOTCH3 in the Chinese population. Methods This study included early-onset AD and FTD patients consecutively recruited from Xuanwu Hospital. We performed the whole exome sequencing of genomic DNA from the patients screened for rare, nonsynonymous, predicted deleterious NOTCH3 variants. The clinical characteristics of dementia patients with likely pathogenic NOTCH3 variants were described in detail. Results Three hundred four AD and 261 FTD patients were screened for variants in the NOTCH3 gene. Four cysteine-altering NOTCH3 variants—c.1630C > T,p.(R544C); c.1672C > T,p.(R558C); c.1759C > T,p.(R587C); and c.1918C > T,p.(R640C)—were identified as likely pathogenic variants according to ACMG guidelines. All four patients with cysteine-altering variants were clinically diagnosed with AD or FTD and presented with characteristic clinical manifestations and neuroimaging profiles. Notably, they also showed mild periventricular and deep white matter signal changes on neuroimaging. Our study showed a 0.7% (4/565) occurrence of NOTCH3 pathogenic variants in Chinese early-onset dementia patients. Conclusions Our findings expand the mutational and phenotypic spectrum associated with NOTCH3. NOTCH3 pathogenic variants are present in clinically diagnosed AD and FTD patients. However, the absence of biomarkers to confirm AD or FTD diagnoses limits the interpretation of whether these cases represent comorbid conditions or phenotypic overlaps with CADASIL. Clinical identification of dementia patients with these variants at an early stage is challenging.https://doi.org/10.1186/s13195-025-01836-1NOTCH3Alzheimer's diseaseFrontotemporal dementiaCADASIL
spellingShingle Haitian Nan
Min Chu
Ailing Yue
Qianqian He
Jieying Li
Yanchen Liu
Lijun Chi
Xiaoyan Liu
Guoping Peng
Liyong Wu
Analyses of NOTCH3 variants in Chinese patients with clinically diagnosed Alzheimer's disease and frontotemporal dementia
Alzheimer’s Research & Therapy
NOTCH3
Alzheimer's disease
Frontotemporal dementia
CADASIL
title Analyses of NOTCH3 variants in Chinese patients with clinically diagnosed Alzheimer's disease and frontotemporal dementia
title_full Analyses of NOTCH3 variants in Chinese patients with clinically diagnosed Alzheimer's disease and frontotemporal dementia
title_fullStr Analyses of NOTCH3 variants in Chinese patients with clinically diagnosed Alzheimer's disease and frontotemporal dementia
title_full_unstemmed Analyses of NOTCH3 variants in Chinese patients with clinically diagnosed Alzheimer's disease and frontotemporal dementia
title_short Analyses of NOTCH3 variants in Chinese patients with clinically diagnosed Alzheimer's disease and frontotemporal dementia
title_sort analyses of notch3 variants in chinese patients with clinically diagnosed alzheimer s disease and frontotemporal dementia
topic NOTCH3
Alzheimer's disease
Frontotemporal dementia
CADASIL
url https://doi.org/10.1186/s13195-025-01836-1
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