CADASIL and CARASIL
Open accessAbstract
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 NOTCH 3 gene, which encodes Notch3 receptor expressed in vascular smooth muscle cells ( VSMC ). Notch3 extracellular domain ( N 3 ECD ) 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 N 3 ECD . Definite diagnosis is made by molecular genetics but is also possible by electron microscopic demonstration of pathognomonic granular osmiophilic material at VSMC s or by positive immunohistochemistry for N 3 ECD 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 ( HTRA 1 ) gene, which result in reduced function of HTRA 1 as repressor of transforming growth factor‐β ( TGF β) ‐signaling. Cerebral arteries show loss of VSMC s and marked hyalinosis, but not stenosis.
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Biallelic mutations in HTRA1 result in subcortical lacunar infarcts and subsequent vascular dementia.
“Biallelic mutations in high-temperature requirement serine peptidase A1 ( HTRA1 ) gene located on chromosome 10q25 result in subcortical lacunar infarcts and subsequent vascular dementia (591).”
From Blood-Brain Barrier: From Physiology to Disease and Back (2019) · cites this paper as [591]
The Genetics and Biochemistry > CARASIL section says mutations on both HTRA1 alleles cause CARASIL and maps the gene defect to chromosome 10q. The Clinical Pictures > Clinical picture in CARASIL section says lacunar-type strokes can lead to dementia, while Imaging in CARASIL reports multiple lacunar infarcts. The copy does not specify the narrower 10q25 location stated in the citing sentence, and says recurrent ischemic strokes occur in half of patients rather than all. (LLM, conf=0.86)
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Kalaria, R. N., Keverne, J., Chuang, W., Low, R., Ziabreva, I., Court, J. A., Oakley, A. E., Wee, P., Low, C. R., Ziabreva, P. I., et al. (2015) · Cited by 59 · see citing works
Impaired Endothelial Function of Forearm Resistance Arteries in CADASIL Patients
Stenborg, A., Kalimo, H., Viitanen, M. H., Terént, A., & Lind, L. (2007) · Stroke · doi:10.1161/strokeaha.107.490029 · Cited by 58 · see citing works
Self-citationAcetazolamide for the treatment of migraine with aura in CADASIL
Forteza, A. M., Brozman, B., Rabinstein, A. A., Romano, J. G., & Bradley, W. G. (2001) · Neurology · doi:10.1212/wnl.57.11.2144 · Cited by 58 · see citing works
Two novel HTRA1 mutations in a European CARASIL patient
Bianchi, S., Palma, C. D., Gallus, G. N., Taglia, I., Poggiani, A., Rosini, F., Rufa, A., Muresanu, D. F., Cerase, A., Dotti, M. T., et al. (2014) · Neurology · doi:10.1212/wnl.0000000000000202 · Cited by 57 · see citing works
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Self-citationFamilial Unusual Encephalopathy of Binswanger's Type without Hypertension
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Detection of the founder effect in Finnish CADASIL families
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Two Japanese CADASIL families exhibiting Notch3 mutation R75P not involving cysteine residue
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Functional analysis of a recurrent missense mutation in Notch3 in CADASIL
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Different Clinical Phenotypes in Monozygotic CADASIL Twins With a Novel NOTCH3 Mutation
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Self-citationCholinergic Neuronal Deficits in CADASIL
Keverne, J. S., Low, W. C. R., Ziabreva, I., Court, J. A., Oakley, A. E., & Kalaria, R. N. (2006) · Stroke · doi:10.1161/01.str.0000251787.90695.05 · Cited by 48 · see citing works
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CADASIL-causing mutations do not alter Notch3 receptor processing and activation
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Cerebral hemorrhages in CADASIL: Report of four cases and a brief review
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Prolonged Cerebral Transit Time in CADASIL
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Proteome Analysis of Cultivated Vascular Smooth Muscle Cells from a CADASIL Patient
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Self-citationHomozygosity for a NOTCH3 mutation in a 65-year-old CADASIL patient with mild symptoms
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An extracellular region of Serrate is essential for ligand-induced cis-inhibition of Notch signaling
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Varicose veins associated with CADASIL result from a novel mutation in the Notch3 gene
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Scanning Laser Doppler Flowmetry Shows Reduced Retinal Capillary Blood Flow in CADASIL
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Self-citationExon-Skipping Therapy: A Roadblock, Detour, or Bump in the Road?
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Characteristic Features of in vivo Skin Microvascular Reactivity in CADASIL
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Allele-specific silencing of mutant Ataxin-7 in SCA7 patient-derived fibroblasts
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Neurologic symptoms are common during gestation and puerperium in CADASIL
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Self-citationRole of Electron Microscopy in the Diagnosis of Cadasil Syndrome: A Study of 32 Patients
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Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
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A Novel Mutation in the HTRA1 Gene Identified in Chinese CARASIL Pedigree
Wang, X., Li, C., Guo, H., & Cao, B. (2012) · CNS Neuroscience & Therapeutics · doi:10.1111/j.1755-5949.2012.00373.x · Cited by 29 · see citing works
Childhood-Onset CADASIL: Clinical, Imaging, and Neurocognitive Features
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Effects of short term atorvastatin treatment on cerebral hemodynamics in CADASIL
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Homozygosity and severity of phenotypic presentation in a CADASIL family
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Spontaneous intracerebral hemorrhage in CADASIL
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Screening for NOTCH3 Gene Mutations Among 151 Consecutive Korean Patients with Acute Ischemic Stroke
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Mutation in htra1 gene in a patient with degenerated spine as a component of carasil syndrome
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CADASIL: The Most Common Hereditary Subcortical Vascular Dementia
Kalimo, H., Miao, Q., Tikka, S., Mykkänen, K., Junna, M., Roine, S., Viitanen, M. H., Pöyhönen, M., & Baumann, M. (2008) · Future Neurology · doi:10.2217/14796708.3.6.683 · Cited by 16 · see citing works
Self-citationNeuroimaging of Cerebral Small Vessel Disease
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Transendocytosis is impaired in CADASIL-mutant NOTCH3
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First evidence of a pathogenic insertion in the NOTCH3 gene causing CADASIL
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Self-citationAccumulation of plasma proteins in Purkinje cells as an indicator of blood-brain barrier breakdown
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- Authors
- Tikka, S., Baumann, M., Siitonen, M., Pasanen, P., Pöyhönen, M., Myllykangas, L., Viitanen, M., Fukutake, T., Cognat, E., Joutel, A., & Kalimo, H.
- Affiliations
- University of Helsinki (FI)
- University of Turku (FI)
- Helsinki University Hospital (FI)
- Karolinska Institutet (SE)
- Kameda Medical Center (JP)
- Inserm (FR)
- Corresponding author
- Kalimo, Hannu
- ORCID
- Venue
- Brain Pathology
- Publisher
- Wiley
- Published
- 2014-09
- Volume
- 24
- Issue
- 5
- Pages
- 525-544
- ISSN
- 1015-6305 (ISSN-L)
- 1750-3639
- PMC
- PMC8029192
- OpenAlex
- W1604840218
- Cited by
- 189
- References
- 138
- Citations by year
- 2026: 6 · 2025: 20 · 2024: 14 · 2023: 19 · 2022: 19 · 2021: 15 · 2020: 17 · 2019: 20 · 2018: 24 · 2017: 10 · 2016: 13 · 2015: 10 · 2014: 1 · 2013: 1
- FWCI
- 1.55
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Brain Pathology (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Työväentutkimus Vuosikirja (submittedVersion)
- Funders
- Fondation Leducq
- Finnish Cultural Foundation
- Sigrid Juselius Foundation
- Swedish Research Council
- Topics
- Health Sciences › Medicine › Neurology › Cerebrovascular and genetic disorders
- Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Genetic Neurodegenerative Diseases
- Keywords
- CADASIL, CARASIL, vascular dementia, NOTCH3 mutations, vascular smooth muscle cells, osmiophilic granules, lacunar infarction, TGF-beta signaling, gain-of-function, hyalinosis
- MeSH terms
- Alopecia, Brain, Cerebral Infarction, Humans, Spinal Diseases, CADASIL, Leukoencephalopathies
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