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Lee S, Yoon JG, Hong J, Kim T, Kim N, Vandrovcova J, Yau WY, Cho J, Kim S, Kim MJ, Kim SY, Lee ST, Chu K, Lee SK, Kim HJ, Choi J, Moon J, Chae JH. Prevalence and Characterization of NOTCH2NLC GGC Repeat Expansions in Koreans: From a Hospital Cohort Analysis to a Population-Wide Study. Neurol Genet 2024; 10:e200147. [PMID: 38779172 PMCID: PMC11110025 DOI: 10.1212/nxg.0000000000200147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/16/2024] [Indexed: 05/25/2024]
Abstract
Background and Objectives GGC repeat expansions in the NOTCH2NLC gene are associated with a broad spectrum of progressive neurologic disorders, notably, neuronal intranuclear inclusion disease (NIID). We aimed to investigate the population-wide prevalence and clinical manifestations of NOTCH2NLC-related disorders in Koreans. Methods We conducted a study using 2 different cohorts from the Korean population. Patients with available brain MRI scans from Seoul National University Hospital (SNUH) were thoroughly reviewed, and NIID-suspected patients presenting the zigzag edging signs underwent genetic evaluation for NOTCH2NLC repeats by Cas9-mediated nanopore sequencing. In addition, we analyzed whole-genome sequencing data from 3,887 individuals in the Korea Biobank cohort to estimate the distribution of the repeat counts in Koreans and to identify putative patients with expanded alleles and neurologic phenotypes. Results In the SNUH cohort, among 90 adult-onset leukoencephalopathy patients with unknown etiologies, we found 20 patients with zigzag edging signs. Except for 2 diagnosed with fragile X-associated tremor/ataxia syndrome and 2 with unavailable samples, all 16 patients (17.8%) were diagnosed with NIID (repeat range: 87-217). By analyzing the Korea Biobank cohort, we estimated the distribution of repeat counts and threshold (>64) for Koreans, identifying 6 potential patients with NIID. Furthermore, long-read sequencing enabled the elucidation of transmission and epigenetic patterns of NOTCH2NLC repeats within a family affected by pediatric-onset NIID. Discussion This study presents the population-wide distribution of NOTCH2NLC repeats and the estimated prevalence of NIID in Koreans, providing valuable insights into the association between repeat counts and disease manifestations in diverse neurologic disorders.
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Affiliation(s)
| | | | | | - Taekeun Kim
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Narae Kim
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Jana Vandrovcova
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Wai Yan Yau
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Jaeso Cho
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Sheehyun Kim
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Man Jin Kim
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Soo Yeon Kim
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Soon-Tae Lee
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Kon Chu
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Sang Kun Lee
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
| | - Han-Joon Kim
- From the Department of Genomic Medicine (S.L., J.G.Y., Jaeso Cho, S.K., M.J.K., S.Y.K., J.M., J.-H.C.), Seoul National University Hospital; Department of Pediatrics (S.L., Jaeso Cho, S.Y.K., J.-H.C.), Seoul National University College of Medicine, Seoul National University Children's Hospital; Department of Biomedical Sciences (J.H., T.K., Jungmin Choi), Korea University College of Medicine; Department of Neurology (N.K., S.-T.L., K.C., S.K.L., H.-J.K., J.M.), Seoul National University Hospital, Korea; Department of Neuromuscular Diseases (J.V.), Institute of Neurology, University College London, United Kingdom; Perron Institute for Neurological and Translational Science (W.Y.Y.), the University of Western Australia, Nedlands, Australia; and Department of Laboratory Medicine (M.J.K.), Seoul National University Hospital, Korea
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Tian Y, Hou X, Cao W, Zhou L, Jiao B, Zhang S, Xiao Q, Xue J, Wang Y, Weng L, Fang L, Yang H, Zhou Y, Yi F, Chen X, Du J, Xu Q, Feng L, Liu Z, Zeng S, Sun Q, Xie N, Luo M, Wang M, Zhang M, Zeng Q, Huang S, Yao L, Hu Y, Long H, Xie Y, Chen S, Huang Q, Wang J, Xie B, Zhou L, Long L, Guo J, Wang J, Yan X, Jiang H, Xu H, Duan R, Tang B, Zhang R, Shen L. Diagnostic value of nerve conduction study in NOTCH2NLC-related neuronal intranuclear inclusion disease. J Peripher Nerv Syst 2023; 28:629-641. [PMID: 37749855 DOI: 10.1111/jns.12599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND AND AIMS Neuronal intranuclear inclusion disease (NIID) is a rare progressive neurodegenerative disorder mainly caused by abnormally expanded GGC repeats within the NOTCH2NLC gene. Most patients with NIID show polyneuropathy. Here, we aim to investigate diagnostic electrophysiological markers of NIID. METHODS In this retrospective dual-center study, we reviewed 96 patients with NOTCH2NLC-related NIID, 94 patients with genetically confirmed Charcot-Marie-Tooth (CMT) disease, and 62 control participants without history of peripheral neuropathy, who underwent nerve conduction studies between 2018 and 2022. RESULTS Peripheral nerve symptoms were presented by 53.1% of patients with NIID, whereas 97.9% of them showed peripheral neuropathy according to electrophysiological examinations. Patients with NIID were characterized by slight demyelinating sensorimotor polyneuropathy; some patients also showed mild axonal lesions. Motor nerve conduction velocity (MCV) of the median nerve usually exceeded 35 m/s, and were found to be negatively correlated with the GGC repeat sizes. Regarding the electrophysiological differences between muscle weakness type (n = 27) and non-muscle weakness type (n = 69) of NIID, nerve conduction abnormalities were more severe in the muscle weakness type involving both demyelination and axonal impairment. Notably, specific DWI subcortical lace sign was presented in only 33.3% of muscle weakness type, thus it was difficult to differentiate them from CMT. Combining age of onset, distal motor latency, and compound muscle action potential of the median nerve showed the optimal diagnostic performance to distinguish NIID from major CMT (AUC = 0.989, sensitivity = 92.6%, specificity = 97.4%). INTERPRETATION Peripheral polyneuropathy is common in NIID. Our study suggest that nerve conduction study is useful to discriminate NIID.
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Affiliation(s)
- Yun Tian
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xuan Hou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Wanqian Cao
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lu Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Bin Jiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Sizhe Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qiao Xiao
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Jin Xue
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Ying Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Ling Weng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Liangjuan Fang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Honglan Yang
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yafang Zhou
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Fang Yi
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoyu Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Juan Du
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qian Xu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhenhua Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Sen Zeng
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qiying Sun
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Nina Xie
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Mengchuan Luo
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Mengli Wang
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Mengqi Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qiuming Zeng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Shunxiang Huang
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lingyan Yao
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Yacen Hu
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Hongyu Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yuanyuan Xie
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Si Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Junpu Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Bin Xie
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Lin Zhou
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Lili Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jifeng Guo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
- Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Junling Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xinxiang Yan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Hongwei Xu
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ranhui Duan
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
- Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Ruxu Zhang
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
- Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
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