Therapeutic NOTCH3 cysteine correction in CADASIL using exon skipping: in vitro proof of concept.

Autor:	Rutten JW; Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands., Dauwerse HG; Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands., Peters DJ; Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands., Goldfarb A; Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands., Venselaar H; NCMLS, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands., Haffner C; Intitute for Stroke and Dementia Research, Klinikum Der Universität München, Ludwig-Maximilians-University, Munich, Germany., van Ommen GJ; Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands., Aartsma-Rus AM; Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands., Lesnik Oberstein SA; Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands lesnik@lumc.nl.
Jazyk:	angličtina
Zdroj:	Brain : a journal of neurology [Brain] 2016 Apr; Vol. 139 (Pt 4), pp. 1123-35. Date of Electronic Publication: 2016 Feb 19.
DOI:	10.1093/brain/aww011
Abstrakt:	Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, or CADASIL, is a hereditary cerebral small vessel disease caused by characteristic cysteine altering missense mutations in the NOTCH3 gene. NOTCH3 mutations in CADASIL result in an uneven number of cysteine residues in one of the 34 epidermal growth factor like-repeat (EGFr) domains of the NOTCH3 protein. The consequence of an unpaired cysteine residue in an EGFr domain is an increased multimerization tendency of mutant NOTCH3, leading to toxic accumulation of the protein in the (cerebro)vasculature, and ultimately reduced cerebral blood flow, recurrent stroke and vascular dementia. There is no therapy to delay or alleviate symptoms in CADASIL. We hypothesized that exclusion of the mutant EGFr domain from NOTCH3 would abolish the detrimental effect of the unpaired cysteine and thus prevent toxic NOTCH3 accumulation and the negative cascade of events leading to CADASIL. To accomplish this NOTCH3 cysteine correction by EGFr domain exclusion, we used pre-mRNA antisense-mediated skipping of specific NOTCH3 exons. Selection of these exons was achieved using in silico studies and based on the criterion that skipping of a particular exon or exon pair would modulate the protein in such a way that the mutant EGFr domain is eliminated, without otherwise corrupting NOTCH3 structure and function. Remarkably, we found that this strategy closely mimics evolutionary events, where the elimination and fusion of NOTCH EGFr domains led to the generation of four functional NOTCH homologues. We modelled a selection of exon skip strategies using cDNA constructs and show that the skip proteins retain normal protein processing, can bind ligand and be activated by ligand. We then determined the technical feasibility of targeted NOTCH3 exon skipping, by designing antisense oligonucleotides targeting exons 2-3, 4-5 and 6, which together harbour the majority of distinct CADASIL-causing mutations. Transfection of these antisense oligonucleotides into CADASIL patient-derived cerebral vascular smooth muscle cells resulted in successful exon skipping, without abrogating NOTCH3 signalling. Combined, these data provide proof of concept for this novel application of exon skipping, and are a first step towards the development of a rational therapeutic approach applicable to up to 94% of CADASIL-causing mutations. (© The Author (2016). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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