A Polymorphism in RNF213 Is a Susceptibility Gene for Intracranial Atherosclerosis

• Published in: PloS one 2016-06, Vol.11 (6), p.e0156607-e0156607
• Main Authors: Bang, Oh Young, Chung, Jong-Won, Cha, Jihoon, Lee, Mi Ji, Yeon, Je Young, Ki, Chang-Seok, Jeon, Pyoung, Kim, Jong-Soo, Hong, Seung Chyul
• Format: Article
• Language: English
• Subjects: Adenosine Triphosphatases - genetics; Adult; Aged; Aged, 80 and over; Angiography; Arteriosclerosis; Asian people; Atherosclerosis; Biology and Life Sciences; Cardiovascular disease; Carotid artery; Carriers; Disease susceptibility; Embolism; Female; Gene polymorphism; Genetic aspects; Genetic polymorphisms; Genetic Predisposition to Disease; Genetics; Heart diseases; Humans; Intracranial Arteriosclerosis - genetics; Ischemia; Magnetic resonance imaging; Male; Medical imaging; Medicine; Medicine and Health Sciences; Middle Aged; Moyamoya disease; Neurology; Neurosurgery; NMR; Nuclear magnetic resonance; Patients; Physiological aspects; Polymorphism; Polymorphism, Genetic; Prevalence; Research and Analysis Methods; Review boards; Risk Factors; Stenosis; Stroke; Susceptibility; Systematic review; Thyroid gland; Ubiquitin-Protein Ligases - genetics; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0156607

Both intracranial atherosclerotic stenosis (ICAS) and moyamoya disease (MMD) are prevalent in Asians. We hypothesized that the Ring Finger protein 213 gene polymorphism (RNF213), a susceptibility locus for MMD in East Asians, is also a susceptibility gene for ICAS in patients whose diagnosis had been confirmed by conventional angiography (absence of basal collaterals) and high-resolution MRI (HR-MRI, presence of plaque). We analyzed 532 consecutive patients with ischemic events in the middle cerebral artery (MCA) distribution and relevant stenotic lesion on the distal internal carotid artery or proximal MCA, but no demonstrable carotid or cardiac embolism sources. Additional angiography was performed on 370 (69.5%) patients and HR-MRI on 283 (53.2%) patients. Based on angiographic and HR-MRI findings, 234 patients were diagnosed with ICAS and 288 with MMD. The RNF213 variant was observed in 50 (21.4%) ICAS patients and in 119 (69.1%) MMD patients. The variant was observed in 25.2% of patients with HR-MRI-confirmed ICAS. Similarly, 15.8% of ICAS patients in whom MMD was excluded by angiography had this variant. Among the ICAS patients, RNF213 variant carriers were younger and more likely to have a family history of MMD than non-carriers were. Multivariate testing showed that only the age of ICAS onset was independently associated with the RNF213 variant (odds ratio, 0.97; 95% CI, 0.944-0.99). RNF213 is a susceptibility gene not only for MMD but also for ICAS in East Asians. Further studies are needed on RNF213 variants in ICAS patients outside East Asian populations.