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Pathogenic variants in the ABCC6 gene are associated with an increased risk for ischemic stroke

(2018) BRAIN PATHOLOGY. 28(6). p.822-831
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Abstract
Ischemic stroke causes a high mortality and morbidity worldwide. It results from a complex interplay of incompletely known environmental and genetic risk factors. We investigated the ABCC6 gene as a candidate risk factor for ischemic stroke because of the increased ischemic stroke incidence in the autosomal recessive disorder pseudoxanthoma elasticum, caused by biallelic pathogenic ABCC6 variants, the higher cardiovascular risk in heterozygous carriers and the established role of ABCC6 dysfunction in myocardial ischemia. We established segregation of a known pathogenic ABCC6 variant (p.[Arg1314Gln]) in 11/19 family members of an ischemic stroke patient in a large multigenerational family suffering from ischemic stroke and/or cardiovascular disease at a relatively young age. In an independent case-control study in 424 ischemic stroke patients and 250 healthy controls, pathogenic ABCC6 variants were 4.9 times more frequent (P = 0.036; 95% CI 1.11-21.33) in the ischemic stroke patient cohort. To study cellular consequences of ABCC6 deficiency in the brain, immunostaining of brain sections in Abcc6-deficient mice and wild-type controls were performed. An upregulation of Bmp4 and Eng and a downregulation of Alk2 was identified in Abcc6-/- mice, suggesting an increase in apoptosis and angiogenesis. As both of these processes are induced in ischemia, we propose that a pro-ischemic state may explain the higher risk to suffer from ischemic stroke in patients carrying a pathogenic ABCC6 variant, as this may lower the threshold to develop acute ischemic events in these patients. In conclusion, this study identified heterozygous ABCC6 variants as a risk factor for ischemic stroke. Further, dysregulation of Bmp (Bmp4, Alk2) and Tgf beta (Eng) signaling in the brain of Abcc6-/- mice could lead to a pro-ischemic state, lowering the threshold to develop acute ischemic events. These data demonstrate the importance of a molecular analysis of the ABCC6 gene in patients diagnosed with cryp togenic ischemic stroke.
Keywords
ABCC6, ischemia, pseudoxanthoma elasticum, stroke, susceptibility, SMALL-VESSEL DISEASE, PSEUDOXANTHOMA ELASTICUM, POLYMORPHISM, R1141X, CLASSIFICATION, METAANALYSIS, DEFICIENCY, EXPRESSION, RESISTANCE, APOPTOSIS

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MLA
De Vilder, Eva et al. “Pathogenic Variants in the ABCC6 Gene Are Associated with an Increased Risk for Ischemic Stroke.” BRAIN PATHOLOGY 28.6 (2018): 822–831. Print.
APA
De Vilder, E., CARDOEN, S., Hosen, M. J., Le Saux, O., De Zaeytijd, J., Leroy, B., De Reuck, J., et al. (2018). Pathogenic variants in the ABCC6 gene are associated with an increased risk for ischemic stroke. BRAIN PATHOLOGY, 28(6), 822–831.
Chicago author-date
De Vilder, Eva, STEFANIE CARDOEN, Mohammad J Hosen, Olivier Le Saux, Julie De Zaeytijd, Bart Leroy, Jacques De Reuck, et al. 2018. “Pathogenic Variants in the ABCC6 Gene Are Associated with an Increased Risk for Ischemic Stroke.” Brain Pathology 28 (6): 822–831.
Chicago author-date (all authors)
De Vilder, Eva, STEFANIE CARDOEN, Mohammad J Hosen, Olivier Le Saux, Julie De Zaeytijd, Bart Leroy, Jacques De Reuck, Paul Coucke, Anne De Paepe, Dimitri Hemelsoet, and Olivier Vanakker. 2018. “Pathogenic Variants in the ABCC6 Gene Are Associated with an Increased Risk for Ischemic Stroke.” Brain Pathology 28 (6): 822–831.
Vancouver
1.
De Vilder E, CARDOEN S, Hosen MJ, Le Saux O, De Zaeytijd J, Leroy B, et al. Pathogenic variants in the ABCC6 gene are associated with an increased risk for ischemic stroke. BRAIN PATHOLOGY. 2018;28(6):822–31.
IEEE
[1]
E. De Vilder et al., “Pathogenic variants in the ABCC6 gene are associated with an increased risk for ischemic stroke,” BRAIN PATHOLOGY, vol. 28, no. 6, pp. 822–831, 2018.
@article{8560906,
  abstract     = {Ischemic stroke causes a high mortality and morbidity worldwide. It results from a complex interplay of incompletely known environmental and genetic risk factors. We investigated the ABCC6 gene as a candidate risk factor for ischemic stroke because of the increased ischemic stroke incidence in the autosomal recessive disorder pseudoxanthoma elasticum, caused by biallelic pathogenic ABCC6 variants, the higher cardiovascular risk in heterozygous carriers and the established role of ABCC6 dysfunction in myocardial ischemia. We established segregation of a known pathogenic ABCC6 variant (p.[Arg1314Gln]) in 11/19 family members of an ischemic stroke patient in a large multigenerational family suffering from ischemic stroke and/or cardiovascular disease at a relatively young age. In an independent case-control study in 424 ischemic stroke patients and 250 healthy controls, pathogenic ABCC6 variants were 4.9 times more frequent (P = 0.036; 95% CI 1.11-21.33) in the ischemic stroke patient cohort. To study cellular consequences of ABCC6 deficiency in the brain, immunostaining of brain sections in Abcc6-deficient mice and wild-type controls were performed. An upregulation of Bmp4 and Eng and a downregulation of Alk2 was identified in Abcc6-/- mice, suggesting an increase in apoptosis and angiogenesis. As both of these processes are induced in ischemia, we propose that a pro-ischemic state may explain the higher risk to suffer from ischemic stroke in patients carrying a pathogenic ABCC6 variant, as this may lower the threshold to develop acute ischemic events in these patients. In conclusion, this study identified heterozygous ABCC6 variants as a risk factor for ischemic stroke. Further, dysregulation of Bmp (Bmp4, Alk2) and Tgf beta (Eng) signaling in the brain of Abcc6-/- mice could lead to a pro-ischemic state, lowering the threshold to develop acute ischemic events. These data demonstrate the importance of a molecular analysis of the ABCC6 gene in patients diagnosed with cryp togenic ischemic stroke.},
  author       = {De Vilder, Eva and CARDOEN, STEFANIE and Hosen, Mohammad J and Le Saux, Olivier and De Zaeytijd, Julie and Leroy, Bart and De Reuck, Jacques and Coucke, Paul and De Paepe, Anne and Hemelsoet, Dimitri and Vanakker, Olivier},
  issn         = {1015-6305},
  journal      = {BRAIN PATHOLOGY},
  keywords     = {ABCC6,ischemia,pseudoxanthoma elasticum,stroke,susceptibility,SMALL-VESSEL DISEASE,PSEUDOXANTHOMA ELASTICUM,POLYMORPHISM,R1141X,CLASSIFICATION,METAANALYSIS,DEFICIENCY,EXPRESSION,RESISTANCE,APOPTOSIS},
  language     = {eng},
  number       = {6},
  pages        = {822--831},
  title        = {Pathogenic variants in the ABCC6 gene are associated with an increased risk for ischemic stroke},
  url          = {http://dx.doi.org/10.1111/bpa.12620},
  volume       = {28},
  year         = {2018},
}

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