Journal: Brain
Article Title: Three-tiered EGFr domain risk stratification for individualized NOTCH3-small vessel disease prediction
doi: 10.1093/brain/awac486
Figure Lengend Snippet: Differences in NOTCH3 aggregation and signalling between EGFr risk categories. ( A – C ) NOTCH3 aggregation load, expressed as immunohistochemical NOTCH3 score, was determined in skin tissue samples of LR-EGFr ( n = 3), MR-EGFr ( n = 6) and HR-EGFr ( n = 12) patients, of which six had an HR-EGFr 1–6 NOTCH3 cys variant and six had a NOTCH3 cys variant located in the newly identified HR-EGFr domain 26. ( A ) As there were only tissue samples available of three LR-EGFr patients, these patients were excluded from the group comparisons. HR-EGFr 1–6 CADASIL patients had a significantly higher NOTCH3 score than MR-EGFr patients: mean NOTCH3 score 43.0 (95% CI: 30.3–55.6) versus 23.2 (95% CI: 10.5–35.8) ( P = 0.033). HR-EGFr 26 patients had a mean NOTCH3 score of 32.8 (95% CI: 20.1–45.5), which did not significantly differ from that of HR-EGFr 1–6 ( P = 0.24) and MR-EGFr ( P = 0.27) patients. The three LR-EGFr patients had a mean NOTCH3 score of 15.4 (95% CI: 0–32.6). ( B ) NVFOR was significantly associated with a NOTCH3 score ( P = 0.003), also after correction for age ( P = 0.006). ( C ) Representative images of NOTCH3-immunohistochemistry of skin biopsies of HR-EGFr 1–6, HR-EGFr 26, MR-EGFr and LR-EGFr patients, showing increasing granular NOTCH3 staining from low- to high-risk EGFr domains. Bar represents 20 µm. ( D ) NOTCH3 signalling activity was assessed in NIH 3T3 cells using a CBF1-responsive luciferase assay with and without Jagged1 stimulation. NOTCH3 signalling was expressed as fold increase of luciferase activity upon Jagged1 stimulation (= ‘luciferase activity with Jagged1 stimulation’/‘luciferase activity without Jagged1 stimulation’). Each dot represents an individual experiment. Signalling activity did not differ significantly between NOTCH3 cys variants located in the other HR-EGFr domains and the MR-EGFr and LR-EGFr domains (all P > 0.58). However, NOTCH3 cys variants in HR-EGFr and MR-EGFr showed a significantly lower NOTCH3 signalling activity compared to wild-type ( P = 0.008 and P = 0.02). As expected, NOTCH3 cys variants located in the HR-EGFr domain 11 had strongly impaired ligand-induced signalling activity, comparable to a deletion of the ligand binding domain ( P = 0.53). There was no significant difference in NOTCH3 signalling activity between HR-EGFr domain 26 and other HR-EGFr domains, MR-EGFr domains and LR-EGFr domains (all P > 0.47). ( E ) NVFOR was not associated with NOTCH3 signalling activity ( P = 0.88). Error bars indicate 95% confidence intervals of the group means. Statistical significance after correction for multiple testing: * P < 0.05, ** P < 0.01, *** P < 0.001, **** P < 0.0001.
Article Snippet: Skin tissue samples were processed and stained with a monoclonal antibody targeting NOTCH3 ECD (clone 1E4, Millipore), full-focus microscopy images were taken and NOTCH3 ECD -positive area was quantified in all visible blood vessel walls (median 30, range 21–37) using ImageJ, as previously described.
Techniques: Immunohistochemical staining, Variant Assay, Immunohistochemistry, Staining, Activity Assay, Luciferase, Ligand Binding Assay