title: Evaluation of diagnostic NOTCH3 immunostaining in CADASIL.
abstract: CADASIL is caused by mutations in the NOTCH3 gene. Although increasingly recognized as a disease entity, the diagnostic confirmation can be lengthy or inconclusive. Recently, NOTCH3 immunostaining of skin biopsy specimens has been introduced as a new diagnostic test. The aim of this study was to independently assess the diagnostic value of NOTCH3 immunostaining, and determine whether the degree of immunostaining correlates with other disease parameters. We determined NOTCH3 mutation carrier status in 62 symptomatic and asymptomatic individuals from 15 CADASIL families. Skin biopsy specimens of these individuals, as well as of a disease control group, were immunostained with NOTCH3 antibody and blindly analyzed by two independent observers to determine sensitivity and specificity. A semiquantitative NOTCH3 immunostaining score was correlated with clinical, genetic and MRI parameters. The sensitivity was 90.2% and 85.4%, respectively, for the two observers, the specificity 95.2% and 100%; both lower than previously reported. Certain NOTCH3 mutations may underlie false-negative results. False-positive results were found in a non-mutated control, and also in one disease control. There was no difference in immunostaining between symptomatic and asymptomatic NOTCH3 mutated individuals. Furthermore, the NOTCH3 immunostaining score did not correlate with clinical or MRI parameters. NOTCH3 immunostaining is a supportive, but not definitive, CADASIL diagnostic test, and should be interpreted in the context of clinical and radiological data. Confirmation by DNA analysis is requisite for positive results, and when there exists high clinical suspicion, also for negative results.
authors.affiliation: Department of Clinical Genetics, K5-R, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands. S.A.M.J.Lesnik_Oberstein@lumc.nl
authors.forename: Saskia A J
authors.initials: SA
authors.lastname: Lesnik Oberstein
authors.forename: Sjoerd G
authors.initials: SG
authors.lastname: van Duinen
authors.forename: Rivka
authors.initials: R
authors.lastname: van den Boom
authors.forename: Marion L C
authors.initials: ML
authors.lastname: Maat-Schieman
authors.forename: Mark A
authors.initials: MA
authors.lastname: van Buchem
authors.forename: Hans C
authors.initials: HC
authors.lastname: van Houwelingen
authors.forename: Ingrid M
authors.initials: IM
authors.lastname: Hegeman-Kleinn
authors.forename: Michel D
authors.initials: MD
authors.lastname: Ferrari
authors.forename: Martijn H
authors.initials: MH
authors.lastname: Breuning
authors.forename: Joost
authors.initials: J
authors.lastname: Haan
mesh_terms: D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000235:genetics / Q000378:metabolism; D015161:Dementia, Multi-Infarct / Q000175:diagnosis* / Q000378:metabolism* / Q000473:pathology; D004185:Disability Evaluation; D005188:False Negative Reactions; D006580:Genetic Carrier Screening; D006801:Humans; D007158:Immunologic Techniques; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009154:Mutation; D011518:Proto-Oncogene Proteins / Q000235:genetics / Q000378:metabolism*; D000071656:Receptor, Notch3; D011956:Receptors, Cell Surface; D051880:Receptors, Notch; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D012867:Skin / Q000473:pathology; D013194:Staining and Labeling
chemical_list: C499374:NOTCH3 protein, human; D011518:Proto-Oncogene Proteins; D000071656:Receptor, Notch3; D011956:Receptors, Cell Surface; D051880:Receptors, Notch