Introduction
Methods
Study cohort
Characteristics | All (n = 75) Mean ± SD (range) | aSAH (N = 48) Mean ± SD (range) | UIA (N = 27) Mean ± SD (range) | ES IND (n = 35) Mean ± SD (range) | FAM IND (n = 30) Mean ± SD (range) | SPO IND (N = 45) Mean ± SD (range) |
---|---|---|---|---|---|---|
Age at SAH (years) | 46.9 ± 12.1 (9–71) | |||||
IA (count) | 1.96 ± 1.40 (1–6) | 1.8 ± 1.3 (0–6) | 2.3 ± 1.6 (1–6) | 2.23 ± 1.57 (1–6) | 1.80 ± 1.27 (1–6) | 2.07 ± 1.48 (1–6) |
Aneurysm diameter (mm) | 7.1 ± 6.6 (1.5–47.0) | 5.7 ± 2.6 (1.5–13.0) | 9.6 ± 910.2 (2.0–47.0) | 5.76 ± 3.22 (1.5–47.0) | 6.75 ± 5.95 (2.0–30.0) | 7.35 ± 7.07 (1.5–47.0) |
Phases score | 4.8 (0–13) | 4.7 (0–12) | 5.0 (0–13) | 4.8 (0–13) | 4.5 (0–13) | 5.0 (0–12) |
Hunt and hess grade | 2.3 (1–5) | |||||
WFNS grade | 1.9 (1–5) | |||||
Fisher score | 3.4 (1–4) | |||||
Outcome at discharge (EGOS) | 4.9 (1–8) | |||||
LAO (months) | 83 ± 298 (2–1343) | |||||
Outcome LAO (MRS) | 1.3 (0–6) |
Count (%) | Count (%) | Count (%) | Count (%) | Count (%) | Count (%) | |
Sex | ||||||
Female | 53 (70.7) | 35 (72.9) | 18 (66.7) | 26 (74.3) | 22 (73.3) | 31 (68.9) |
Male | 22 (29.3) | 13 (17.3) | 9 (33.3) | 9 (25.7) | 8 (26.7) | 14 (31.1) |
Aneurysm locationa | ||||||
Anterior circulation | 56 (80.0) | 34 (77.3) | 22 (84.6) | 25 (75.8) | 22 (81.5) | 34 (79.1) |
Posterior circulation | 11 (15.7) | 10 (22.7) | 1 (3.8) | 7 (21.2) | 5 (18.5) | 6 (14.0) |
Both | 3 (4.3) | – | 3 (11.5) | 1 (3.0) | – | 3 (7.0) |
Unknown | 5 | 2 | 3 | 2 | ||
Family history | ||||||
Yes | 30 (40) | 13 (27.1) | 17 (63.0) | 14 (60.0) | 30 (100.0) | 0 (0.0) |
No | 45 (60) | 35 (72.9) | 10 (37.0) | 21 (40.0) | 0 (0.0) | 45 (100.0) |
Vascular risk factors | ||||||
Hypertension | 27 (36.5) | 13 (27.7) | 14 (51.9) | 13 (37.1) | 12 (41.4) | 15 (33.3) |
Diabetes | 3 (4.1) | 1 (2.1) | 2 (7.4) | 1 (2.9) | 1 (3.4) | 2 (4.4.) |
Hyperlipidemia | 6 (8.1) | 3 (6.4) | 3 (11.1) | 4 (11.4) | 3 (10.3) | 3 (6.7) |
Prev. cardiovas. disease | 4 (5.5) | 2 (4.3) | 2 (7.4) | 2 (5.7) | 1 (3.4) | 3 (6.8) |
Prev. neurol. disease | 12 (16.4) | 9 (19.6) | 3 (11.1) | 9 (25.7) | 1 (3.4) | 7 (15.9) |
Ever smoker | 41 (56.2) | 28 (59.6) | 13 (50.0) | 20 (57.1) | 18 (62.1) | 23 (52.3) |
Alcohol | 2 (2.7) | 2 (4.3) | 0 (0.0) | 1 (2.9) | 0 (0.0) | 2 (4.4) |
Treatment | ||||||
Endovascular | 34 (47.2) | 29 (63.0) | 5 (47.2) | 12 (36.4) | 8 (29.6) | 26 (57.8) |
Surgical | 27 (37.5) | 13 (28.3) | 14 (53.8) | 15 (45.5) | 12 (44.4) | 15 (33.3) |
Both | 11 (15.3) | 4 (8.7) | 7 (26.9) | 6 (18.2) | 7 (25.9) | 4 (8.9) |
No | – | – | – | – | – | – |
Unknown | 3 | 2 | 3 | |||
DCI | ||||||
Yes | 16 (38.1) | |||||
No | 26 (61.9) | |||||
Unknown | 6 |
Exome sequencing, variant calling, filtering strategies, variant prioritization and pathogenicity assignment
Results
Clinical characteristics
Genetic analysis of reported risk genes
Gene gnomAD constraint metrics | Transcript ID | c. notation p. notation | dbSNP rs ID ClinVar allele ID | Classificationa | gnomAD all MAFb het/hom/Σ | Pathogenicity predictionsc | Subjects | Clinical findings; family history (FH) | |
---|---|---|---|---|---|---|---|---|---|
CADD/REVEL/M-CAP/ClinPred | Impact on splicing | ||||||||
ADAMTS15 misZ = 0.60 pLI = 0.0 | NM_139055 | c.1258G>A p.Gly420Ser | rs767345140 n.r | VUSPM1+PP3 | 0.006092% 17/0/279072 | 33/0.506/0.011/0.641 | last nucleotide in exon 3; donor loss (HSF, NG2, MES) | IA83 | 1 IA + 1 aSAH FH neg |
ANGPTL6 misZ = 0.64 pLI = 0.0 | NM_031917 | c.1072G>A p.Arg358Cys | rs147149731 n.r | VUSPM1+BP4 | 1.139% 3221/32/282740 | 13.39/0.238/n.a./0.014 | n.d | IA61 (+ VUSRNF213) | 4 IA + 1 aSAH FH neg |
c.287A>G p.Leu96Pro | rs559282550 n.r | VUSPP3 | 1.552% 447/4/28796 | 32/0.573/n.a./0.183 | n.d | IA78 (+ 2VUSRNF213) | 1 giant IA FH pos | ||
IA84 | 1 IA FH pos | ||||||||
PCNT misZ = -1.33 pLI = 0.0 | NM_006031 | c.959G > A p.Arg320Lys | rs149844283 194,942 | VUSPM2+BP1+BP4 | 0.01048% 26/0/248208 | 15.60/0.070/0.003/0.097 | no impact | IA72 | 1 IA + 1 aSAH FH neg |
c.2033A>G p.Lys678Arg | rs149623054 265,806 | LBVBP1+BP4 | 0.1591% 450/2/282880 | 8.311/0.026/0.012/0.019 | acceptor gain (HSF) | IA85 (+ VUSPCNT) | 4 IA + 1 aSAH FH pos | ||
c.2839G>C p.Ala947Pro | rs1177229119 n.r | VUSPM2+PP3+BP1 | 0.001595% 4/0/250744 | 20.5/0.093/0.027/0.669 | n.d | IA75 | 1 IA + 1 aSAH FH neg | ||
c.4345C>G p.Gln1449Glu | rs139432601 169,656 | LBVBP1+BP4 | 0.347% 981/9/282746 | 14.70/0.134/0.011/0.010 | n.d | IA63 (+ transVUSPCNT) | 2 IA + 1 aSAH FH neg | ||
c.4354G>A p.Gly1452Arg | rs143796569 169,657 | VUSPP3+BP1+BP4 | 0.267% 755/6/282742 | 22.0/0.227/n.a./0.036 | gain of AGGT; donor gain (NG2, BDGP); acceptor gain (HSF) | IA63 (+ transLBVPCNT) | 2 IA + 1 aSAH FH neg | ||
IA79 (+ VUSRNF213) | 2 IA FH pos | ||||||||
c.6404C>T p.Thr2135Met | rs145710874 n.r | VUSPM2+BP1+BP4 | 0.001193% 3/0/2514320 | 11.77/0.053/0.002/0.078 | n.d | IA54 (+ VUSTHSD1) | 5 IA FH neg | ||
c.6739C>T p.His2247Tyr | rs61735812 142,330 | LBVBS4+BP1+BP4 | 1.218% 2866/22/235400 | 1.606/0.038/n.a./0.002 | n.d | IA24d | 1 IA + 1 aSAH FH pos | ||
c.7652C>T p.Ala2551Val | rs12481791 142,308 | VUSPP3+BP1+BP4 | 1.444% 3848/39/266458 | 22.5/0.109/n.a./0.027 | gain of AGGT; donor gain (HSF, NG2, MES) | IA57 | 4 IA + 2 aSAH FH neg | ||
IA59 | 1 IA FH pos | ||||||||
c.7988G>A p.Arg2663His | rs778334017 430,519 | VUSPM2+BP1+BP4 | 0.00115% 2/0/173878 | 15.38/0.042/0.011/0.467 | n.d | IA85 (+ LBVPCNT) | 4 IA + 1 aSAH FH pos | ||
RNF213 misZ = 2.64 pLI = 0.0 | NM_001256071 | c.397C>A p.Leu133Met | rs149177904 404,723 | VUSPP2+BP4 | 0.1089% 231/1/212142 | 7.116/0.047/0.006/0.002 | n.d | IA78 (+ VUSANGPTL6, + VUSRNF213) | 1 giant IA FH pos |
c.626T>A p.Ile209Asn | rs144769597 404,724 | VUSPP2+BP4 | 0.1151% 323/1/280624 | 0.295/0.165/0.017/0.007 | n.d | IA78 (+ VUSANGPTL6, + VUSRNF213) | 1 giant IA FH pos | ||
c.8084C>T p.Ala2695Val | rs202096577 n.r | VUSPP2+BP4 | 0.05313% 150/0/282338 | 24.4/0.325/0.018/0.187 | n.d | IA61 (+ VUSANGPTL6) | 4 IA + 1 aSAH FH neg | ||
c.14030G>T p.Trp4677Leu | rs61741961 n.r | VUSPP2+PP3 | 1.047% 2962/29/282802 | 23.4/0.602/n.a./0.088 | n.d | IA79 (+ VUSPCNT) | 2 IA FH pos | ||
THSD1 misZ = 0.49 pLI = 0.0 | NM_018676 | c.1666G>C p.Gln556Glu | rs148515012 n.r | VUSBP4 | 0.01344% 38/0/282718 | 25.0/0.228/0.041/0.193 | n.d | IA64S481Nr111 | 1 IA FH pos |
c.871C>T p.Glu291Lys | rs41292808 n.r | VUSBP4 | 1.864% 5271/78/282824 | 12.32/0.090/n.a./0.031 | n.d | IA17 (+ VUSTMEM132B) | 1 IA + 1 aSAH FH neg | ||
IA49 | 1 IA + 1 AA FH pos | ||||||||
IA54 (+ VUSPCNT) | 5 IA FH neg | ||||||||
IA90e | 3 IA FH pos | ||||||||
c.592G>C p.Gln198Glu | rs186046951 n.r | VUSBP4 | 0.01097% 31/0/282698 | 18.67/0.046/0.007/0.071 | n.d | IA76 | 4 IA FH pos | ||
TMEM132B misZ = 1.66 pLI = 1.0 | NM_052907 | c.2737C>A p.Leu913Met | rs61940807 n.r | VUSPM1+BP4 | 0.9920% 2787/52/280952 | 23.2/0.165/n.a./0.075 | n.d | IA17 (+ VUSTHSD1) | 1 IA + 1 aSAH FH neg |
Determination of novel putative risk genes
Gene gnomAD constraint metrics | Transcript ID | c. notation p. notation | Classificationa | Phenotype; MIM number; inheritance | Pathogenicity predictionsb | Subjects: clinical findings | |
---|---|---|---|---|---|---|---|
CADD/REVEL/M-CAP/ClinPred | Impact on splicing | ||||||
NEK4 misZ = 0.88 pLI = 0.0 | NM_003157 | c.190A>T p.Asn64Tyr | VUSPM1+PM2+PP3 | n.r | 23.7/0.452/0.113/0.984 | n.d | IA7: 2 IA IA8: 1 IA + 1 aSAH IA15: 6 IA |
EDIL3 misZ = 1.16 pLI = 0.0 | NM_005711 | c.383G>A p.Cys128Tyr | VUSPM1+PM2+PP3 | n.r | 29.1/0.946/0.523/0.998 | n.d | |
EDNRB misZ = 1.18 pLI = 0.01 | NM_001201397 | c.891T>G p.Ser297Arg | VUSPM2 | Waardenburg syndrome, type 4A; 277580; AD, AR; ABCD syndrome, 600501, AR; Hirschsprung disease, susceptibility to, 2, 600155, AD | 23.7/0.303/0.020/0.972 | Gain of ESS site (HSF); no impact (NG2, MES) | |
DNAH9 misZ = − 0.04 pLI = 0.0 | NM_001372 | c.13304T>C p.Ile4435Thr | VUSPM2 | Ciliary dyskinesia, primary, 40; 618300; AR | 24.5/0.203/0.010/0.983 | n.d | |
GGA3 misZ = − 0.01 pLI = 0.0 | NM_138619 | c.16G>A p.Gly6Arg | VUSPM2+PP3 | n.r | 33.0/0.299/0.049/0.988 | n.d |