RNF213 Polymorphisms in Intracranial Artery Dissection

Abstract

The ring finger protein 213 gene (RNF213) is involved in several vascular diseases, both intracranial and systemic ones. Some variants are common in the Asian population and are reported as a risk factor for moyamoya disease, intracranial stenosis and intracranial aneurysms. Among intracranial vascular diseases, both moyamoya disease and intracranial artery dissection are more prevalent in the Asian population. We performed a systematic review of the literature, aiming to assess the rate of RNF213 variants in patients with spontaneous intracranial dissections. Four papers were identified, providing data on 53 patients with intracranial artery dissection. The rate of RNF213 variants is 10/53 (18.9%) and it increases to 10/29 (34.5%), excluding patients with vertebral artery dissection. All patients had the RNF213 p.Arg4810Lys variant. RNF213 variants seems to be involved in intracranial dissections in Asian cohorts. The small number of patients, the inclusion of only patients of Asian descent and the small but non-negligible coexistence with moyamoya disease familiarity might be limiting factors, requiring further studies to confirm these preliminary findings and the embryological interpretation.

Keywords: RNF213; atherosclerosis; intracranial artery dissection; intracranial stenosis; magnetic resonance angiography; moyamoya disease.

Figure 1

The main sites of systemic vasculopathy described in RNF213 variants are summarized.

Figure 2

PRISMA diagram [31]. ** The excluded paper [32] included both symptomatic and asymptomatic patients with intracranial artery diseases and relies on a single MRI technique to diagnose the subtype of the disease, and this is not reliable for intracranial artery dissections. Moreover, details on RNF213 polymorphisms were not provided.