Department of Neurosurgery, Yale University, New Haven, CT 06510, USA.
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA.
Brain. 2024 Apr 4;147(4):1553-1570. doi: 10.1093/brain/awad405.
Hydrocephalus, characterized by cerebral ventriculomegaly, is the most common disorder requiring brain surgery in children. Recent studies have implicated SMARCC1, a component of the BRG1-associated factor (BAF) chromatin remodelling complex, as a candidate congenital hydrocephalus gene. However, SMARCC1 variants have not been systematically examined in a large patient cohort or conclusively linked with a human syndrome. Moreover, congenital hydrocephalus-associated SMARCC1 variants have not been functionally validated or mechanistically studied in vivo. Here, we aimed to assess the prevalence of SMARCC1 variants in an expanded patient cohort, describe associated clinical and radiographic phenotypes, and assess the impact of Smarcc1 depletion in a novel Xenopus tropicalis model of congenital hydrocephalus. To do this, we performed a genetic association study using whole-exome sequencing from a cohort consisting of 2697 total ventriculomegalic trios, including patients with neurosurgically-treated congenital hydrocephalus, that total 8091 exomes collected over 7 years (2016-23). A comparison control cohort consisted of 1798 exomes from unaffected siblings of patients with autism spectrum disorder and their unaffected parents were sourced from the Simons Simplex Collection. Enrichment and impact on protein structure were assessed in identified variants. Effects on the human fetal brain transcriptome were examined with RNA-sequencing and Smarcc1 knockdowns were generated in Xenopus and studied using optical coherence tomography imaging, in situ hybridization and immunofluorescence. SMARCC1 surpassed genome-wide significance thresholds, yielding six rare, protein-altering de novo variants localized to highly conserved residues in key functional domains. Patients exhibited hydrocephalus with aqueductal stenosis; corpus callosum abnormalities, developmental delay, and cardiac defects were also common. Xenopus knockdowns recapitulated both aqueductal stenosis and cardiac defects and were rescued by wild-type but not patient-specific variant SMARCC1. Hydrocephalic SMARCC1-variant human fetal brain and Smarcc1-variant Xenopus brain exhibited a similarly altered expression of key genes linked to midgestational neurogenesis, including the transcription factors NEUROD2 and MAB21L2. These results suggest de novo variants in SMARCC1 cause a novel human BAFopathy we term 'SMARCC1-associated developmental dysgenesis syndrome', characterized by variable presence of cerebral ventriculomegaly, aqueductal stenosis, developmental delay and a variety of structural brain or cardiac defects. These data underscore the importance of SMARCC1 and the BAF chromatin remodelling complex for human brain morphogenesis and provide evidence for a 'neural stem cell' paradigm of congenital hydrocephalus pathogenesis. These results highlight utility of trio-based whole-exome sequencing for identifying pathogenic variants in sporadic congenital structural brain disorders and suggest whole-exome sequencing may be a valuable adjunct in clinical management of congenital hydrocephalus patients.
脑积水的特征是脑室内扩大,是儿童中最常见的需要脑部手术的疾病。最近的研究表明,SMARCC1 是 BRG1 相关因子 (BAF) 染色质重塑复合物的一个组成部分,是候选先天性脑积水基因。然而,SMARCC1 变体尚未在大型患者队列中进行系统检查,也没有与人类综合征明确相关。此外,先天性脑积水相关的 SMARCC1 变体在体内尚未进行功能验证或机制研究。在这里,我们旨在评估扩展患者队列中 SMARCC1 变体的患病率,描述相关的临床和影像学表型,并评估新型 Xenopus tropicalis 先天性脑积水模型中 Smarcc1 耗竭的影响。为此,我们使用包含接受神经外科治疗的先天性脑积水患者的 2697 个全脑室三胞胎的外显子组测序进行了遗传关联研究,包括 8091 个外显子,这些外显子是在 7 年(2016-23 年)期间收集的。一个比较对照队列由 1798 个来自自闭症谱系障碍患者未受影响的兄弟姐妹及其未受影响的父母的外显子组成,这些样本来自 Simons Simplex 集合。在鉴定的变体中评估了对蛋白质结构的富集和影响。使用 RNA-seq 检查了对人类胎儿大脑转录组的影响,并在 Xenopus 中生成了 Smarcc1 敲低,并通过光学相干断层扫描成像、原位杂交和免疫荧光进行了研究。SMARCC1 超过了全基因组显著性阈值,产生了六个罕见的、蛋白质改变的新生变体,定位于关键功能域的高度保守残基。患者表现为伴有导水管狭窄的脑积水;胼胝体异常、发育迟缓、心脏缺陷也很常见。Xenopus 敲低可重现导水管狭窄和心脏缺陷,野生型可挽救,但患者特异性变体 SMARCC1 不可挽救。患有脑积水的 SMARCC1 变体人类胎儿大脑和具有 Smarcc1 变体的 Xenopus 大脑表现出与中孕期神经发生相关的关键基因表达的类似改变,包括转录因子 NEUROD2 和 MAB21L2。这些结果表明,SMARCC1 中的新生变体导致了一种我们称之为“SMARCC1 相关发育不良综合征”的新型人类 BAF 病变,其特征是脑室内扩大、导水管狭窄、发育迟缓以及各种结构脑或心脏缺陷的可变存在。这些数据强调了 SMARCC1 和 BAF 染色质重塑复合物对人类大脑形态发生的重要性,并为先天性脑积水发病机制的“神经干细胞”范式提供了证据。这些结果突出了基于三亲的全外显子组测序在识别散发性先天性结构性脑疾病的致病性变体方面的效用,并表明全外显子组测序可能是先天性脑积水患者临床管理的有价值的辅助手段。