Evaluation of the roles of common genetic mutations in leukoaraiosis
Objectives– Leukoaraiosis, a relatively frequent neuroimaging entity, is presumed to be primarily a vascular problem. However, it can be explained only in part by vascular risk factors. With the assumption of genetic susceptibility, the roles of common genetic polymorphisms and mutations in leukoaraiosis were examined in this study. Material and methods– A detailed clinical scrutiny of 843 Hungarian neurological patients with mild cognitive-like complaints revealed 229 subjects with leukoaraiosis that was probably vascular in origin: 143 with leukoaraiosis alone (group 1), and 86 with leukoaraiosis plus cerebral infarction (group 2). In all 229 patients, the methylenetetrahydrofolate reductase C677T (MTHFR C677T) mutation and angiotensin-converting enzyme (ACE I/D) polymorphism were examined by means of the PCR technique. The prevalences of the different genotypes for the examined mutations in the 2 groups were analysed in comparison with the data on 362 neuroimaging alteration-free subjects as controls. Results– The ACE D/D genotype (38.37%, P<0.0005; OR 2.46, 95% CI, 1.49–4.08) and ACE D allele (61%; P<0.001) were more frequent in group 2 than in the control group (20.17%; 47%). Neither the homozygous nor the heterozygous MTHFR C677T mutation alone was found to be a risk factor for leukoaraiosis. The homozygous MTHFR C677T mutation combined with the ACE D/D genotype was significantly more frequent in group 1 (11.89%, P<0.0005; OR 4.75, 95% CI, 2.12–10.65), in group 2 (12.79%, P<0.0005; OR 5.16, 95% CI, 2.12–12.6) and in combined group 1+2 (12.23%, P<0.0005; OR 4.9, 95% CI, 2.33–10.3) than in the control group (2.76%). Conclusion– These data indicate that the contributions of the ACE D/D genotype and the homozygous MTHFR C677T mutation to leukoaraiosis should be taken into consideration not as major, but as additive factors. These findings draw attention to the fact that genetic polymorphisms that alone are insignificant can be risk factors for leukoaraiosis if they cluster in the same subjects.