Abstract 3116: Elucidating The Molecular Progression Of Hereditary Vascular Dementia In A Novel Mouse Model

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Aging is an immutable risk factor for the development of numerous cardiovascular diseases, including vascular dementia. Vascular dementia is the second most common cause of dementia with up to 20% of dementia cases in the elderly attributed to dysfunctional vasculature. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), is a mendelian vascular dementia characterized by progressive dysfunction of vascular smooth muscle cells (vSMCs) due to gene variants in NOTCH3 . With over 250 known disease - causing variants in NOTCH3 identified in the past 24 years, the allelic heterogeneity observed in CADASIL has long contributed to our impaired understanding of the molecular progression from NOTCH3 variation to clinical presentation. Recent work published by our group has shown that Notch3 is lost from in the cerebral vasculature of mouse ( Notch3 -/- ) and humans during aging. With time, the progressive loss of Notch3 in the aging mouse brain vasculature drives the formation of cerebral micro-aneurysms as well as impairs vascular reactivity and cerebral blood flow. These vascular consequences also hinder glymphatic flow which promotes an accelerated aggregation of glycosaminoglycans and the development of neuronal gene signature analogous to those observed in other neurodegenerative diseases such as Alzheimer’s disease. To assess if CADASIL represents a loss of NOTCH3 function and thus an accelerated cerebral aging or novel gain of function in NOTCH3, we used CRISPR-Cas9 genome editing to create a novel CADASIL mouse model: Notch3C175Y (N3Y). This alteration faithfully recapitulates the human variant within the same locus and shows the pathological hallmark of CADASIL: GOMs (granular osmiophilic material). Histopathological assessment of the N3Y mouse shows dysregulation of the vSMC organization as early as 8 weeks of age along with novel structural abnormalities as compared to the Notch3 -/- . Using single-cell RNA sequencing we also performed in-depth molecular characterization of the vascular changes in N3Y. Analysis at 2 months and at 24 months allowed us to identify temporal progression of the disease and provided novel molecular insights into the mechanisms of this mendelian form of vascular dementia.