Design and Rationale for Examining Neuroimaging Genetics in Ischemic Stroke the MRI-GENIE Study
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Design and rationale for examining neuroimaging genetics in ischemic stroke The MRI-GENIE study Anne-Katrin Giese, MD ABSTRACT Markus D. Schirmer, PhD Objective: To describe the design and rationale for the genetic analysis of acute and chronic cere- Kathleen L. Donahue, BS brovascular neuroimaging phenotypes detected on clinical MRI in patients with acute ischemic Lisa Cloonan, BA stroke (AIS) within the scope of the MRI–GENetics Interface Exploration (MRI-GENIE) study. Robert Irie, PhD Methods: MRI-GENIE capitalizes on the existing infrastructure of the Stroke Genetics Network Stefan Winzeck, MS (SiGN). In total, 12 international SiGN sites contributed MRIs of 3,301 patients with AIS. Detailed Mark J.R.J. Bouts, PhD clinical phenotyping with the web-based Causative Classification of Stroke (CCS) system and Elissa C. McIntosh, MA genome-wide genotyping data were available for all participants. Neuroimaging analyses include Steven J. Mocking, MSc the manual and automated assessments of established MRI markers. A high-throughput MRI anal- Adrian V. Dalca, PhD ysis pipeline for the automated assessment of cerebrovascular lesions on clinical scans will be Ramesh Sridharan, PhD developed in a subset of scans for both acute and chronic lesions, validated against gold stan- Huichun Xu, MD, PhD dard, and applied to all available scans. The extracted neuroimaging phenotypes will improve Petrea Frid, MD characterization of acute and chronic cerebrovascular lesions in ischemic stroke, including Eva Giralt-Steinhauer, CCS subtypes, and their effect on functional outcomes after stroke. Moreover, genetic testing MD, PhD will uncover variants associated with acute and chronic MRI manifestations of cerebrovascular Lukas Holmegaard, MD disease. Jaume Roquer, MD, PhD Johan Wasselius, MD, PhD Conclusions: The MRI-GENIE study aims to develop, validate, and distribute the MRI analysis plat- John W. Cole, MD form for scans acquired as part of clinical care for patients with AIS, which will lead to (1) novel Patrick F. McArdle, PhD genetic discoveries in ischemic stroke, (2) strategies for personalized stroke risk assessment, and Neurol Genet Joseph P. Broderick, MD (3) personalized stroke outcome assessment. 2017;3:e180; doi: 10.1212/ Jordi Jimenez-Conde, NXG.0000000000000180 MD, PhD Christina Jern, MD, PhD GLOSSARY 5 5 5 5 Brett M. Kissela, MD, MS ADC apparent diffusion coefficient; AIS acute ischemic stroke; CE cardioembolic; CCS Causative Classification of Stroke; CCSc 5 causative CCS; DICOM 5 Digital Imaging and Communications in Medicine; DWI 5 diffusion-weighted Dawn O. Kleindorfer, MD imaging; DWIv 5 DWI volume; FLAIR 5 fluid-attenuated inversion recovery; GISCOME 5 Genetics of Ischemic Stroke Robin Lemmens, MD, PhD Functional Outcome; GWAS 5 genome-wide association studies; ICC 5 intraclass correlation coefficient; LAA 5 large artery atherosclerosis; MGH 5 Massachusetts General Hospital; MRI-GENIE 5 MRI–GENetics Interface Exploration; mRS 5 Arne Lindgren, MD, PhD modified Rankin Scale; PHI 5 protected health information; QC 5 quality control; SAO 5 small artery occlusion; SiGN 5 James F. Meschia, MD Stroke Genetics Network; SNP 5 single nucleotide polymorphism; SWI 5 susceptibility-weighted imaging; TOAST 5 Trial of Org 10172 Acute Stroke Treatment; VLSM 5 voxel-based lesion–symptom mapping; WMHv 5 white matter hyperintensity Tatjana Rundek, MD, PhD volume; XNAT 5 eXtensible Neuroimaging Archive Toolkit. Ralph L. Sacco, MD, MS Reinhold Schmidt, MD Genome-wide association studies (GWAS) have been instrumental in elucidating the genetics of Pankaj Sharma, MD, PhD complex vascular traits (ischemic stroke1,2 and coronary artery disease3,4) and their risk factors Agnieszka Slowik, MD, (blood pressure,5 atrial fibrillation,6 hyperlipidemia,7 and diabetes mellitus8). Despite recent PhD advances in prevention and treatment, stroke remains a leading cause of adult neurologic Vincent Thijs, MD, PhD 9 Daniel Woo, MD, MS disability and death in the United States and worldwide. Recent GWAS have uncovered several 10,11 Bradford B. Worrall, MD, risk loci for ischemic stroke and its subtypes, specifically PITX2 and ZFHX3 for cardioem- 11,12 11,12 11 11 MSc bolic (CE) stroke, HDAC9 and TSPAN2 for large artery stroke, and ALDH2 for Steven J. Kittner, MD, small artery stroke. These results highlight the necessity for large-scale collaborations such as MPH Braxton D. Mitchell, *These authors contributed equally to the manuscript. PhD, MPH Author affiliations are provided at the end of the article. Funding information and disclosures are provided at the end of the article. Go to Neurology.org/ng for full disclosure forms. The Article Processing Charge was funded by the NIH. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC Author list continued on next page BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Neurology.org/ng Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology 1 Jonathan Rosand, MD, METASTROKE and Stroke Genetics Net- study participants to data sharing was mandatory for all sites. MSc work (SiGN) to identify risk loci for these Shared data include basic demographics, vascular risk factors and Polina Golland, PhD detailed Causative Classification of Stroke (CCS) phenotyping, complex diseases. genotypic data, and clinical MRIs. Ona Wu, PhD* Improving our understanding of the mech- Study oversight. The primary aims and progress of the MRI- Natalia S. Rost, MD, anisms underlying stroke is crucial, as treat- GENIE study are overseen by a Scientific Steering Committee. In MPH* ment options remain limited for this conjunction with the SiGN Publication Committee, the MRI- GENIE Steering Committee critically reviews project proposals debilitating disease. Unlike clinical diagnosis by collaborators to avoid potential overlap with existing SiGN Correspondence to of stroke, cerebrovascular phenotypes detected projects and to assess feasibility of the proposed projects. This Dr. Rost: on brain MRI can be characterized with high effort is supported by the Phenotyping Committee, which is in [email protected] validity and quantified with good precision charge of the data access to phenotypes previously obtained Supplemental data through SiGN, current data acquisition for neuroimaging at Neurology.org/ng using advanced neuroimaging analysis techni- markers, and quality control (QC) of new neuroimaging phe- ques.13 Targeting these specific endopheno- notypes. In addition, it is responsible for the oversight of statis- types will lead to substantial pathophysiologic tical analysis of MRI-derived phenotypes and functional outcomes related to specific stroke subtypes. The Neuroimaging insight into stroke mechanisms and foster Analysis Committee is in charge of designing, validating, and future advances in individualized therapy and implementing the MRI pipeline to automatically assess acute prevention. and chronic neuroimaging markers. Moreover, it facilitates and The MRI–Genetics Interface Exploration monitors the assessment of manually obtained neuroimaging markers. The Genetic Analysis Committee conducts the primary (MRI-GENIE) study aims to bridge current genetic analyses for the MRI-GENIE study to identify genetic knowledge gaps by facilitating genetic discov- variants associated with acute and chronic MRI-based manifes- ery and developing novel therapeutic and tations of cerebrovascular disease. It is also essential in conducting preventive strategies in stroke through auto- secondary analyses and additional projects as proposed by col- laborators (detailed listings of committee memberships are mated, multimodal MRI analysis. Leveraging available in coinvestigator appendix e-1 at Neurology.org/ng). the existing infrastructure of SiGN and har- Imaging platform. An integral part of the MRI-GENIE study nessing its expertise, MRI-GENIE focuses on is the centrally maintained imaging platform hosting deidentified the subset of richly phenotyped and genotyped acute or subacute brain MRIs obtained within 48 hours of participants for whom clinical MRIs have been symptom onset from all contributing SiGN sites. The MRI- obtained. This article outlines the premises, GENIE Imaging Platform is maintained centrally at MGH and has been described previously.14 Initially developed in the scope methodology, and aims of MRI-GENIE. of an NIH-funded project to create a centralized system to share canonical human stroke data (R01 NS063925-01A1, O. Wu/ METHODS MRI-GENIE capitalizes on SiGN, an ongoing Sorensen—PI), the underlying technology for the imaging plat- multicenter, NIH-funded collaboration within the community form integrates the eXtensible Neuroimaging Archive Toolkit of stroke neurologists, geneticists, and neuroimaging analysts, (XNAT)15 as the back-end data repository with a flexible, open- which enabled the initial development of the SiGN Imaging source content management system with user-friendly features 14 Platform. We have amassed the largest-to-date collection of (conglomeration of Plone,16 Deliverance,17 and NGINX18) as the ischemic stroke cases with comprehensively ascertained cerebro- front end for the users. An example of such features is the ability vascular phenotypes and genome-wide data. The project is fun- to search the imaging repository by stroke-specific clinical