[Molecular basis and physiopathogenic mechanisms of CADASIL: a model of small vessel diseases of the brain].

Diseases of the small cerebral arteries account for approximately 20% of the ischaemic strokes. Their diagnosis is difficult and their pathogenic mechanisms are yet unclear. A certain proportion of these diseases is familial. CADASIL is a recently identified small-artery disease of the brain, which occurs both as an autosomal dominant and a sporadic condition caused by mutations in the Notch3 gene. Since the acronym CADASIL was coined to designate this disorder in 1993, an exponentially growing number of patients has been identified all over the world. Notch3 belongs to the highly conserved Notch genes family which encode transmembrane receptors involved in cell fate specification during development. The role of Notch3 is so far unknown. We recently established that in normal adult tissues expression of Notch3 is essentially restricted to vessel and vascular smooth muscle cells (VSMC). CADASIL patients carry highly stereotyped mutations leading to an odd number of cysteine residues within the extracellular domain. Mutations are associated with an impaired clearance of the Notch3 protein leading to its abnormal accumulation at the membrane of VSMC. These data establish that VSMC is the primary target of the pathogenic process. In addition they give support to the role of the Notch3 pathway in vascular homeostasis. Furthermore, they open new perspectives in the field of small-artery diseases of the brain and should help to further dissect their genetic etiologies and understand their pathogenic mechanisms.