Autosomal dominant cerebral arteriopathy with subcortical infarcts and
leukoencephalopathy (CADASIL) is a rare hereditary neurovascular disorder caused by
mutations in the NOTCH3 gene, affecting approximately 1 in 100,000 individuals globally. Characterized by progressive degeneration of small arteries in the brain, CADASIL primarily impacts mural cells within the gliovascular unit (GVU), with limited understanding of its effects on other cell types and a lack of effective treatment options. This study aims to elucidate the pathology of CADASIL across various GVU cell types to identify potential therapeutic targets. To achieve this, we performed single-cell RNA sequencing (scRNA-seq) on brains from NOTCH3 knock-out (N3KO) mice and postmortem tissues from human CADASIL patients. In N3KO mice, our results in N3KO mice identified 13 cell groups among 39,158 cells, with the predominant types being microglia (44%), oligodendrocytes (30%), astrocytes (16%), and vascular cells (3%). In human samples, we identified 13 cell groups among 88,961 cells, with the most prevalent types being oligodendrocytes (37%), astrocytes (9%), microglia (7%), and vascular cells (5%). Interestingly, when comparing the changes in cellular fractions, we observed a decrease in endothelial and smooth muscle cells in the murine model, whereas this pattern was not found in humans. However, an increase in microglia was noted in humans, indicating microgliosis, a typical characteristic of the disease. Additionally, when we explored the regulated genes, we found that genetic programs related to angiogenesis, inflammation, and the NOTCH pathway were altered in various cell types in both mouse and human samples. Specifically, angiogenesis-related genes were altered in microglia, endothelial
and smooth muscle (SMC) cell types, inflammation-related genes in microglia, astrocytes, endothelial and SMC cell types, and NOTCH pathway-related genes in astrocytes, endothelial and SMC cell types. Transcriptional control analysis revealed regulatory functions of key transcription factors, mainly RUNX1, PPARD, SPI1, and YAP1, which were common to both mouse and human models and are related to the NOTCH, inflammatory and cell proliferating pathways. Overall, these results establish an approach to discern the regulatory mechanisms controlling the genetic program in the brain, not only in SMC but also in other cell types such as microglia and astrocytes, where inflammation and angiogenesis were found. These findings lay the groundwork for future research aimed at developing novel therapeutic strategies for CADASIL.