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Background . The NOTCH pathway is known to be important in the pathogenesis of calcific aortic valve disease, possibly through regulators of osteoprotegerin (OPG), receptor activator of nuclear factor  κ B (RANK), and its ligand (RANKL) system. The  purpose  of the present study was to search for possible associations between  NOTCH1  gene mutations and circulating levels of OPG and soluble RANKL (sRANKL) in patients with aortic stenosis (AS).  Methods . The study was performed on 61 patients with AS including 31 with bicuspid and 30 with tricuspid aortic valves. We applied a strategy of targeted mutation screening for 10 out of 34 exons of the  NOTCH1  gene by direct sequencing. Serum OPG and sRANKL levels were assessed.  Results . In total, 6 genetic variants of the  NOTCH1  gene including two new mutations were identified in the study group. In an age- and arterial hypertension-adjusted multivariable regression analysis, the serum OPG levels and the OPG/sRANKL ratio were correlated with  NOTCH1  missense variants. All studied missense variants in NOTCH1 gene were found in Ca(2+)-binding EGF motif of the NOTCH extracellular domain bound to Delta-like 4.  Conclusion . Our results suggest that the OPG/RANKL/RANK system might be directly influenced by genetic variants of NOTCH1 in aortic valve calcification.

NOTCH1 Mutations in Aortic Stenosis: Association with Osteoprotegerin/RANK/RANKL