Nonsense mutation in CFAP43 causes normal-pressure hydrocephalus with ciliary abnormalities

Objective: To identify genes related to normal pressure hydrocephalus (NPH) in one particular Japanese family with several members affected by NPH.
Methods: We performed WES on a Japanese family with multiple individuals affected by NPH and identified a candidate gene. Then we generated knockout mouse using CRISPR/Cas9 to confirm the effect of the candidate gene on the pathogenesis of hydrocephalus.
Results: In WES, we identified a loss-of-function variant in CFAP43 that segregated with the disease. CFAP43 encoding cilia- and flagella-associated protein is preferentially expressed in the testis. Recent studies have revealed that mutations in this gene cause male infertility owing to morphological abnormalities of sperm flagella. We knocked out mouse ortholog Cfap43 using CRISPR/Cas9 technology, resulting in Cfap43-deficient mice that exhibited a hydrocephalus phenotype with morphological abnormality of motile cilia.
Conclusion: Our results strongly suggest that CFAP43 is responsible for morphological or movement abnormalities of cilia in the brain that result in normal-pressure hydrocephalus.