Locus NIID NOTCH2NLC

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Disease

NameNeuronal intranuclear inclusion disease, Alzheimer disease and parkinsonism phenotype, Oculopharyngodistal myopathy (OPDM) type 3, hereditary essential tremor type 6
Description
Neuronal intranuclear inclusion disease (NIID) is a very rare multisystem neurodegenerative disorder characterized by the presence of eosinophilic intranuclear inclusions in neuronal and glial cells, and neuronal loss . Stroke-like episodes may occur in over one third of patients and can be misdiagnosed as recurrent ischemic stroke, . Often presents with gastrointestinal symptoms, including chronic refractory nausea, which preceded neurologic manifestations by decades in one documented case . Renal involvement has been reported and may occasionally precede neurological symptoms,, . Peripheral neuropathy has been reported in NOTCH2NLC-related NIID , where expansions account for ~1-5.5% of genetically undiagnosed inherited peripheral neuropathy cases, typically motor-dominant . Due to overlapping phenotypes and the shared locus, it is unclear whether these four diseases are comorbid, synonymous, or entirely separate.
Prevalence
400 patients reported in literature . Found in individuals of East Asian ancestry .
Age of OnsetAge of Onset(Typical)Years7  7830  70
Typical: 30-70 ; Range: 7 - 78 .
Association
Mendelian

Locus

Details
Benign alleles are less than 38 repeats, while pathogenic alleles contain 66+ repeats . Intermediate alleles may be associated with a phenotypic spectrum, and even pathogenic cases can have variable phenotype, : NOTCH2NLC expansions have been linked to Alzheimer's disease and Parkinson's disease, leading to a potential role in NIID-related disorders . Age of onset inversely related to allele size . Motif variation in controls: (AGG)(CGG)n(AGG)0-3(CGG)0-2. GGA and AGC interruptions may influence phenotype . Interruptions documented: GGA, GGG ; ACCGAGAAGATGCCCGCCCTGC interruption proposed but not confirmed . Detection may be challenging due to paralogy between genes: C253572.1, NOTCH2, NOTCH2NL, NBPF14, NBPF19.
Mechanism
GoF
Polyglycine expansion; may relate to methylation or RNA pathogenicity,, . Proposed mechanisms include toxic uN2CpolyG/polyglycine aggregation, RNA pathogenicity, impaired autophagy, mitochondrial dysfunction, and innate immune activation . The polyglycine-containing protein sequesters a key subunit of transcription factor NF-κB in nuclear inclusions, leading to impaired autophagy . Tau pathology is evident; changes in p-tau levels and tau deposition have been reported . Expanded polyG proteins also induce nucleolar stress through interaction with NPM1 and rRNA. This disrupts ribosomal homeostasis and alters 3D chromatin organization through reduced CTCF/RAD21 expression . Aggregates of a second polyglycine protein translated from NOTCH2NLC variant 2 are present in the majority of p62-positive intranuclear inclusions in patient skin and skeletal muscle and co-localize with uN2CpolyG .
Detection
Short-read sequencing is reported to be unreliable for sizing of large or complex expansions . RP-PCR has screened for expansions, , while long-read sequencing has resolved size, structure, and methylation .
Year
2019
Location in Gene
5' UTR
Gene Strand

Alleles

Ref. Motif
CGG
RangesBenignIntermediatePathogenicUnits7  3738  6566  517
Benign (ref.)
–
Benign (gene)
–
Pathogenic (ref.)
CGG
Pathogen. (gene)
CGG
Unknown (ref.)
–
Unknown (gene)
–
Interruption (ref.)
AGG, CAG
Interrup. (gene)
AGG, CAG

gnomAD

Pathogenic genotype frequency data is not displayed for this locus because a substantial number of large alleles failed manual review by the gnomAD team.

References

Direct supporting references for info on this page.

1
Ontology Lookup Service (OLS)
mondo:0011327
2
Clinical features of
Yun,Tian, Lu,Zhou, Jing,Gao, Bin,Jiao, Sizhe,Zhang, Qiao,Xiao, Jin,Xue, Ying,Wang, Hui,Liang, Yaling,Liu, Guang,Ji, Chenhui,Mao, Caiyan,Liu, Liling,Dong, Long,Zhang, Shugang,Zhang, Jiping,Yi, Guohua,Zhao, Yingying,Luo, Qiying,Sun, Yafang,Zhou, Fang,Yi, Xiaoyu,Chen, Chaojun,Zhou, Nina,Xie, Mengchuan,Luo, Lingyan,Yao, Yacen,Hu, Mengqi,Zhang, Qiuming,Zeng, Liangjuan,Fang, Hong-Yu,Long, Yuanyuan,Xie, Ling,Weng, Si,Chen, Juan,Du, Qian,Xu, Li,Feng, Qing,Huang, Xuan,Hou, Junpu,Wang, Bin,Xie, Lin,Zhou, Lili,Long, Ji-Feng,Guo, Junling,Wang, Xinxiang,Yan, Hong,Jiang, Hongwei,Xu, Ranhui,Duan, Beisha,Tang, Lu,Shen
Journal of neurology, neurosurgery, and psychiatry · 2022-09-23
pmid:36150844
3
Neuronal intranuclear inclusion disease in patients with adult-onset non-vascular leukoencephalopathy.
Yi Hong,Liu, Ying Tsen,Chou, Fu Pang,Chang, Wei Ju,Lee, Yuh Cherng,Guo, Cheng Ta,Chou, Hui Chun,Huang, Takeshi,Mizuguchi, Chien Chen,Chou, Hsiang Yu,Yu, Kai Wei,Yu, Hsiu Mei,Wu, Pei Chien,Tsai, Naomichi,Matsumoto, Yi Chung,Lee, Yi Chu,Liao
Brain : a journal of neurology · 2022-09-14
pmid:35411397
4
Neuronal intranuclear inclusion disease with initial manifestation of intractable nausea and vomiting responsive to corticosteroids: a case report.
Long,Luo, Ling,Zhu, Yong,Liang, Ying,Yuan, Lei,Chen, Weiwen,Peng, Gao,Yang, Ronghe,Yang
Frontiers in immunology · 2026-03-18
pmid:41929501
5
High burden of kidney involvement in neuronal intranuclear inclusion disease.
Zhenxian,Hu, Hongfei,Tai, An,Wang, Yi,Zhou, Hua,Pan, Zaiqiang,Zhang
Frontiers in neurology · 2026-08-11
pmid:42643490
6
Immunological characterization of neuronal intranuclear inclusion disease with kidney injury: an exploratory analysis in a multi-center cohort.
Ying,Ji, Xiaowen,Li, Jin,Tian, Xian,Chen, Guang,Ji, Maofeng,Shi, Jing,Zhang, Man,Xia, Qianru,An, Xiang,Li, Liangyu,Li, Wenjing,Song, Ruixue,Zhang, Lei,Bao, Yuqiao,Wang, Yingying,Cui, Yuyao,Tian, Hao,Chen
Frontiers in immunology · 2026-04-14
pmid:42058219
7
Adult-Onset Neuronal Intranuclear Inclusion Disease Initially Manifesting as Bladder Dysfunction: A Case Report.
Anna,Yamaki, Hirofumi,Sekino, Satoshi,Kawana, Ryo,Yamakuni, Shiro,Ishii, Hiroshi,Ito
Cureus · 2026-03-19
pmid:42005169
8
Subclinical peripheral nerve demyelination without overt symptoms in a family with neuronal intranuclear inclusion disease harboring biallelic repeat expansions.
Hang,Zhang, Taiqi,Zhao, Honglin,Zheng, Suying,Duan, Chenyang,Liu, Yaochong,Zhang, Qiang,Li, Han,Liu, Haiyang,Luo, Yuming,Xu
BMC neurology · 2026-04-18
pmid:42001002
9
Non-coding repeat expansions within NOTCH2NLC and RFC1 genes contribute to unsolved inherited peripheral neuropathies.
Xin-Yun,Zhang, Hao,Yu, Gong-Lu,Liu, Zhi-Ying,Wu, Hai-Lin,Dong
Journal of human genetics · 2026-09-10
pmid:42716992
10
Heterogenous Genetic, Clinical, and Imaging Features in Patients with Neuronal Intranuclear Inclusion Disease Carrying
Yusran Ady,Fitrah, Yo,Higuchi, Norikazu,Hara, Takayoshi,Tokutake, Masato,Kanazawa, Kazuhiro,Sanpei, Tomone,Taneda, Akihiko,Nakajima, Shin,Koide, Shintaro,Tsuboguchi, Midori,Watanabe, Junki,Fukumoto, Shoichiro,Ando, Tomoe,Sato, Yohei,Iwafuchi, Aki,Sato, Hideki,Hayashi, Takanobu,Ishiguro, Hayato,Takeda, Toshiaki,Takahashi, Nobuyoshi,Fukuhara, Kensaku,Kasuga, Akinori,Miyashita, Osamu,Onodera, Takeshi,Ikeuchi
Brain sciences · 2023-06-15
pmid:37371433
11
Neurological disorders caused by novel non-coding repeat expansions: clinical features and differential diagnosis.
Elisa,Vegezzi, Hiroyuki,Ishiura, D Cristopher,Bragg, David,Pellerin, Francesca,Magrinelli, Riccardo,Currò, Stefano,Facchini, Arianna,Tucci, John,Hardy, Nutan,Sharma, Matt C,Danzi, Stephan,Zuchner, Bernard,Brais, Mary M,Reilly, Shoji,Tsuji, Henry,Houlden, Andrea,Cortese
The Lancet. Neurology · 2024-07-01
pmid:38876750
13
Clinical phenotypic diversity of
Masahiro,Ando, Yujiro,Higuchi, Jun-Hui,Yuan, Akiko,Yoshimura, Mika,Dozono, Takahiro,Hobara, Fumikazu,Kojima, Yutaka,Noguchi, Mika,Takeuchi, Jun,Takei, Yu,Hiramatsu, Satoshi,Nozuma, Tomonori,Nakamura, Yusuke,Sakiyama, Akihiro,Hashiguchi, Eiji,Matsuura, Yuji,Okamoto, Jun,Sone, Hiroshi,Takashima
Journal of neurology, neurosurgery, and psychiatry · 2023-03-22
pmid:36948577
14
Rapidly progressive adult-onset neuronal intranuclear inclusion disease beginning with autonomic symptoms: a case report.
Yi,Zhu, Qian,Yang, Yun,Tian, Weibing,Fan, Xinfa,Mao
Frontiers in neurology · 2023-05-25
pmid:37305750
15
Resources for Genetics Professionals — Genetic Disorders Caused by Nucleotide Repeat Expansions and Contractions
Stephanie E.,Wallace, Lora JH,Bean
GeneReviews® [Internet] · 2022-10-20
genereviews:NBK535148
16
Erratum: Prevalence and Characterization of
Neurology. Genetics · 2024-07-12
pmid:39055960
17
Familial adult-onset neuronal intranuclear inclusion disease: A case report and literature review.
Lijun,Wei, Jiaqi,Wang, Changming,Xu, Tengchao,Yang, Yun,Tian, Lu,Shen
Medicine · 2024-11-01
pmid:39496005
18
Expansion of Human-Specific GGC Repeat in Neuronal Intranuclear Inclusion Disease-Related Disorders.
Yun,Tian, Jun-Ling,Wang, Wen,Huang, Sheng,Zeng, Bin,Jiao, Zhen,Liu, Zhao,Chen, Yujing,Li, Ying,Wang, Hao-Xuan,Min, Xue-Jing,Wang, Yong,You, Ru-Xu,Zhang, Xiao-Yu,Chen, Fang,Yi, Ya-Fang,Zhou, Hong-Yu,Long, Chao-Jun,Zhou, Xuan,Hou, Jun-Pu,Wang, Bin,Xie, Fan,Liang, Zhuan-Yi,Yang, Qi-Ying,Sun, Emily G,Allen, Andrew Mark,Shafik, Ha Eun,Kong, Ji-Feng,Guo, Xin-Xiang,Yan, Zheng-Mao,Hu, Kun,Xia, Hong,Jiang, Hong-Wei,Xu, Ran-Hui,Duan, Peng,Jin, Bei-Sha,Tang, Lu,Shen
American journal of human genetics · 2019-06-06
pmid:31178126
19
Neuronal Intranuclear Inclusion Disease with NOTCH2NLC GGC Repeat Expansion: A Systematic Review and Challenges of Phenotypic Characterization.
Tian,Zeng, Yiqun,Chen, Honghao,Huang, Shengqi,Li, Jiaqi,Huang, Haobo,Xie, Shenyi,Lin, Siyao,Chen, Guangyong,Chen, Dehao,Yang
Aging and disease · 2024-01-31
pmid:38377026
20
The Phenotypes and Mechanisms of NOTCH2NLC-Related GGC Repeat Expansion Disorders: a Comprehensive Review.
Xiu-Rong,Huang, Bei-Sha,Tang, Peng,Jin, Ji-Feng,Guo
Molecular neurobiology · 2021-10-31
pmid:34718964
21
Comprehensive genetic diagnosis of tandem repeat expansion disorders with programmable targeted nanopore sequencing.
Igor,Stevanovski, Sanjog R,Chintalaphani, Hasindu,Gamaarachchi, James M,Ferguson, Sandy S,Pineda, Carolin K,Scriba, Michel,Tchan, Victor,Fung, Karl,Ng, Andrea,Cortese, Henry,Houlden, Carol,Dobson-Stone, Lauren,Fitzpatrick, Glenda,Halliday, Gianina,Ravenscroft, Mark R,Davis, Nigel G,Laing, Avi,Fellner, Marina,Kennerson, Kishore R,Kumar, Ira W,Deveson
Science advances · 2022-03-04
pmid:35245110
22
Sequence composition changes in short tandem repeats: heterogeneity, detection, mechanisms and clinical implications.
Indhu-Shree,Rajan-Babu, Egor,Dolzhenko, Michael A,Eberle, Jan M,Friedman
Nature reviews. Genetics · 2024-03-11
pmid:38467784
23
Clinical and neuroimaging review of triplet repeat diseases.
Ryo,Kurokawa, Mariko,Kurokawa, Akihiko,Mitsutake, Moto,Nakaya, Akira,Baba, Yasuhiro,Nakata, Toshio,Moritani, Osamu,Abe
Japanese journal of radiology · 2022-09-28
pmid:36169768
24
uN2CpolyG-mediated p65 nuclear sequestration suppresses the NF-κB-NLRP3 pathway in neuronal intranuclear inclusion disease.
Yu,Shen, Kaiyan,Jiang, Dandan,Tan, Min,Zhu, Yusen,Qiu, Pencheng,Huang, Wenquan,Zou, Jianwen,Deng, Zhaoxia,Wang, Ying,Xiong, Daojun,Hong
Cell communication and signaling : CCS · 2025-02-07
pmid:39920690
25
Plasma p-tau species are elevated in presymptomatic and symptomatic neuronal intranuclear inclusion disease.
Sizhe,Zhang, Bin,Jiao, Yan,Zeng, Qiying,Sun, Xiaoyu,Chen, Weiwei,Zhang, Ziyu,Ouyang, Qiao,Xiao, Lu,Zhou, Yunni,Li, Ling,Weng, Juan,Du, Qian,Xu, Yang,Yang, Mengqi,Zhang, Qiuming,Zeng, Liangjuan,Fang, Hongyu,Long, Yuanyuan,Xie, Si,Chen, Li,Feng, Qing,Huang, Lili,Long, Yafang,Zhou, Fang,Yi, Yacen,Hu, Qiong,Liu, Yongcheng,Pan, Lin,Zhou, Yulai,Li, Shuo,Hu, Jifeng,Guo, Junling,Wang, Hong,Jiang, Hongwei,Xu, Ranhui,Duan, Beisha,Tang, Yun,Tian, Lu,Shen
EBioMedicine · 2026-01-14
pmid:41539185
26
ASO therapy rescues NOTCH2NLC GGC repeat expansion-induced genomic damage, 3D chromatin structural abnormalities, and senescence.
Mengjie,Li, Mibo,Tang, Xiaoyan,Hao, Zhengwei,Hu, Dongrui,Ma, Shuangjie,Li, Chunyan,Zuo, Zhiyun,Wang, Yuanyuan,Liang, Yanmei,Feng, Chenwei,Hao, Chen,Wang, Huanyu,Li, Yalan,Yang, Yuemeng,Sun, Shasha,Qi, Chengyuan,Mao, Yuming,Xu, Qun,Wang, De,Yang, Ruwei,Yang, Ziyao,Zhou, Peilin,Ji, Song,Tan, Zaiqiang,Zhang, Hao,Chen, Albert R,La Spada, Changhe,Shi
Nature communications · 2026-04-07
pmid:41942455
27
A Second Pathogenic Protein, PolyGN2C-iso2, Reveals a Dual-Protein Pathology in Neuronal Intranuclear Inclusion Disease.
Kang,Zhang, Wenhao,Ma, Yi,Zhou, Zhijie,Wu, Pan,Gao, Hongze,Niu, Hongfei,Tai, Tianyi,Zhao, Zheyue,Dong, Li,Li, Yan,Zhang, An,Wang, Si,Shen, Yueyang,Li, Sifei,Yu, Yan,Peng, Wang,Sheng, Xiaoyan,Dong, Hua,Pan, Kaibin,Shi, Magdalena J,Koziol, Xiaobing,Wu, Zaiqiang,Zhang
Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026-07-23
pmid:42489345
28
An update on the neurological short tandem repeat expansion disorders and the emergence of long-read sequencing diagnostics.
Sanjog R,Chintalaphani, Sandy S,Pineda, Ira W,Deveson, Kishore R,Kumar
Acta neuropathologica communications · 2021-05-25
pmid:34034831
29
Saliva-Based Triple-Primed PCR as a Non-Invasive Tool for Detecting NOTCH2NLC GGC Repeat Expansions in NIID.
Yangye,Lian, Shaoping,Zhong, Jingzhen,Liang, Yuzhe,Li, Xing,Chen, Xin,Wang, Jing,Ding
Clinical laboratory · 2026-07-01
pmid:42411677
30
Father-to-offspring transmission of extremely long NOTCH2NLC repeat expansions with contractions: genetic and epigenetic profiling with long-read sequencing.
Hiromi,Fukuda, Daisuke,Yamaguchi, Kristofor,Nyquist, Yasushi,Yabuki, Satoko,Miyatake, Yuri,Uchiyama, Kohei,Hamanaka, Ken,Saida, Eriko,Koshimizu, Naomi,Tsuchida, Atsushi,Fujita, Satomi,Mitsuhashi, Kazuyuki,Ohbo, Yuki,Satake, Jun,Sone, Hiroshi,Doi, Keisuke,Morihara, Tomoko,Okamoto, Yuji,Takahashi, Aaron M,Wenger, Norifumi,Shioda, Fumiaki,Tanaka, Naomichi,Matsumoto, Takeshi,Mizuguchi
Clinical epigenetics · 2021-11-13
pmid:34774111
31
Noncoding CGG repeat expansions in neuronal intranuclear inclusion disease, oculopharyngodistal myopathy and an overlapping disease.
Hiroyuki,Ishiura, Shota,Shibata, Jun,Yoshimura, Yuta,Suzuki, Wei,Qu, Koichiro,Doi, M Asem,Almansour, Junko Kanda,Kikuchi, Makiko,Taira, Jun,Mitsui, Yuji,Takahashi, Yaeko,Ichikawa, Tatsuo,Mano, Atsushi,Iwata, Yasuo,Harigaya, Miho Kawabe,Matsukawa, Takashi,Matsukawa, Masaki,Tanaka, Yuichiro,Shirota, Ryo,Ohtomo, Hisatomo,Kowa, Hidetoshi,Date, Aki,Mitsue, Hiroyuki,Hatsuta, Satoru,Morimoto, Shigeo,Murayama, Yasushi,Shiio, Yuko,Saito, Akihiko,Mitsutake, Mizuho,Kawai, Takuya,Sasaki, Yusuke,Sugiyama, Masashi,Hamada, Gaku,Ohtomo, Yasuo,Terao, Yoshihiko,Nakazato, Akitoshi,Takeda, Yoshio,Sakiyama, Yumi,Umeda-Kameyama, Jun,Shinmi, Katsuhisa,Ogata, Yutaka,Kohno, Shen-Yang,Lim, Ai Huey,Tan, Jun,Shimizu, Jun,Goto, Ichizo,Nishino, Tatsushi,Toda, Shinichi,Morishita, Shoji,Tsuji
Nature genetics · 2019-07-22
pmid:31332380

Additional Literature

Additional literature related to this locus.

Raw PubMed search results
(All PubMed results returned by searching for this gene, tandem repeats, and disease, in medline format)

Non-coding repeat expansions within NOTCH2NLC and RFC1 genes contribute to unsolved inherited peripheral neuropathies.
Xin-Yun,Zhang, Hao,Yu, Gong-Lu,Liu, Zhi-Ying,Wu, Hai-Lin,Dong
Journal of human genetics · 2026-09-10
pmid:42716992
Sequestration of CAPNS1 into Polyglycine Aggregates in a Cellular Model of NOTCH2NLC Repeat Expansion.
Arisa,Kubokawa, Ai,Ohki, Risa,Ono, Makoto,Araki, Motoaki,Yanaizu, Yoshihiro,Kino
Biological & pharmaceutical bulletin · 2026-01-01
pmid:42686620
Optimized Cas9-Enriched Nanopore Sequencing and Analysis Workflow for Clinical Diagnosis of Repeat Expansion Disorders.
Seungbok,Lee, Chanju,Jung, Minjeong,Kim, Narae,Kim, Gue-Ho,Hwang, Soon-Tae,Lee, Kon,Chu, Sang Kun,Lee, Han-Joon,Kim, Jong-Hee,Chae, Sangsu,Bae, Jangsup,Moon
Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026-08-29
pmid:42667167
High burden of kidney involvement in neuronal intranuclear inclusion disease.
Zhenxian,Hu, Hongfei,Tai, An,Wang, Yi,Zhou, Hua,Pan, Zaiqiang,Zhang
Frontiers in neurology · 2026-08-11
pmid:42643490
Novel proteomics and neuropathology of
Feixia,Zhan, Jiaxin,Zhu, Yang,Wang, Yuwen,Cao, Xiya,Shen, Wenlu,Lv, Jiewei,Wei, Xiaojun,Huang, Steven X,Hou, Xinghua,Luan, Li,Cao
Frontiers in aging neuroscience · 2026-07-03
pmid:42490784
PolyG Fibrils Coalesce Into Nuclear Ribbons That Engage Proteostasis Machinery in Neuronal Intranuclear Inclusion Disease.
Hui,Dong, Yongcheng,Pan, Zhiyao,Tang, Yuxuan,Yao, Guicong,Zhang, Junpu,Wang, Haonan,Xiao, Yun,Tian, Beisha,Tang, Dan,Li, Qiang,Guo, Ruijun,Tian, Qiong,Liu, Cong,Liu
Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026-07-20
pmid:42474087
Evolutionary implications of
Si,Shen, Hong-Fei,Tai, Songtao,Niu, Hua,Pan, Xingao,Wang, Bin,Chen, Yuzhi,Shi, Hengheng,Wang, Shan,Lv, Yaou,Liu, Zaiqiang,Zhang
Brain communications · 2026-06-03
pmid:42396598
Case Report: Neuronal intranuclear inclusion disease mimicking recurrent stroke in the setting of intracranial stenosis.
Jingmin,Zhao, Guangxun,Shen, Lumei,Chi
Frontiers in medicine · 2026-05-20
pmid:42245955
Re-evaluating archival specimens as a pathologic diagnostic resource for neuronal intranuclear inclusion disease.
Yangye,Lian, Shaoping,Zhong, Jingzhen,Liang, Ke,Xu, Xin,Wang, Yuan,Ji, Jing,Ding
American journal of clinical pathology · 2026-05-05
pmid:42177789