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Walcott BP, Winkler EA, Rouleau GA, Lawton MT. Molecular, Cellular, and Genetic Determinants of Sporadic Brain Arteriovenous Malformations. Neurosurgery 2018; 63 Suppl 1:37-42. [PMID: 27399362 DOI: 10.1227/neu.0000000000001300] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Brian P Walcott
- Department of Neurological Surgery and.,Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, California
| | - Ethan A Winkler
- Department of Neurological Surgery and.,Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, California
| | - Guy A Rouleau
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Michael T Lawton
- Department of Neurological Surgery and.,Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, California
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Faughnan ME, Gossage JR, Chakinala MM, Oh SP, Kasthuri R, Hughes CCW, McWilliams JP, Parambil JG, Vozoris N, Donaldson J, Paul G, Berry P, Sprecher DL. Pazopanib may reduce bleeding in hereditary hemorrhagic telangiectasia. Angiogenesis 2018; 22:145-155. [PMID: 30191360 PMCID: PMC6510884 DOI: 10.1007/s10456-018-9646-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/14/2018] [Indexed: 12/22/2022]
Abstract
Pazopanib (Votrient) is an orally administered tyrosine kinase inhibitor that blocks VEGF receptors potentially serving as anti-angiogenic treatment for hereditary hemorrhagic telangiectasia (HHT). We report a prospective, multi-center, open-label, dose-escalating study [50 mg, 100 mg, 200 mg, and 400 mg], designed as a proof-of-concept study to demonstrate efficacy of pazopanib on HHT-related bleeding, and to measure safety. Patients, recruited at 5 HHT Centers, required ≥ 2 Curacao criteria AND [anemia OR severe epistaxis with iron deficiency]. Co-primary outcomes, hemoglobin (Hgb) and epistaxis severity, were measured during and after treatment, and compared to baseline. Safety monitoring occurred every 1.5 weeks. Seven patients were treated with 50 mg pazopanib daily. Six/seven showed at least 50% decrease in epistaxis duration relative to baseline at some point during study; 3 showed at least 50% decrease in duration during Weeks 11 and 12. Six patients showed a decrease in ESS of > 0.71 (MID) relative to baseline at some point during study; 3/6 showed a sustained improvement. Four patients showed > 2 gm improvement in Hgb relative to baseline at one or more points during study. Health-related QOL scores improved on all SF-36 domains at Week 6 and/or Week 12, except general health (unchanged). There were 19 adverse events (AE) including one severe AE (elevated LFTs, withdrawn from dosing at 43 days); with no serious AE. In conclusion, we observed an improvement in Hgb and/or epistaxis in all treated patients. This occurred at a dose much lower than typically used for oncologic indications, with no serious AE. Further studies of pazopanib efficacy are warranted.
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Affiliation(s)
- Marie E Faughnan
- Toronto HHT Program, Division of Respirology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute of St. Michaels Hospital, 30 Bond St, Toronto, ON, M5B-1W8, Canada.
| | - James R Gossage
- Division of Pulmonary and Critical Care Medicine, Augusta University, Augusta, GA, USA
| | - Murali M Chakinala
- Division of Pulmonary and Critical Care Medicine, Washington University, St. Louis, MO, USA
| | - S Paul Oh
- Barrow Aneurysm & AVM Research Center, Barrow Neurological Institute/Dignity Health, Phoenix, AZ, USA
| | - Raj Kasthuri
- Division of Hematology and Oncology, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, USA
| | - Christopher C W Hughes
- Department of Molecular Biology & Biochemistry, and Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Justin P McWilliams
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Nicholas Vozoris
- Toronto HHT Program, Division of Respirology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St. Michaels Hospital, 30 Bond St, Toronto, ON, M5B-1W8, Canada
| | | | | | - Pamela Berry
- Patient Reported Outcomes, Janssen Global Services, LLC, Horsham, PA, USA
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Zhu W, Chen W, Zou D, Wang L, Bao C, Zhan L, Saw D, Wang S, Winkler E, Li Z, Zhang M, Shen F, Shaligram S, Lawton M, Su H. Thalidomide Reduces Hemorrhage of Brain Arteriovenous Malformations in a Mouse Model. Stroke 2018; 49:1232-1240. [PMID: 29593101 DOI: 10.1161/strokeaha.117.020356] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/13/2018] [Accepted: 02/16/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Brain arteriovenous malformation (bAVM) is an important risk factor for intracranial hemorrhage. Current treatments for bAVM are all associated with considerable risks. There is no safe method to prevent bAVM hemorrhage. Thalidomide reduces nose bleeding in patients with hereditary hemorrhagic telangiectasia, an inherited disorder characterized by vascular malformations. In this study, we tested whether thalidomide and its less toxic analog, lenalidomide, reduce bAVM hemorrhage using a mouse model. METHODS bAVMs were induced through induction of brain focal activin-like kinase 1 (Alk1, an AVM causative gene) gene deletion and angiogenesis in adult Alk1-floxed mice. Thalidomide was injected intraperitoneally twice per week for 6 weeks, starting either 2 or 8 weeks after AVM induction. Lenalidomide was injected intraperitoneally daily starting 8 weeks after AVM induction for 6 weeks. Brain samples were collected at the end of the treatments for morphology, mRNA, and protein analyses. The influence of Alk1 downregulation on PDGFB (platelet-derived growth factor B) expression was also studied on cultured human brain microvascular endothelial cells. The effect of PDGFB in mural cell recruitment in bAVM was explored by injection of a PDGFB overexpressing lentiviral vector to the mouse brain. RESULTS Thalidomide or lenalidomide treatment reduced the number of dysplastic vessels and hemorrhage and increased mural cell (vascular smooth muscle cells and pericytes) coverage in the bAVM lesion. Thalidomide reduced the burden of CD68+ cells and the expression of inflammatory cytokines in the bAVM lesions. PDGFB expression was reduced in ALK1-knockdown human brain microvascular endothelial cells and in mouse bAVM lesion. Thalidomide increased Pdgfb expression in bAVM lesion. Overexpression of PDGFB mimicked the effect of thalidomide. CONCLUSIONS Thalidomide and lenalidomide improve mural cell coverage of bAVM vessels and reduce bAVM hemorrhage, which is likely through upregulation of Pdgfb expression.
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Affiliation(s)
- Wan Zhu
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., W.C., D.Z., L.W., C.B., L.Z., D.S., S.W., Z.L., M.Z., F.S., S.S., H.S.)
| | - Wanqiu Chen
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., W.C., D.Z., L.W., C.B., L.Z., D.S., S.W., Z.L., M.Z., F.S., S.S., H.S.)
| | - Dingquan Zou
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., W.C., D.Z., L.W., C.B., L.Z., D.S., S.W., Z.L., M.Z., F.S., S.S., H.S.).,University of California, San Francisco; and Department of Anesthesiology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China (D.Z.)
| | - Liang Wang
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., W.C., D.Z., L.W., C.B., L.Z., D.S., S.W., Z.L., M.Z., F.S., S.S., H.S.)
| | - Chen Bao
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., W.C., D.Z., L.W., C.B., L.Z., D.S., S.W., Z.L., M.Z., F.S., S.S., H.S.)
| | - Lei Zhan
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., W.C., D.Z., L.W., C.B., L.Z., D.S., S.W., Z.L., M.Z., F.S., S.S., H.S.)
| | - Daniel Saw
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., W.C., D.Z., L.W., C.B., L.Z., D.S., S.W., Z.L., M.Z., F.S., S.S., H.S.)
| | - Sen Wang
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., W.C., D.Z., L.W., C.B., L.Z., D.S., S.W., Z.L., M.Z., F.S., S.S., H.S.)
| | | | - Zhengxi Li
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., W.C., D.Z., L.W., C.B., L.Z., D.S., S.W., Z.L., M.Z., F.S., S.S., H.S.)
| | - Meng Zhang
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., W.C., D.Z., L.W., C.B., L.Z., D.S., S.W., Z.L., M.Z., F.S., S.S., H.S.)
| | - Fanxia Shen
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., W.C., D.Z., L.W., C.B., L.Z., D.S., S.W., Z.L., M.Z., F.S., S.S., H.S.)
| | - Sonali Shaligram
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., W.C., D.Z., L.W., C.B., L.Z., D.S., S.W., Z.L., M.Z., F.S., S.S., H.S.)
| | | | - Hua Su
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., W.C., D.Z., L.W., C.B., L.Z., D.S., S.W., Z.L., M.Z., F.S., S.S., H.S.)
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Vascular deficiency of Smad4 causes arteriovenous malformations: a mouse model of Hereditary Hemorrhagic Telangiectasia. Angiogenesis 2018; 21:363-380. [PMID: 29460088 PMCID: PMC5878194 DOI: 10.1007/s10456-018-9602-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/28/2018] [Indexed: 12/18/2022]
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disorder that leads to abnormal connections between arteries and veins termed arteriovenous malformations (AVM). Mutations in TGFβ pathway members ALK1, ENG and SMAD4 lead to HHT. However, a Smad4 mouse model of HHT does not currently exist. We aimed to create and characterize a Smad4 endothelial cell (EC)-specific, inducible knockout mouse (Smad4f/f;Cdh5-CreERT2) that could be used to study AVM development in HHT. We found that postnatal ablation of Smad4 caused various vascular defects, including the formation of distinct AVMs in the neonate retina. Our analyses demonstrated that increased EC proliferation and size, altered mural cell coverage and distorted artery-vein gene expression are associated with Smad4 deficiency in the vasculature. Furthermore, we show that depletion of Smad4 leads to decreased Vegfr2 expression, and concurrent loss of endothelial Smad4 and Vegfr2 in vivo leads to AVM enlargement. Our work provides a new model in which to study HHT-associated phenotypes and links the TGFβ and VEGF signaling pathways in AVM pathogenesis.
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Goumans MJ, Zwijsen A, Ten Dijke P, Bailly S. Bone Morphogenetic Proteins in Vascular Homeostasis and Disease. Cold Spring Harb Perspect Biol 2018; 10:cshperspect.a031989. [PMID: 28348038 DOI: 10.1101/cshperspect.a031989] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
It is well established that control of vascular morphogenesis and homeostasis is regulated by vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), Delta-like 4 (Dll4), angiopoietin, and ephrin signaling. It has become clear that signaling by bone morphogenetic proteins (BMPs), which have a long history of studies in bone and early heart development, are also essential for regulating vascular function. Indeed, mutations that cause deregulated BMP signaling are linked to two human vascular diseases, hereditary hemorrhagic telangiectasia and pulmonary arterial hypertension. These observations are corroborated by data obtained with vascular cells in cell culture and in mouse models. BMPs are required for normal endothelial cell differentiation and for venous/arterial and lymphatic specification. In adult life, BMP signaling orchestrates neo-angiogenesis as well as vascular inflammation, remodeling, and calcification responses to shear and oxidative stress. This review emphasizes the pivotal role of BMPs in the vascular system, based on studies of mouse models and human vascular disorders.
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Affiliation(s)
- Marie-José Goumans
- Department of Molecular Cell Biology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - An Zwijsen
- VIB Center for the Biology of Disease, 3000 Leuven, Belgium.,KU Leuven Department of Human Genetics, 3000 Leuven, Belgium
| | - Peter Ten Dijke
- Department of Molecular Cell Biology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.,Cancer Genomics Centre Netherlands, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Sabine Bailly
- Institut National de la Santé et de la Recherche Mécale (INSERM), U1036, 38000 Grenoble, France.,Laboratoire Biologie du Cancer et de l'Infection, Commissariat à l'Énergie Atomique et aux Energies Alternatives, Biosciences and Biotechnology Institute of Grenoble, 38000 Grenoble, France.,University of Grenoble Alpes, 38000 Grenoble, France
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56
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Roman BL, Hinck AP. ALK1 signaling in development and disease: new paradigms. Cell Mol Life Sci 2017; 74:4539-4560. [PMID: 28871312 PMCID: PMC5687069 DOI: 10.1007/s00018-017-2636-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/01/2017] [Accepted: 08/28/2017] [Indexed: 12/21/2022]
Abstract
Activin A receptor like type 1 (ALK1) is a transmembrane serine/threonine receptor kinase in the transforming growth factor-beta receptor family that is expressed on endothelial cells. Defects in ALK1 signaling cause the autosomal dominant vascular disorder, hereditary hemorrhagic telangiectasia (HHT), which is characterized by development of direct connections between arteries and veins, or arteriovenous malformations (AVMs). Although previous studies have implicated ALK1 in various aspects of sprouting angiogenesis, including tip/stalk cell selection, migration, and proliferation, recent work suggests an intriguing role for ALK1 in transducing a flow-based signal that governs directed endothelial cell migration within patent, perfused vessels. In this review, we present an updated view of the mechanism of ALK1 signaling, put forth a unified hypothesis to explain the cellular missteps that lead to AVMs associated with ALK1 deficiency, and discuss emerging roles for ALK1 signaling in diseases beyond HHT.
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Affiliation(s)
- Beth L Roman
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, 130 DeSoto St, Pittsburgh, PA, 15261, USA.
| | - Andrew P Hinck
- Department of Structural Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Li P, Zhang L, Chen D, Zeng M, Chen F. Focal neurons: another source of vascular endothelial growth factor in brain arteriovenous malformation tissues? Neurol Res 2017; 40:122-129. [PMID: 29191115 DOI: 10.1080/01616412.2017.1405574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Brain arteriovenous malformations (bAVMs) are devastating, hemorrhage-prone, cerebrovascular entities characterized by well-defined feeding arteries, draining veins, and the absence of a capillary bed. The endothelial cells that comprise bAVMs exhibit a loss of arterial and venous specification. The role of abnormal angiogenesis in the formation and progression of bAVMs is still unclear. This study aimed to investigate the expression of vascular endothelial growth factor (VEGF) in neurons and glial cells in bAVMs to try to uncover the multiple cell origin of VEGF. Methods A total of 25 bAVM specimens and 25 control tissues were obtained. Western blot and immunohistochemical analyses were used to evaluate the expression of VEGF. The distribution of VEGF in neurons and glial cells in these bAVMs were observed by double-label immunofluorescence staining and subsequent imaging. Results Western blot analysis revealed a significant overexpression of VEGF in bAVM tissues (P < 0.05). Immunohistochemistry showed that the amount of cells that overexpressed VEGF in bAVM tissues was significantly greater compared to that in normal tissues (P < 0.05). Double-label immunofluorescence staining showed no significant difference between the mean amounts of VEGF-positive cells in astrocytes and in neurons (P < 0.05). Conclusions The formation and progression of bAVMs is related to the local overexpression of VEGF. Similar levels of VEGF overexpression are found in astrocytes, neurons, and vascular endothelial cells, which suggest that VEGF may be derived from astrocytes and neurons. It implied that focal neurons may play a certain role in the pathophysical process of bAVMs, however, identification of the production and functional mechanisms of VEGF in the neurons still requires further investigation.
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Affiliation(s)
- Pengchen Li
- a Department of Neurosurgery , Xiangya Hospital, Central South University , Changsha , P.R. China
| | - Longbo Zhang
- a Department of Neurosurgery , Xiangya Hospital, Central South University , Changsha , P.R. China
| | - Deshun Chen
- a Department of Neurosurgery , Xiangya Hospital, Central South University , Changsha , P.R. China
| | - Ming Zeng
- a Department of Neurosurgery , Xiangya Hospital, Central South University , Changsha , P.R. China
| | - Fenghua Chen
- a Department of Neurosurgery , Xiangya Hospital, Central South University , Changsha , P.R. China
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Abstract
Correct organization of the vascular tree requires the balanced activities of several signaling pathways that regulate tubulogenesis and vascular branching, elongation, and pruning. When this balance is lost, the vessels can be malformed and fragile, and they can lose arteriovenous differentiation. In this review, we concentrate on the transforming growth factor (TGF)-β/bone morphogenetic protein (BMP) pathway, which is one of the most important and complex signaling systems in vascular development. Inactivation of these pathways can lead to altered vascular organization in the embryo. In addition, many vascular malformations are related to deregulation of TGF-β/BMP signaling. Here, we focus on two of the most studied vascular malformations that are induced by deregulation of TGF-β/BMP signaling: hereditary hemorrhagic telangiectasia (HHT) and cerebral cavernous malformation (CCM). The first of these is related to loss-of-function mutation of the TGF-β/BMP receptor complex and the second to increased signaling sensitivity to TGF-β/BMP. In this review, we discuss the potential therapeutic targets against these vascular malformations identified so far, as well as their basis in general mechanisms of vascular development and stability.
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Affiliation(s)
- Sara I Cunha
- From the Department of Immunology, Genetics, and Pathology, Uppsala University, Sweden (S.I.C., P.U.M., E.D.); FIRC Institute of Molecular Oncology, Milan, Italy (E.D., M.G.L.); and Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (M.G.L.)
| | - Peetra U Magnusson
- From the Department of Immunology, Genetics, and Pathology, Uppsala University, Sweden (S.I.C., P.U.M., E.D.); FIRC Institute of Molecular Oncology, Milan, Italy (E.D., M.G.L.); and Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (M.G.L.)
| | - Elisabetta Dejana
- From the Department of Immunology, Genetics, and Pathology, Uppsala University, Sweden (S.I.C., P.U.M., E.D.); FIRC Institute of Molecular Oncology, Milan, Italy (E.D., M.G.L.); and Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (M.G.L.).
| | - Maria Grazia Lampugnani
- From the Department of Immunology, Genetics, and Pathology, Uppsala University, Sweden (S.I.C., P.U.M., E.D.); FIRC Institute of Molecular Oncology, Milan, Italy (E.D., M.G.L.); and Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (M.G.L.)
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Zhu W, Shen F, Mao L, Zhan L, Kang S, Sun Z, Nelson J, Zhang R, Zou D, McDougall CM, Lawton MT, Vu TH, Wu Z, Scaria A, Colosi P, Forsayeth J, Su H. Soluble FLT1 Gene Therapy Alleviates Brain Arteriovenous Malformation Severity. Stroke 2017; 48:1420-1423. [PMID: 28325846 DOI: 10.1161/strokeaha.116.015713] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/05/2017] [Accepted: 01/23/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Brain arteriovenous malformation (bAVM) is an important risk factor for intracranial hemorrhage. Current therapies are associated with high morbidities. Excessive vascular endothelial growth factor has been implicated in bAVM pathophysiology. Because soluble FLT1 binds to vascular endothelial growth factor with high affinity, we tested intravenous delivery of an adeno-associated viral vector serotype-9 expressing soluble FLT1 (AAV9-sFLT1) to alleviate the bAVM phenotype. METHODS Two mouse models were used. In model 1, bAVM was induced in R26CreER;Eng2f/2f mice through global Eng gene deletion and brain focal angiogenic stimulation; AAV2-sFLT02 (an AAV expressing a shorter form of sFLT1) was injected into the brain at the time of model induction, and AAV9-sFLT1, intravenously injected 8 weeks after. In model 2, SM22αCre;Eng2f/2f mice had a 90% occurrence of spontaneous bAVM at 5 weeks of age and 50% mortality at 6 weeks; AAV9-sFLT1 was intravenously delivered into 4- to 5-week-old mice. Tissue samples were collected 4 weeks after AAV9-sFLT1 delivery. RESULTS AAV2-sFLT02 inhibited bAVM formation, and AAV9-sFLT1 reduced abnormal vessels in model 1 (GFP versus sFLT1: 3.66±1.58/200 vessels versus 1.98±1.29, P<0.05). AAV9-sFLT1 reduced the occurrence of bAVM (GFP versus sFLT1: 100% versus 36%) and mortality (GFP versus sFLT1: 57% [12/22 mice] versus 24% [4/19 mice], P<0.05) in model 2. Kidney and liver function did not change significantly. Minor liver inflammation was found in 56% of AAV9-sFLT1-treated model 1 mice. CONCLUSIONS By applying a regulated mechanism to restrict sFLT1 expression to bAVM, AAV9-sFLT1 can potentially be developed into a safer therapy to reduce the bAVM severity.
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Affiliation(s)
- Wan Zhu
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Fanxia Shen
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Lei Mao
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Lei Zhan
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Shuai Kang
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Zhengda Sun
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Jeffrey Nelson
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Rui Zhang
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Dingquan Zou
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Cameron M McDougall
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Michael T Lawton
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Thiennu H Vu
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Zhijian Wu
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Abraham Scaria
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Peter Colosi
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - John Forsayeth
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Hua Su
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.).
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Bongetta D, Zoia C, Lafe E, Gaetani P. Could Thalidomide Be a Treatment Option for Arteriovenous Malformations? World Neurosurg 2017; 99:802. [DOI: 10.1016/j.wneu.2016.10.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 10/12/2016] [Indexed: 10/19/2022]
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Lohkamp LN, Strong C, Rojas R, Anderson M, Laviv Y, Kasper EM. Hypervascular glioblastoma multiforme or arteriovenous malformation associated Glioma? A diagnostic and therapeutic challenge: A case report. Surg Neurol Int 2016; 7:S883-S888. [PMID: 27999714 PMCID: PMC5154202 DOI: 10.4103/2152-7806.194506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 07/12/2016] [Indexed: 11/05/2022] Open
Abstract
Background: Simultaneous presentation of arteriovenous malformation (AVM) and glioblastoma multiforme (GBM) is rarely reported in the literature and needs to be differentiated from “angioglioma”, a highly vascular glioma and other differential diagnosis such as hypervascular glioblastoma. Incorporating critical features of both, malignant glioma and AVM, such lesions lack a standard algorithm for diagnosis and therapy due to their rare incidence as well as their complex radiological and highly individualized clinical presentation. Case Description: We present a case of a 71-year-old female with newly developing motor deficits and radiographic findings of a heterogeneously contrast enhancing right-sided thalamic lesion with highly prominent vasculature. While computed tomography angiogram and cerebral digital subtraction angiography supported the diagnosis of AVM, contrast-enhancing magnetic resonance imaging (MRI) and MR-spectroscopy was suggestive of malignant glioma. A stereotactic biopsy revealed the diagnosis of a GBM (WHO IV) and the patient was treated accordingly. Conclusion: The coincidental presentation of vascular lesions such as AVM and malignant glioma is rare and presents a major challenge when establishing a diagnosis. The respective treatment decision is complicated by the fact that available treatment modalities (e.g. radiosurgery and/or open resection) carry disease specific complications for each entity. Finding a suitable solution for such cases requires standardization of early diagnostic and therapeutic management.
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Affiliation(s)
- Laura-Nanna Lohkamp
- Department of Neurosurgery with Pediatric Neurosurgery, Charité-University Medicine, Campus Virchow, Berlin, Germany
| | - Christian Strong
- Department of Neurosurgery, Brigham and Woman's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rafael Rojas
- Department of Neuroradiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Anderson
- Department of Pathology and Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Yosef Laviv
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ekkehard M Kasper
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
PURPOSE To report a case of racemose hemangioma with macular involvement and treated with anti-vascular endothelial growth factor. METHODS Observational case report. RESULTS JFS, a 31-year-old woman, presented with a complaint of blurred vision in her right eye over the preceding 2 months, worsening during the previous month. An examination conducted in May 2013 showed visual acuity of 20/30 in her right eye and 20/20 in her left eye, deteriorating to 20/40 in the right eye 1 month later. Retinography of the right eye revealed a dilated tortuous retinal vessel in the lower temporal arcade, affecting the macular region. Because of progressive deterioration in the patient's visual acuity, she was treated with 3 intravitreal bevacizumab injections, with an interval of 1 month between them. At the end of the proposed treatment, the patient was followed up on an outpatient basis for 12 months, with visual acuity of 20/20 in both eyes and no signs of retinal exudation throughout the entire follow-up period. CONCLUSION Racemose hemangioma with focal macular involvement may lead to a progressive reduction in visual acuity because of exudation. Further studies need to be conducted to confirm the efficacy of bevacizumab injections to treat vascular malformation; however, this form of management does seem promising.
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Ntumba K, Akla N, Oh SP, Eichmann A, Larrivée B. BMP9/ALK1 inhibits neovascularization in mouse models of age-related macular degeneration. Oncotarget 2016; 7:55957-55969. [PMID: 27517154 PMCID: PMC5302889 DOI: 10.18632/oncotarget.11182] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/13/2016] [Indexed: 12/15/2022] Open
Abstract
Age-related macular degeneration (AMD) is the leading cause of blindness in aging populations of industrialized countries. The drawbacks of inhibitors of vascular endothelial growth factor (VEGFs) currently used for the treatment of AMD, which include resistance and potential serious side-effects, require the identification of new therapeutic targets to modulate angiogenesis. BMP9 signaling through the endothelial Alk1 serine-threonine kinase receptor modulates the response of endothelial cells to VEGF and promotes vessel quiescence and maturation during development. Here, we show that BMP9/Alk1 signaling inhibits neovessel formation in mouse models of pathological ocular angiogenesis relevant to AMD. Activating Alk1 signaling in laser-induced choroidal neovascularization (CNV) and oxygen-induced retinopathy (OIR) inhibited neovascularization and reduced the volume of vascular lesions. Alk1 signaling was also found to interfere with VEGF signaling in endothelial cells whereas BMP9 potentiated the inhibitory effects of VEGFR2 signaling blockade, both in OIR and laser-induced CNV. Together, our data show that targeting BMP9/Alk1 efficiently prevents the growth of neovessels in AMD models and introduce a new approach to improve conventional anti-VEGF therapies.
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Affiliation(s)
- Kalonji Ntumba
- Department of Biomedical Sciences, Maisonneuve-Rosemont Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Naoufal Akla
- Department of Biochemistry, Maisonneuve-Rosemont Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
| | - S. Paul Oh
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, USA
| | - Anne Eichmann
- Yale Cardiovascular Research Center, New Haven, CT, USA
- Inserm U970, Paris Cardiovascular Research Center, Paris, France
| | - Bruno Larrivée
- Department of Biomedical Sciences, Maisonneuve-Rosemont Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
- Department of Molecular Biology, Maisonneuve-Rosemont Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
- Department of Ophthalmology, Maisonneuve-Rosemont Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
- Department of Biological Sciences, Université du Québec à Montréal, Montréal, Quebec, Canada
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Dréan A, Goldwirt L, Verreault M, Canney M, Schmitt C, Guehennec J, Delattre JY, Carpentier A, Idbaih A. Blood-brain barrier, cytotoxic chemotherapies and glioblastoma. Expert Rev Neurother 2016; 16:1285-1300. [PMID: 27310463 DOI: 10.1080/14737175.2016.1202761] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Glioblastomas (GBM) are the most common and aggressive primary malignant brain tumors in adults. The blood brain barrier (BBB) is a major limitation reducing efficacy of anti-cancer drugs in the treatment of GBM patients. Areas covered: Virtually all GBM recur after the first-line treatment, at least partly, due to invasive tumor cells protected from chemotherapeutic agents by the intact BBB in the brain adjacent to tumor. The passage through the BBB, taken by antitumor drugs, is poorly and heterogeneously documented in the literature. In this review, we have focused our attention on: (i) the BBB, (ii) the passage of chemotherapeutic agents across the BBB and (iii) the strategies investigated to overcome this barrier. Expert commentary: A better preclinical knowledge of the crossing of the BBB by antitumor drugs will allow optimizing their clinical development, alone or combined with BBB bypassing strategies, towards an increased success rate of clinical trials.
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Affiliation(s)
- Antonin Dréan
- a Inserm U 1127, CNRS UMR 7225 , Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM , Paris , France.,b Carthera SAS , Institut du Cerveau et de la Moelle épinière, ICM , Paris , France
| | - Lauriane Goldwirt
- c AP-HP , Hôpital Universitaire Saint Louis, Service de Pharmacologie , Paris , France
| | - Maïté Verreault
- a Inserm U 1127, CNRS UMR 7225 , Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM , Paris , France
| | - Michael Canney
- b Carthera SAS , Institut du Cerveau et de la Moelle épinière, ICM , Paris , France
| | - Charlotte Schmitt
- a Inserm U 1127, CNRS UMR 7225 , Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM , Paris , France
| | - Jeremy Guehennec
- a Inserm U 1127, CNRS UMR 7225 , Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM , Paris , France
| | - Jean-Yves Delattre
- a Inserm U 1127, CNRS UMR 7225 , Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM , Paris , France.,d AP-HP , Hôpital Universitaire La Pitié Salpêtrière, Service de Neurologie 2-Mazarin , Paris , France
| | - Alexandre Carpentier
- b Carthera SAS , Institut du Cerveau et de la Moelle épinière, ICM , Paris , France.,e AP-HP , Hôpital Universitaire La Pitié Salpêtrière, Service de Neurochirurgie , Paris , France
| | - Ahmed Idbaih
- a Inserm U 1127, CNRS UMR 7225 , Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM , Paris , France.,d AP-HP , Hôpital Universitaire La Pitié Salpêtrière, Service de Neurologie 2-Mazarin , Paris , France
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Belagodu AP, Zendeli L, Slater BJ, Galvez R. Blocking elevated VEGF‐A attenuates non‐vasculature Fragile X syndrome abnormalities. Dev Neurobiol 2016; 77:14-25. [DOI: 10.1002/dneu.22404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/15/2016] [Accepted: 05/31/2016] [Indexed: 01/19/2023]
Affiliation(s)
- Amogh P. Belagodu
- Neuroscience Program, University of Illinois at Urbana‐Champaign405 N Mathews AveUrbana Illinois61801
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana‐Champaign405 N Mathews AveUrbana Illinois61801
| | - Liridon Zendeli
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana‐Champaign405 N Mathews AveUrbana Illinois61801
| | - Bernard J. Slater
- Neuroscience Program, University of Illinois at Urbana‐Champaign405 N Mathews AveUrbana Illinois61801
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana‐Champaign405 N Mathews AveUrbana Illinois61801
| | - Roberto Galvez
- Neuroscience Program, University of Illinois at Urbana‐Champaign405 N Mathews AveUrbana Illinois61801
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana‐Champaign405 N Mathews AveUrbana Illinois61801
- Psychology DepartmentUniversity of Illinois at Urbana‐Champaign405 N Mathews AveUrbana Illinois61801
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66
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Ding D, Starke RM, Liu KC, Crowley RW. Cortical plasticity in patients with cerebral arteriovenous malformations. J Clin Neurosci 2016; 22:1857-61. [PMID: 26256067 DOI: 10.1016/j.jocn.2015.06.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/20/2015] [Indexed: 10/22/2022]
Abstract
The aim of this review is to ascertain the evidence for cortical plasticity in arteriovenous malformation (AVM) patients. Chronic hypoperfusion due to vascular steal from cerebral AVM can result in a translocation of eloquent neurological functions to other brain areas, a phenomenon known as cortical plasticity. We performed a systematic literature review of the studies that have evaluated cortical plasticity in AVM patients. A total of 22 studies from 1996 to 2014 were included for the analyses. The evaluation of cortical plasticity was performed prior to AVM intervention in 109 patients, and during or after AVM intervention in 18. The most commonly assessed neurological functions were motor in 85% and language in 11% of the former cohort, and motor in 78% and language, cognition, and memory each in 39% of the latter cohort. Functional MRI was the most frequently used method for evaluating cortical plasticity, and was performed in 63% of the former and 56% of the latter cohort. In conclusion, cortical plasticity appears to be influenced by both AVM pathogenesis and intervention. Given the limited evidence that is currently available for cortical plasticity in AVM patients, further studies are warranted to determine its incidence and impact on long term clinical outcomes.
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Affiliation(s)
- Dale Ding
- Department of Neurosurgery, University of Virginia, Post Office Box 800212, Charlottesville, VA 22908, USA.
| | - Robert M Starke
- Department of Neurosurgery, University of Virginia, Post Office Box 800212, Charlottesville, VA 22908, USA
| | - Kenneth C Liu
- Department of Neurosurgery, University of Virginia, Post Office Box 800212, Charlottesville, VA 22908, USA; Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - R Webster Crowley
- Department of Neurosurgery, University of Virginia, Post Office Box 800212, Charlottesville, VA 22908, USA; Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
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Zhang R, Zhu W, Su H. Vascular Integrity in the Pathogenesis of Brain Arteriovenous Malformation. ACTA NEUROCHIRURGICA. SUPPLEMENT 2016; 121:29-35. [PMID: 26463919 DOI: 10.1007/978-3-319-18497-5_6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Brain arteriovenous malformation (bAVM) is an important cause of intracranial hemorrhage (ICH), particularly in the young population. ICH is the first clinical symptom in about 50 % of bAVM patients. The vessels in bAVM are fragile and prone to rupture, causing bleeding into the brain. About 30 % of unruptured and non-hemorrhagic bAVMs demonstrate microscopic evidence of hemosiderin in the vascular wall. In bAVM mouse models, vascular mural cell coverage is reduced in the AVM lesion, accompanied by vascular leakage and microhemorrhage. In this review, we discuss possible signaling pathways involved in abnormal vascular development in bAVM.
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Affiliation(s)
- Rui Zhang
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, 1001 Potrero Avenue, 1363, San Francisco, CA, 94110, USA
| | - Wan Zhu
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, 1001 Potrero Avenue, 1363, San Francisco, CA, 94110, USA
| | - Hua Su
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, 1001 Potrero Avenue, 1363, San Francisco, CA, 94110, USA.
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Animal Models in Studying Cerebral Arteriovenous Malformation. BIOMED RESEARCH INTERNATIONAL 2015; 2015:178407. [PMID: 26649296 PMCID: PMC4663287 DOI: 10.1155/2015/178407] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/11/2015] [Accepted: 10/25/2015] [Indexed: 12/13/2022]
Abstract
Brain arteriovenous malformation (AVM) is an important cause of hemorrhagic stroke. The etiology is largely unknown and the therapeutics are controversial. A review of AVM-associated animal models may be helpful in order to understand the up-to-date knowledge and promote further research about the disease. We searched PubMed till December 31, 2014, with the term “arteriovenous malformation,” limiting results to animals and English language. Publications that described creations of AVM animal models or investigated AVM-related mechanisms and treatments using these models were reviewed. More than 100 articles fulfilling our inclusion criteria were identified, and from them eight different types of the original models were summarized. The backgrounds and procedures of these models, their applications, and research findings were demonstrated. Animal models are useful in studying the pathogenesis of AVM formation, growth, and rupture, as well as in developing and testing new treatments. Creations of preferable models are expected.
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69
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Fish JE, Wythe JD. The molecular regulation of arteriovenous specification and maintenance. Dev Dyn 2015; 244:391-409. [PMID: 25641373 DOI: 10.1002/dvdy.24252] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/02/2015] [Accepted: 01/04/2015] [Indexed: 12/21/2022] Open
Abstract
The formation of a hierarchical vascular network, composed of arteries, veins, and capillaries, is essential for embryogenesis and is required for the production of new functional vasculature in the adult. Elucidating the molecular mechanisms that orchestrate the differentiation of vascular endothelial cells into arterial and venous cell fates is requisite for regenerative medicine, as the directed formation of perfused vessels is desirable in a myriad of pathological settings, such as in diabetes and following myocardial infarction. Additionally, this knowledge will enhance our understanding and treatment of vascular anomalies, such as arteriovenous malformations (AVMs). From studies in vertebrate model organisms, such as mouse, zebrafish, and chick, a number of key signaling pathways have been elucidated that are required for the establishment and maintenance of arterial and venous fates. These include the Hedgehog, Vascular Endothelial Growth Factor (VEGF), Transforming Growth Factor-β (TGF-β), Wnt, and Notch signaling pathways. In addition, a variety of transcription factor families acting downstream of, or in concert with, these signaling networks play vital roles in arteriovenous (AV) specification. These include Notch and Notch-regulated transcription factors (e.g., HEY and HES), SOX factors, Forkhead factors, β-Catenin, ETS factors, and COUP-TFII. It is becoming apparent that AV specification is a highly coordinated process that involves the intersection and carefully orchestrated activity of multiple signaling cascades and transcriptional networks. This review will summarize the molecular mechanisms that are involved in the acquisition and maintenance of AV fate, and will highlight some of the limitations in our current knowledge of the molecular machinery that directs AV morphogenesis.
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Affiliation(s)
- Jason E Fish
- Toronto General Research Institute, University Health Network, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada; Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, Toronto, Canada
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Brinjikji W, Iyer VN, Sorenson T, Lanzino G. Cerebrovascular Manifestations of Hereditary Hemorrhagic Telangiectasia. Stroke 2015; 46:3329-37. [PMID: 26405205 DOI: 10.1161/strokeaha.115.010984] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/28/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Waleed Brinjikji
- From the Departments of Radiology (W.B.), Pulmonary and Critical Care Medicine (V.N.I.), and Neurosurgery (T.S., G.L.), Mayo Clinic, Rochester, MN.
| | - Vivek N Iyer
- From the Departments of Radiology (W.B.), Pulmonary and Critical Care Medicine (V.N.I.), and Neurosurgery (T.S., G.L.), Mayo Clinic, Rochester, MN
| | - Thomas Sorenson
- From the Departments of Radiology (W.B.), Pulmonary and Critical Care Medicine (V.N.I.), and Neurosurgery (T.S., G.L.), Mayo Clinic, Rochester, MN
| | - Giuseppe Lanzino
- From the Departments of Radiology (W.B.), Pulmonary and Critical Care Medicine (V.N.I.), and Neurosurgery (T.S., G.L.), Mayo Clinic, Rochester, MN
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Colletti G, Dalmonte P, Moneghini L, Ferrari D, Allevi F. Adjuvant role of anti-angiogenic drugs in the management of head and neck arteriovenous malformations. Med Hypotheses 2015; 85:298-302. [DOI: 10.1016/j.mehy.2015.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/28/2015] [Indexed: 01/06/2023]
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Inhibition of pathological brain angiogenesis through systemic delivery of AAV vector expressing soluble FLT1. Gene Ther 2015; 22:893-900. [PMID: 26090874 PMCID: PMC4636448 DOI: 10.1038/gt.2015.57] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/27/2015] [Accepted: 06/05/2015] [Indexed: 12/21/2022]
Abstract
The soluble vascular endothelial growth factor (VEGF) receptor 1 (sFLT1) has been tested in both animals and humans for anti-angiogenic therapies, e.g., age-related macular degeneration. We hypothesized that adeno-associated viral vector (AAV)-mediated sFLT1 expression could be used to inhibit abnormal brain angiogenesis. We tested the anti-angiogenic effect of sFLT1 and the feasibility of using AAV serotype 9 to deliver sFLT1 through intravenous injection (IV) to the brain angiogenic region. AAV vectors were packaged in AAV serotypes 1 and 2 (stereotactic injection) and 9 (IV-injection). Brain angiogenesis was induced in adult mice through stereotactic injection of AAV1-VEGF. AAV2-sFLT02 containing sFLT1 VEGF-binding domain (domain 2) was injected into the brain angiogenic region, and AAV9-sFLT1 was injected into the jugular vein at the time of or 4 weeks after AAV1-VEGF injection. We showed that AAV2-sFLT02 inhibited brain angiogenesis at both time points. Intravenous injection of AAV9-sFLT1 inhibited angiogenesis only when the vector was injected 4 weeks after angiogenic induction. Neither lymphocyte infiltration nor neuron loss was observed in AAV9-sFLT1-treated mice. Our data show that systemically delivered AAV9-sFLT1 inhibits angiogenesis in the mouse brain, which could be utilized to treat brain angiogenic diseases such as brain arteriovenous malformation.
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73
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Sehl ME, M. Gruber T, McWilliams JP, Marder VJ. Successful management of chronic gastrointestinal hemorrhage using bevacizumab in the setting of hereditary hemorrhagic telangiectasia. Am J Hematol 2015; 90:561-3. [PMID: 25677911 DOI: 10.1002/ajh.23969] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/02/2015] [Accepted: 02/03/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Mary E. Sehl
- Division of Hematology-Oncology; Department of Medicine, David Geffen School of Medicine; University of California; Los Angeles California
| | - Theresa M. Gruber
- Division of Hematology-Oncology; Department of Medicine, David Geffen School of Medicine; University of California; Los Angeles California
| | - Justin P. McWilliams
- Department of Radiology; David Geffen School of Medicine; University of California; Los Angeles California
| | - Victor J. Marder
- Division of Hematology-Oncology; Department of Medicine, David Geffen School of Medicine; University of California; Los Angeles California
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74
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Tual-Chalot S, Oh SP, Arthur HM. Mouse models of hereditary hemorrhagic telangiectasia: recent advances and future challenges. Front Genet 2015; 6:25. [PMID: 25741358 PMCID: PMC4332371 DOI: 10.3389/fgene.2015.00025] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/19/2015] [Indexed: 12/15/2022] Open
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is a genetic disorder characterized by a multi-systemic vascular dysplasia and hemorrhage. The precise factors leading to these vascular malformations are not yet understood and robust animal models of HHT are essential to gain a detailed understanding of the molecular and cellular events that lead to clinical symptoms, as well as to test new therapeutic modalities. Most cases of HHT are caused by mutations in either endoglin (ENG) or activin receptor-like kinase 1 (ACVRL1, also known as ALK1). Both genes are associated with TGFβ/BMP signaling, and loss of function mutations in the co-receptor ENG are causal in HHT1, while HHT2 is associated with mutations in the signaling receptor ACVRL1. Significant advances in mouse genetics have provided powerful ways to study the function of Eng and Acvrl1 in vivo, and to generate mouse models of HHT disease. Mice that are null for either Acvrl1 or Eng genes show embryonic lethality due to major defects in angiogenesis and heart development. However mice that are heterozygous for mutations in either of these genes develop to adulthood with no effect on survival. Although these heterozygous mice exhibit selected vascular phenotypes relevant to the clinical pathology of HHT, the phenotypes are variable and generally quite mild. An alternative approach using conditional knockout mice allows us to study the effects of specific inactivation of either Eng or Acvrl1 at different times in development and in different cell types. These conditional knockout mice provide robust and reproducible models of arteriovenous malformations, and they are currently being used to unravel the causal factors in HHT pathologies. In this review, we will summarize the strengths and limitations of current mouse models of HHT, discuss how knowledge obtained from these studies has already informed clinical care and explore the potential of these models for developing improved treatments for HHT patients in the future.
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Affiliation(s)
| | - S Paul Oh
- Department of Physiology and Functional Genomics, University of Florida , Gainesville, FL, USA
| | - Helen M Arthur
- Institute of Genetic Medicine, Newcastle University , Newcastle, UK
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Thalgott J, Dos-Santos-Luis D, Lebrin F. Pericytes as targets in hereditary hemorrhagic telangiectasia. Front Genet 2015; 6:37. [PMID: 25763012 PMCID: PMC4327729 DOI: 10.3389/fgene.2015.00037] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/26/2015] [Indexed: 12/04/2022] Open
Abstract
Defective paracrine Transforming Growth Factor-β (TGF-β) signaling between endothelial cells and the neighboring mural cells have been thought to lead to the development of vascular lesions that are characteristic of Hereditary Hemorrhagic Telangiectasia (HHT). This review highlights recent progress in our understanding of TGF-β signaling in mural cell recruitment and vessel stabilization and how perturbed TGF-β signaling might contribute to defective endothelial-mural cell interaction affecting vessel functionalities. Our recent findings have provided exciting insights into the role of thalidomide, a drug that reduces both the frequency and the duration of epistaxis in individuals with HHT by targeting mural cells. These advances provide opportunities for the development of new therapies for vascular malformations.
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Affiliation(s)
- Jérémy Thalgott
- INSERM, Center for Interdisciplinary Research in Biology, UMR CNRS 7241/INSERM U1050, Group Pathological Angiogenesis and Vessel Normalization, Collège de France Paris, France
| | - Damien Dos-Santos-Luis
- INSERM, Center for Interdisciplinary Research in Biology, UMR CNRS 7241/INSERM U1050, Group Pathological Angiogenesis and Vessel Normalization, Collège de France Paris, France
| | - Franck Lebrin
- INSERM, Center for Interdisciplinary Research in Biology, UMR CNRS 7241/INSERM U1050, Group Pathological Angiogenesis and Vessel Normalization, Collège de France Paris, France
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Mouchtouris N, Jabbour PM, Starke RM, Hasan DM, Zanaty M, Theofanis T, Ding D, Tjoumakaris SI, Dumont AS, Ghobrial GM, Kung D, Rosenwasser RH, Chalouhi N. Biology of cerebral arteriovenous malformations with a focus on inflammation. J Cereb Blood Flow Metab 2015; 35:167-75. [PMID: 25407267 PMCID: PMC4426734 DOI: 10.1038/jcbfm.2014.179] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 09/05/2014] [Accepted: 09/22/2014] [Indexed: 01/01/2023]
Abstract
Cerebral arteriovenous malformations (AVMs) entail a significant risk of intracerebral hemorrhage owing to the direct shunting of arterial blood into the venous vasculature without the dissipation of the arterial blood pressure. The mechanisms involved in the growth, progression and rupture of AVMs are not clearly understood, but a number of studies point to inflammation as a major contributor to their pathogenesis. The upregulation of proinflammatory cytokines induces the overexpression of cell adhesion molecules in AVM endothelial cells, resulting in enhanced recruitment of leukocytes. The increased leukocyte-derived release of metalloproteinase-9 is known to damage AVM walls and lead to rupture. Inflammation is also involved in altering the AVM angioarchitecture via the upregulation of angiogenic factors that affect endothelial cell proliferation, migration and apoptosis. The effects of inflammation on AVM pathogenesis are potentiated by certain single-nucleotide polymorphisms in the genes of proinflammatory cytokines, increasing their protein levels in the AVM tissue. Furthermore, studies on metalloproteinase-9 inhibitors and on the involvement of Notch signaling in AVMs provide promising data for a potential basis for pharmacological treatment of AVMs. Potential therapeutic targets and areas requiring further investigation are highlighted.
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Affiliation(s)
- Nikolaos Mouchtouris
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Pascal M Jabbour
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - David M Hasan
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA
| | - Mario Zanaty
- 1] Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA [2] Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA
| | - Thana Theofanis
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Dale Ding
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Stavropoula I Tjoumakaris
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Aaron S Dumont
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - George M Ghobrial
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - David Kung
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Nohra Chalouhi
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
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77
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Yang ST, Rodriguez-Hernandez A, Walker EJ, Young WL, Su H, Lawton MT. Adult mouse venous hypertension model: common carotid artery to external jugular vein anastomosis. J Vis Exp 2015:50472. [PMID: 25650793 DOI: 10.3791/50472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The understanding of the pathophysiology of brain arteriovenous malformations and arteriovenous fistulas has improved thanks to animal models. A rat model creating an artificial fistula between the common carotid artery (CCA) and the external jugular vein (EJV) has been widely described and proved technically feasible. This construct provokes a consistent cerebral venous hypertension (CVH), and therefore has helped studying the contribution of venous hypertension to formation, clinical symptoms, and prognosis of brain AVMs and dural AVFs. Equivalent mice models have been only scarcely described and have shown trouble with stenosis of the fistula. An established murine model would allow the study of not only pathophysiology but also potential genetic therapies for these cerebrovascular diseases. We present a model of arteriovenous fistula that produces a durable intracranial venous hypertension in the mouse. Microsurgical anastomosis of the murine CCA and EJV can be difficult due to diminutive anatomy and frequently result in a non-patent fistula. In this step-by-step protocol we address all the important challenges encountered during this procedure. Avoiding excessive retraction of the vein during the exposure, using 11-0 sutures instead of 10-0, and making a carefully planned end-to-side anastomosis are some of the critical steps. Although this method requires advanced microsurgical skills and a longer learning curve that the equivalent in the rat, it can be consistently developed. This novel model has been designed to integrate transgenic mouse techniques with a previously well-established experimental system that has proved useful to study brain AVMs and dural AVFs. By opening the possibility of using transgenic mice, a broader spectrum of valid models can be achieved and genetic treatments can also be tested. The experimental construct could also be further adapted to the study of other cerebrovascular diseases related with venous hypertension such as migraine, transient global amnesia, transient monocular blindness, etc.
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Affiliation(s)
- Shun-Tai Yang
- Department of Anesthesia and Perioperative Care and Center for Cerebrovascular Research, University of California, San Francisco
| | | | - Espen J Walker
- Department of Anesthesia and Perioperative Care and Center for Cerebrovascular Research, University of California, San Francisco
| | - William L Young
- Department of Anesthesia and Perioperative Care and Center for Cerebrovascular Research, University of California, San Francisco; Department of Neurological Surgery, University of California, San Francisco; Department of Neurology, University of California, San Francisco
| | - Hua Su
- Department of Anesthesia and Perioperative Care and Center for Cerebrovascular Research, University of California, San Francisco
| | - Michael T Lawton
- Department of Neurological Surgery, University of California, San Francisco;
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78
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Zhang Z, Zhang F, Lu Y, Zheng S. Update on implications and mechanisms of angiogenesis in liver fibrosis. Hepatol Res 2015; 45:162-78. [PMID: 25196587 DOI: 10.1111/hepr.12415] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/15/2014] [Accepted: 08/31/2014] [Indexed: 02/06/2023]
Abstract
Liver fibrosis occurs as a compensatory response to the process of tissue repair in a wide range of chronic liver injures. It is characterized by excessive deposition of extracellular matrix in liver tissues. As the pathogenesis progresses without effective management, it will lead to formation of liver fiber nodules and disruption of normal liver structure and function, finally culminating in cirrhosis and hepatocellular carcinoma. A new discovery shows that liver angiogenesis is strictly associated with, and may even favor fibrogenic progression of chronic liver diseases. Recent basic and clinical investigations also demonstrate that liver fibrogenesis is accompanied by pathological angiogenesis and sinusoidal remodeling, which critically determine the pathogenesis and prognosis of liver fibrosis. Inhibition of pathological angiogenesis is considered to be a new strategy for the treatment of liver fibrosis. This review summarizes current knowledge on the process of angiogenesis, the relationships between angiogenesis and liver fibrosis, and on the molecular mechanisms of liver angiogenesis. On the other hand, it also presents the different strategies that have been used in experimental models to counteract excessive angiogenesis and the role of angiogenesis in the prevention and treatment of liver fibrosis.
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Affiliation(s)
- Zili Zhang
- Department of Pharmacology, College of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
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79
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Roman BL, Finegold DN. Genetic and Molecular Basis for Hereditary Hemorrhagic Telangiectasia. CURRENT GENETIC MEDICINE REPORTS 2014. [DOI: 10.1007/s40142-014-0061-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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80
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Buell TJ, Ding D, Starke RM, Webster Crowley R, Liu KC. Embolization-induced angiogenesis in cerebral arteriovenous malformations. J Clin Neurosci 2014; 21:1866-71. [DOI: 10.1016/j.jocn.2014.04.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/31/2014] [Accepted: 04/05/2014] [Indexed: 12/13/2022]
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81
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BMP signaling modulation attenuates cerebral arteriovenous malformation formation in a vertebrate model. J Cereb Blood Flow Metab 2014; 34:1688-94. [PMID: 25052553 PMCID: PMC4269730 DOI: 10.1038/jcbfm.2014.134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/02/2014] [Accepted: 06/30/2014] [Indexed: 12/22/2022]
Abstract
Cerebral arteriovenous malformations (AVMs) are vascular anomalies that carry a high risk of stroke and death. To test potential AVM therapies, a reverse genetics approach was used to model AVMs in zebrafish. Antisense morpholino oligonucleotides were used to knockdown activin receptor-like kinase I (alk1), which encodes a transforming growth factor (TGF)-beta family type I receptor implicated in a subset of human AVMs. Knockdown of alk1 caused a spectrum of morphologic, functional, and molecular defects that resemble those seen in humans with AVMs. It was found that losartan, an angiotensin II receptor antagonist, attenuated abnormal blood vessel morphology and systemic manifestations of high-output arteriovenous shunting in vivo. SMAD1 phosphorylation was significantly decreased in alk1 morphants compared with uninjected organisms (0.189±0.0201, 0.429±0.0164, P=0.0002). After treatment, morphant SMAD1 levels approached uninjected levels (0.326±0.0360, P=0.0355) and were significantly higher than those seen in the morphant-control group (P=0.0294). These data suggest that modulating the BMP signaling pathway with losartan, a drug in widespread clinical use in humans as an antihypertensive, may have the potential to be further evaluated as a therapeutic strategy for patients with AVMs.
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82
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Vascular endothelial growth factor blockade: A potential new therapy in the management of cerebral arteriovenous malformations. JOURNAL OF MEDICAL HYPOTHESES AND IDEAS 2014. [DOI: 10.1016/j.jmhi.2013.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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83
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Han C, Choe SW, Kim YH, Acharya AP, Keselowsky BG, Sorg BS, Lee YJ, Oh SP. VEGF neutralization can prevent and normalize arteriovenous malformations in an animal model for hereditary hemorrhagic telangiectasia 2. Angiogenesis 2014; 17:823-830. [PMID: 24957885 DOI: 10.1007/s10456-014-9436-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 06/05/2014] [Indexed: 12/18/2022]
Abstract
Arteriovenous malformation (AVM) refers to a vascular anomaly where arteries and veins are directly connected through a complex, tangled web of abnormal AV fistulae without a normal capillary network. Hereditary hemorrhagic telangiectasia (HHT) types 1 and 2 arise from heterozygous mutations in endoglin (ENG) and activin receptor-like kinase 1 (ALK1), respectively. HHT patients possess AVMs in various organs, and telangiectases (small AVMs) along the mucocutaneous surface. Understanding why and how AVMs develop is crucial for developing therapies to inhibit the formation, growth, or maintenance of AVMs in HHT patients. Previously, we have shown that secondary factors such as wounding are required for Alk1-deficient vessels to develop skin AVMs. Here, we present evidences that AVMs establish from nascent arteries and veins rather than from remodeling of a preexistent capillary network in the wound-induced skin AVM model. We also show that VEGF can mimic the wound effect on skin AVM formation, and VEGF-neutralizing antibody can prevent skin AVM formation and ameliorate internal bleeding in Alk1-deficient adult mice. With topical applications at different stages of AVM development, we demonstrate that the VEGF blockade can prevent the formation of AVM and cease the progression of AVM development. Taken together, the presented experimental model is an invaluable system for precise molecular mechanism of action of VEGF blockades as well as for preclinical screening of drug candidates for epistaxis and gastrointestinal bleedings.
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Affiliation(s)
- Chul Han
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL 32610
| | - Se-Woon Choe
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL 32610.,Department of Biomedical Engineering, Tongmyong University, Busan, Republic of Korea
| | - Yong Hwan Kim
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL 32610
| | - Abhinav P Acharya
- J. Crayton Pruitt Family Department of Biomedical Engineering, College of Engineering, University of Florida, Gainesville, FL 32611
| | - Benjamin G Keselowsky
- J. Crayton Pruitt Family Department of Biomedical Engineering, College of Engineering, University of Florida, Gainesville, FL 32611
| | - Brian S Sorg
- J. Crayton Pruitt Family Department of Biomedical Engineering, College of Engineering, University of Florida, Gainesville, FL 32611
| | - Young-Jae Lee
- World Class University program, Lee Gil Ya Cancer and Diabetes Institute, Gachon University of Medicine and Science, Incheon, Republic of Korea
| | - S Paul Oh
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL 32610.,World Class University program, Lee Gil Ya Cancer and Diabetes Institute, Gachon University of Medicine and Science, Incheon, Republic of Korea
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84
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Zheng W, Yang L, Liu Y, Qin X, Zhou Y, Zhou Y, Liu J. Mo polyoxometalate nanoparticles inhibit tumor growth and vascular endothelial growth factor induced angiogenesis. SCIENCE AND TECHNOLOGY OF ADVANCED MATERIALS 2014; 15:035010. [PMID: 27877686 PMCID: PMC5090531 DOI: 10.1088/1468-6996/15/3/035010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 04/28/2014] [Indexed: 06/06/2023]
Abstract
Tumor growth depends on angiogenesis, which can furnish the oxygen and nutrients that proliferate tumor cells. Thus, blocking angiogenesis can be an effective strategy to inhibit tumor growth. In this work, three typical nanoparticles based on polyoxometalates (POMs) have been prepared; we investigated their capability as antitumor and anti-angiogenesis agents. We found that Mo POM nanoparticles, especially complex 3, inhibited the growth of human hepatocellular liver carcinoma cells (HepG2) through cellular reactive oxygen species levels' elevation and mitochondrial membrane potential damage. Complex 3 also suppressed the proliferation, migration, and tube formation of endothelial cells in vitro and chicken chorioallantoic membrane development ex vivo. Furthermore, western blot analysis of cell signaling molecules indicated that Mo POMs blocked the vascular endothelial growth factor receptor 2-mediated ERK1/2 and AKT signaling pathways in endothelial cells. Using transmission electron microscopy, we demonstrated their cellular uptake and localization within the cytoplasm of HepG2 cells. These results indicate that, owing to the extraordinary physical and chemical properties, Mo POM nanoparticles can significantly inhibit tumor growth and angiogenesis, which makes them potential drug candidates in anticancer and anti-angiogenesis therapies.
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Affiliation(s)
- Wenjing Zheng
- Department of Chemistry, Jinan University, Guangzhou 510632, People’s Republic of China
| | - Licong Yang
- Department of Chemistry, Jinan University, Guangzhou 510632, People’s Republic of China
| | - Ying Liu
- Department of Chemistry, Jinan University, Guangzhou 510632, People’s Republic of China
| | - Xiuying Qin
- Department of Chemistry, Jinan University, Guangzhou 510632, People’s Republic of China
| | - Yanhui Zhou
- Department of Chemistry, Jinan University, Guangzhou 510632, People’s Republic of China
| | - Yunshan Zhou
- State Key Laboratory of Chemical Resource Engineering, Institute of Science, Beijing University of Chemical Technology, Beijing 100029, People’s Republic of China
| | - Jie Liu
- Department of Chemistry, Jinan University, Guangzhou 510632, People’s Republic of China
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85
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Brain arteriovenous malformation modeling, pathogenesis, and novel therapeutic targets. Transl Stroke Res 2014; 5:316-29. [PMID: 24723256 DOI: 10.1007/s12975-014-0343-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 02/07/2023]
Abstract
Patients harboring brain arteriovenous malformation (bAVM) are at life-threatening risk of rupture and intracranial hemorrhage (ICH). The pathogenesis of bAVM has not been completely understood. Current treatment options are invasive, and ≈ 20 % of patients are not offered interventional therapy because of excessive treatment risk. There are no specific medical therapies to treat bAVMs. The lack of validated animal models has been an obstacle for testing hypotheses of bAVM pathogenesis and testing new therapies. In this review, we summarize bAVM model development and bAVM pathogenesis and potential therapeutic targets that have been identified during model development.
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86
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Walcott BP, Peterson RT. Zebrafish models of cerebrovascular disease. J Cereb Blood Flow Metab 2014; 34:571-7. [PMID: 24517974 PMCID: PMC3982096 DOI: 10.1038/jcbfm.2014.27] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/27/2013] [Accepted: 01/07/2014] [Indexed: 12/18/2022]
Abstract
Perturbations in cerebral blood flow and abnormalities in blood vessel structure are the hallmarks of cerebrovascular disease. While there are many genetic and environmental factors that affect these entities through a heterogeneous group of disease processes, the ultimate final pathologic insult in humans is defined as a stroke, or damage to brain parenchyma. In the case of ischemic stroke, blood fails to reach its target destination whereas in hemorrhagic stroke, extravasation of blood occurs outside of the blood vessel lumen, resulting in direct damage to brain parenchyma. As these acute events can be neurologically devastating, if not fatal, development of novel therapeutics are urgently needed. The zebrafish (Danio rerio) is an attractive model for the study of cerebrovascular disease because of its morphological and physiological similarity to human cerebral vasculature, its ability to be genetically manipulated, and its fecundity allowing for large-scale, phenotype-based screens.
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Affiliation(s)
- Brian P Walcott
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
| | - Randall T Peterson
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
- Broad Institute, Cambridge, Massachusetts, USA
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87
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Dmytriw AA, ter Brugge KG, Krings T, Agid R. Endovascular treatment of head and neck arteriovenous malformations. Neuroradiology 2014; 56:227-36. [DOI: 10.1007/s00234-014-1328-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/15/2014] [Indexed: 02/02/2023]
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88
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Atri D, Larrivée B, Eichmann A, Simons M. Endothelial signaling and the molecular basis of arteriovenous malformation. Cell Mol Life Sci 2013; 71:10.1007/s00018-013-1475-1. [PMID: 24077895 PMCID: PMC3969452 DOI: 10.1007/s00018-013-1475-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/08/2013] [Accepted: 09/10/2013] [Indexed: 12/21/2022]
Abstract
Arteriovenous malformations occur when abnormalities of vascular patterning result in the flow of blood from arteries to veins without an intervening capillary bed. Recent work has revealed the importance of the Notch and TGF-β signaling pathways in vascular patterning. Specifically, Notch signaling has an increasingly apparent role in arterial specification and suppression of branching, whereas TGF-β is implicated in vascular smooth muscle development and remodeling under angiogenic stimuli. These physiologic roles, consequently, have implicated both pathways in the pathogenesis of arteriovenous malformation. In this review, we summarize the studies of endothelial signaling that contribute to arteriovenous malformation and the roles of genes implicated in their pathogenesis. We further discuss how endothelial signaling may contribute to vascular smooth muscle development and how knowledge of signaling pathways may provide us targets for medical therapy in these vascular lesions.
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Affiliation(s)
- Deepak Atri
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, United States
| | - Bruno Larrivée
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, United States
- Department of Ophthalmology, Hôpital Maisonneuve-Rosemont Research Centre, University of Montreal, Montreal, Canada
| | - Anne Eichmann
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, United States
- Center for Interdisciplinary Research in Biology (CIRB), Collège de France, Paris, France
| | - Michael Simons
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, United States
- Department of Cell Biology, Yale University School of Medicine, New Haven, United States
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Ardelean DS, Jerkic M, Yin M, Peter M, Ngan B, Kerbel RS, Foster FS, Letarte M. Endoglin and activin receptor-like kinase 1 heterozygous mice have a distinct pulmonary and hepatic angiogenic profile and response to anti-VEGF treatment. Angiogenesis 2013; 17:129-46. [PMID: 24061911 DOI: 10.1007/s10456-013-9383-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 09/09/2013] [Indexed: 02/08/2023]
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is a vascular dysplasia associated with dysregulated angiogenesis and arteriovascular malformations. The disease is caused by mutations in endoglin (ENG; HHT1) or activin receptor-like kinase 1 (ALK1; HHT2) genes, coding for transforming growth factor β (TGF-β) superfamily receptors. Vascular endothelial growth factor (VEGF) has been implicated in HHT and beneficial effects of anti-VEGF treatment were recently reported in HHT patients. To investigate the systemic angiogenic phenotype of Endoglin and Alk1 mutant mice and their response to anti-VEGF therapy, we assessed microvessel density (MVD) in multiple organs after treatment with an antibody to mouse VEGF or vehicle. Lungs were the only organ showing an angiogenic defect, with reduced peripheral MVD and secondary right ventricular hypertrophy (RVH), yet distinctly associated with a fourfold increase in thrombospondin-1 (TSP-1) in Eng (+/-) versus a rise in angiopoietin-2 (Ang-2) in Alk1 (+/-) mice. Anti-VEGF treatment did reduce lung VEGF levels but interestingly, led to an increase in peripheral pulmonary MVD and attenuation of RVH; it also normalized TSP-1 and Ang-2 expression. Hepatic MVD, unaffected in mutant mice, was reduced by anti-VEGF therapy in heterozygous and wild type mice, indicating a liver-specific effect of treatment. Contrast-enhanced micro-ultrasound demonstrated a reduction in hepatic microvascular perfusion after anti-VEGF treatment only in Eng (+/-) mice. Our findings indicate that the mechanisms responsible for the angiogenic imbalance and the response to anti-VEGF therapy differ between Eng and Alk1 heterozygous mice and raise the need for systemic monitoring of anti-angiogenic therapy effects in HHT patients.
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MESH Headings
- Activin Receptors, Type I/genetics
- Activin Receptors, Type I/metabolism
- Activin Receptors, Type II
- Animals
- Antibodies, Monoclonal/pharmacology
- Endoglin
- Heterozygote
- Intracellular Signaling Peptides and Proteins/genetics
- Intracellular Signaling Peptides and Proteins/metabolism
- Liver/blood supply
- Liver/metabolism
- Liver/pathology
- Lung/blood supply
- Lung/metabolism
- Lung/pathology
- Mice
- Mice, Mutant Strains
- Neovascularization, Pathologic/drug therapy
- Neovascularization, Pathologic/genetics
- Neovascularization, Pathologic/metabolism
- Neovascularization, Pathologic/pathology
- Ribonuclease, Pancreatic/genetics
- Ribonuclease, Pancreatic/metabolism
- Telangiectasia, Hereditary Hemorrhagic/drug therapy
- Telangiectasia, Hereditary Hemorrhagic/genetics
- Telangiectasia, Hereditary Hemorrhagic/metabolism
- Telangiectasia, Hereditary Hemorrhagic/pathology
- Vascular Endothelial Growth Factor A/antagonists & inhibitors
- Vascular Endothelial Growth Factor A/genetics
- Vascular Endothelial Growth Factor A/metabolism
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Affiliation(s)
- Daniela S Ardelean
- Molecular Structure and Function Program, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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Hawinkels LJ, Garcia de Vinuesa A, Ten Dijke P. Activin receptor-like kinase 1 as a target for anti-angiogenesis therapy. Expert Opin Investig Drugs 2013; 22:1371-83. [PMID: 24053899 DOI: 10.1517/13543784.2013.837884] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Formation of blood vessels from pre-existing ones, also termed angiogenesis, is of crucial importance for the outgrowth of tumours beyond 1 - 2 mm³. Therefore, anti-angiogenic therapies, mainly focussing on inhibition of vascular endothelial growth factor (VEGF) are used in clinical therapy. However, although initially reducing tumour size, therapy resistance occurs frequently and new targets are needed. A possible target is activin receptor-like kinase (ALK)-1, a transforming growth factor (TGF)-β type-I receptor, which binds bone morphogenetic protein (BMP)-9 and -10 with high affinity and has an important role in regulating angiogenesis. AREAS COVERED Several approaches to interfere with ALK1 signalling have been developed, that is, ALK1 neutralising antibodies and a soluble ALK1 extracellular domain/Fc fusion protein (ALK1-Fc), acting as a ligand trap. In this review, we discuss the involvement of ALK1 in angiogenesis, in a variety of diseases and the current status of the development of ALK1 inhibitors for cancer therapy. EXPERT OPINION Based on current, mainly preclinical studies on inhibition of ALK1 signalling by ligand traps and neutralising antibodies, targeting ALK1 seems very promising. Both ALK1-Fc and neutralising antibodies strongly inhibit angiogenesis in vitro and in vivo. The results from the first Phase I clinical trials are to be reported soon and multiple Phase II studies are ongoing.
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Affiliation(s)
- Lukas Jac Hawinkels
- Leiden University Medical Centre, Cancer Genomics Centre Netherlands and Centre for BioMedical Genetics, Department of Molecular Cell Biology , Building-2, S1-P, PO box 9600, 2300 RC Leiden , The Netherlands +31 71 526 9272 ; +31 71 526 8270 ;
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