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San Basilio M, Rodríguez-Laguna L, Triana Junco P, Martínez-Glez V, Ramirez-Amoros C, Delgado-Miguel C, Rodriguez-Arias JP, Lopez-Gutierrez JC. Association of Somatic KRAS Variants with Osteolysis in Arteriovenous Malformations. Eur J Pediatr Surg 2025. [PMID: 40157373 DOI: 10.1055/a-2540-3621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2025]
Abstract
The genetic study of vascular anomalies provides a better understanding of their etiopathogenesis and allows the use of targeted therapies. Activating KRAS pathogenic variants promote cell proliferation by activating MAPK and PI3K signalling pathways, which have been associated with the pathogenesis of vascular anomalies, especially high-flow ones such as arteriovenous malformations (AVMs). AVMs' genomic landscape is extensive, and a genotype-phenotype correlation has not been shown. In this study, we aimed to prove an association between KRAS gene mutations and the presence of osteolysis in patients with AVMs. Herein, we present a clinical-molecular retrospective study of patients with AVMs, bone involvement, and KRAS pathogenic variants.A retrospective review of patients with AVMs and KRAS somatic variants followed by the Vascular Anomalies Unit at our institution was performed. All patients present bone involvement. We analyzed demographics, clinical features (AVMs location, phenotype), treatment received, and response to treatment. Previous imaging studies were used to assess bone involvement. Genetic studies were performed by high-throughput sequencing using a custom-designed panel.Of the 77 patients with AVMs currently followed in our clinic, 60 (77.9%) had genetic testing, and 19 (31.6%) presented a KRAS somatic activating variant and were therefore included in the study. There were 12 women and 7 men aged 10 to 79 years. When studying radiographies or CT scans, we found that all 19 patients associated osteolysis adjacent to the AVMs. Regarding the KRAS variants, the most frequent one was p.Gly12Asp, followed by p.Gln61His and p.Gly13Arg. Additionally, we reviewed imaging studies from the other 41 patients with AVMs and different pathogenic variants such as MAP2K1, RASA1, and BRAF, and did not find osteolysis.We have described for the first time the relationship between somatic, activating KRAS pathogenic variants and osteolysis in patients with AVMs. Early detection of these KRAS alterations in this type of patient should lead us to rule out bone involvement. Moreover, identifying these mutations may help guide targeted therapies, potentially preventing the development of osteolysis and improving patient outcomes.
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Affiliation(s)
- María San Basilio
- Department of Pediatric Surgery, Hospital Universitario La Paz, Paseo de la Castellana, Madrid, Spain
| | | | - Paloma Triana Junco
- Department of Pediatric Surgery, Hospital Universitario La Paz, Paseo de la Castellana, Madrid, Spain
| | | | - Carla Ramirez-Amoros
- Department of Pediatric Surgery, Hospital Universitario La Paz, Paseo de la Castellana, Madrid, Spain
| | - Carlos Delgado-Miguel
- Department of Pediatric Surgery, Hospital Universitario La Paz, Paseo de la Castellana, Madrid, Spain
- Department of Pediatric Surgery, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | | | - Juan C Lopez-Gutierrez
- Division of Vascular Anomalies, Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain
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Mukhtarova K, Nurimanov C, Zholdybayeva E, Makhambetov Y, Akshulakov S. Associations of Brain Arteriovenous Malformation-Related Factors with Epileptic Seizure Presentations. Diagnostics (Basel) 2024; 14:1077. [PMID: 38893604 PMCID: PMC11171662 DOI: 10.3390/diagnostics14111077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Arteriovenous malformations (AVMs) are abnormal tangles of arteries and veins that connect directly without an intervening capillary bed. Epileptic seizures are the second most common symptom in patients with brain AVMs, occurring in 30 to 50% of cases. However, the exact mechanism of epileptic seizure development in AVMs remains unclear. In this study, we aimed to investigate the factors associated with epileptic seizures in patients with brain arteriovenous malformation (AVMs) in Kazakhstan. METHODS A case-control study was conducted, which included 163 patients diagnosed with brain AVMs. Demographic and clinical data were collected and analyzed, and multivariate logistic regression was built to assess the factors associated with seizures in brain AVMs. RESULTS from this rupture of vessels OR = 0.36 95% CI (0.14-0.91, a medium-to-high Spetzler-Martin score (III-V) OR = 6.16 (2.14-17.69) and OR = 3.05 (1.08-8.68), respectively), location in brain cortex (frontal lobe OR = 6.16 (2.04-18.54), parietal lobe OR = 9.37 (3.26-26.91), temporal lobe OR = 4.57 (1.56-13.36), occipital lobe OR = 0.27 (0.08-0.91), and the presence of hemiparesis OR = 0.12 (0.02-0.66) in adverse outcomes were statistically significantly associated with the presence of epileptic seizures in brain arteriovenous malformations patients. CONCLUSIONS To conclude, this contributed to model factors associated with brain arteriovenous malformations that are linked to epileptic seizures.
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Affiliation(s)
- Kymbat Mukhtarova
- National Center for Biotechnology, 13/5, Kurgalzhynskoye Road, Astana 010000, Kazakhstan;
| | - Chingiz Nurimanov
- Department of Vascular and Functional Neurosurgery, National Center for Neurosurgery, 34/1 Turan Avenue, Astana 010000, Kazakhstan (Y.M.); (S.A.)
| | - Elena Zholdybayeva
- National Center for Biotechnology, 13/5, Kurgalzhynskoye Road, Astana 010000, Kazakhstan;
| | - Yerbol Makhambetov
- Department of Vascular and Functional Neurosurgery, National Center for Neurosurgery, 34/1 Turan Avenue, Astana 010000, Kazakhstan (Y.M.); (S.A.)
| | - Serik Akshulakov
- Department of Vascular and Functional Neurosurgery, National Center for Neurosurgery, 34/1 Turan Avenue, Astana 010000, Kazakhstan (Y.M.); (S.A.)
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Shabani Z, Schuerger J, Zhu X, Tang C, Ma L, Yadav A, Liang R, Press K, Weinsheimer S, Schmidt A, Wang C, Sekhar A, Nelson J, Kim H, Su H. Increased Collagen I/Collagen III Ratio Is Associated with Hemorrhage in Brain Arteriovenous Malformations in Human and Mouse. Cells 2024; 13:92. [PMID: 38201296 PMCID: PMC10778117 DOI: 10.3390/cells13010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/23/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Background: The increase in the collagen I (COL I)/COL III ratio enhances vessel wall stiffness and renders vessels less resistant to blood flow and pressure changes. Activated microglia enhance inflammation-induced fibrosis. Hypotheses: The COL I/COL III ratio in human and mouse brain arteriovenous malformations (bAVMs) is associated with bAVM hemorrhage, and the depletion of microglia decreases the COL I/COL III ratio and hemorrhage. Method: COL I, COL III, and hemorrhages were analyzed in 12 human bAVMs and 6 control brains, and mouse bAVMs induced in three mouse lines with activin receptor-like kinase 1 (n = 7) or endoglin (n = 7) deleted in the endothelial cells or brain focally (n = 5). The controls for the mouse study were no-gene-deleted litter mates. Mouse bAVMs were used to test the relationships between the Col I/Col III ratio and hemorrhage and whether the transient depletion of microglia reduces the Col I/Col III ratio and hemorrhage. Results: The COL I/COL III ratio was higher in the human and mouse bAVMs than in controls. The microhemorrhage in mouse bAVMs was positively correlated with the Col I/Col III ratio. Transient depletion of microglia reduced the Col I/Col III ratio and microhemorrhage. Conclusions: The COL I/COL III ratio in the bAVMs was associated with bAVM hemorrhage. The depletion of microglia reduced the bAVM Col I/Col III ratio and hemorrhage.
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Affiliation(s)
- Zahra Shabani
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA; (Z.S.); (J.S.); (X.Z.); (C.T.); (L.M.); (A.Y.); (R.L.); (K.P.); (S.W.); (A.S.); (C.W.); (A.S.); (J.N.); (H.K.)
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA
| | - Joana Schuerger
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA; (Z.S.); (J.S.); (X.Z.); (C.T.); (L.M.); (A.Y.); (R.L.); (K.P.); (S.W.); (A.S.); (C.W.); (A.S.); (J.N.); (H.K.)
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA
| | - Xiaonan Zhu
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA; (Z.S.); (J.S.); (X.Z.); (C.T.); (L.M.); (A.Y.); (R.L.); (K.P.); (S.W.); (A.S.); (C.W.); (A.S.); (J.N.); (H.K.)
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA
| | - Chaoliang Tang
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA; (Z.S.); (J.S.); (X.Z.); (C.T.); (L.M.); (A.Y.); (R.L.); (K.P.); (S.W.); (A.S.); (C.W.); (A.S.); (J.N.); (H.K.)
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA
| | - Li Ma
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA; (Z.S.); (J.S.); (X.Z.); (C.T.); (L.M.); (A.Y.); (R.L.); (K.P.); (S.W.); (A.S.); (C.W.); (A.S.); (J.N.); (H.K.)
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA
| | - Alka Yadav
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA; (Z.S.); (J.S.); (X.Z.); (C.T.); (L.M.); (A.Y.); (R.L.); (K.P.); (S.W.); (A.S.); (C.W.); (A.S.); (J.N.); (H.K.)
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA
| | - Rich Liang
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA; (Z.S.); (J.S.); (X.Z.); (C.T.); (L.M.); (A.Y.); (R.L.); (K.P.); (S.W.); (A.S.); (C.W.); (A.S.); (J.N.); (H.K.)
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA
| | - Kelly Press
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA; (Z.S.); (J.S.); (X.Z.); (C.T.); (L.M.); (A.Y.); (R.L.); (K.P.); (S.W.); (A.S.); (C.W.); (A.S.); (J.N.); (H.K.)
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA
| | - Shantel Weinsheimer
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA; (Z.S.); (J.S.); (X.Z.); (C.T.); (L.M.); (A.Y.); (R.L.); (K.P.); (S.W.); (A.S.); (C.W.); (A.S.); (J.N.); (H.K.)
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA
| | - Annika Schmidt
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA; (Z.S.); (J.S.); (X.Z.); (C.T.); (L.M.); (A.Y.); (R.L.); (K.P.); (S.W.); (A.S.); (C.W.); (A.S.); (J.N.); (H.K.)
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA
| | - Calvin Wang
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA; (Z.S.); (J.S.); (X.Z.); (C.T.); (L.M.); (A.Y.); (R.L.); (K.P.); (S.W.); (A.S.); (C.W.); (A.S.); (J.N.); (H.K.)
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA
| | - Abinav Sekhar
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA; (Z.S.); (J.S.); (X.Z.); (C.T.); (L.M.); (A.Y.); (R.L.); (K.P.); (S.W.); (A.S.); (C.W.); (A.S.); (J.N.); (H.K.)
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA
| | - Jeffrey Nelson
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA; (Z.S.); (J.S.); (X.Z.); (C.T.); (L.M.); (A.Y.); (R.L.); (K.P.); (S.W.); (A.S.); (C.W.); (A.S.); (J.N.); (H.K.)
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA
| | - Helen Kim
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA; (Z.S.); (J.S.); (X.Z.); (C.T.); (L.M.); (A.Y.); (R.L.); (K.P.); (S.W.); (A.S.); (C.W.); (A.S.); (J.N.); (H.K.)
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA
| | - Hua Su
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA; (Z.S.); (J.S.); (X.Z.); (C.T.); (L.M.); (A.Y.); (R.L.); (K.P.); (S.W.); (A.S.); (C.W.); (A.S.); (J.N.); (H.K.)
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA
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Wang S, Deng X, Wu Y, Wu Y, Zhou S, Yang J, Huang Y. Understanding the pathogenesis of brain arteriovenous malformation: genetic variations, epigenetics, signaling pathways, and immune inflammation. Hum Genet 2023; 142:1633-1649. [PMID: 37768356 DOI: 10.1007/s00439-023-02605-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023]
Abstract
Brain arteriovenous malformation (BAVM) is a rare but serious cerebrovascular disease whose pathogenesis has not been fully elucidated. Studies have found that epigenetic regulation, genetic variation and their signaling pathways, immune inflammation, may be the cause of BAVM the main reason. This review comprehensively analyzes the key pathways and inflammatory factors related to BAVMs, and explores their interplay with epigenetic regulation and genetics. Studies have found that epigenetic regulation such as DNA methylation, non-coding RNAs and m6A RNA modification can regulate endothelial cell proliferation, apoptosis, migration and damage repair of vascular malformations through different target gene pathways. Gene defects such as KRAS, ACVRL1 and EPHB4 lead to a disordered vascular environment, which may promote abnormal proliferation of blood vessels through ERK, NOTCH, mTOR, Wnt and other pathways. PDGF-B and PDGFR-β were responsible for the recruitment of vascular adventitial cells and smooth muscle cells in the extracellular matrix environment of blood vessels, and played an important role in the pathological process of BAVM. Recent single-cell sequencing data revealed the diversity of various cell types within BAVM, as well as the heterogeneous expression of vascular-associated antigens, while neutrophils, macrophages and cytokines such as IL-6, IL-1, TNF-α, and IL-17A in BAVM tissue were significantly increased. Currently, there are no specific drugs targeting BAVMs, and biomarkers for BAVM formation, bleeding, and recurrence are lacking clinically. Therefore, further studies on molecular biological mechanisms will help to gain insight into the pathogenesis of BAVM and develop potential therapeutic strategies.
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Affiliation(s)
- Shiyi Wang
- Department of Neurology, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, Zhejiang, China
| | - Xinpeng Deng
- Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, Zhejiang, China
| | - Yuefei Wu
- Department of Neurology, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, Zhejiang, China
| | - Yiwen Wu
- Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, Zhejiang, China
| | - Shengjun Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, Zhejiang, China
| | - Jianhong Yang
- Department of Neurology, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, Zhejiang, China.
| | - Yi Huang
- Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, Zhejiang, China.
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, 315010, Zhejiang, China.
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State of the Art in the Role of Endovascular Embolization in the Management of Brain Arteriovenous Malformations-A Systematic Review. J Clin Med 2022; 11:jcm11237208. [PMID: 36498782 PMCID: PMC9739246 DOI: 10.3390/jcm11237208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
As a significant cause of intracerebral hemorrhages, seizures, and neurological decline, brain arteriovenous malformations (bAVMs) are a rare group of complex vascular lesions with devastating implications for patients' quality of life. Although the concerted effort of the scientific community has improved our understanding of bAVM biology, the exact mechanism continues to be elucidated. Furthermore, to this day, due to the high heterogeneity of bAVMs as well as the lack of objective data brought by the lack of evaluative and comparative studies, there is no clear consensus on the treatment of this life-threatening and dynamic disease. As a consequence, patients often fall short of obtaining the optimal treatment. Endovascular embolization is an inherent part of multidisciplinary bAVM management that can be used in various clinical scenarios, each with different objectives. Well-trained neuro-interventional centers are proficient at curing bAVMs that are smaller than 3 cm; are located superficially in noneloquent areas; and have fewer, larger, and less tortuous feeding arteries. The transvenous approach is an emerging effective and safe technique that potentially offers a chance to cure previously untreatable bAVMs. This review provides the state of the art in all aspects of endovascular embolization in the management of bAVMs.
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Associations of Reported Genetic Risk Loci with Sporadic Brain Arteriovenous Malformations: Meta-analysis. J Mol Neurosci 2022; 72:2207-2217. [PMID: 36209311 DOI: 10.1007/s12031-022-02073-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/22/2022] [Indexed: 12/13/2022]
Abstract
An arteriovenous malformation (AVM) is an abnormal nidus of blood vessels that is characterized by a direct connection between arteries and veins without intervening in the capillary network. The exact underlying cause of sporadic AVMs is unknown, but many studies have reported genetic associations between genes that contribute to angiogenesis, vasculogenesis, and inflammation. Eleven studies retrieved from Medline Complete, PubMed, and Google Scholar up to February 2022 were included. Heterogeneity was assessed using I2 and Q-tests. Publication bias was also assessed for the shortlisted CDKN2B-AS1 rs1333040 (T > C), ACVRL1 rs2071219 (A > G), and rs11169953 (C > T) polymorphisms. The rs1333040 polymorphism showed a lower association with sporadic brain AVM for T versus C in an allelic model (OR = 0.59, 95% confidence interval [CI] = 0.41-0.84). In the recessive model, rs2071219 for AA + AG vs. GG was OR = 0.62, 95% CI = 0.43-0.9. In the recessive model, rs11169953 CC + CT vs. TT was OR = 0.56, 95% CI = 0.33-0.95. In summary, the results of this study support the association between CDKN2B-AS1 and ACVRL1 polymorphisms and sporadic brain arteriovenous malformations. This study summarized the existing information and showed the need for more replication studies on the genetic basis of sporadic AVM. In the future, more genome-wide studies should be conducted to validate and fill existing gaps in knowledge about the mechanisms of sporadic AVM development.
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Soluble Endoglin Stimulates Inflammatory and Angiogenic Responses in Microglia That Are Associated with Endothelial Dysfunction. Int J Mol Sci 2022; 23:ijms23031225. [PMID: 35163148 PMCID: PMC8835690 DOI: 10.3390/ijms23031225] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 02/06/2023] Open
Abstract
Increased soluble endoglin (sENG) has been observed in human brain arteriovenous malformations (bAVMs). In addition, the overexpression of sENG in concurrence with vascular endothelial growth factor (VEGF)-A has been shown to induce dysplastic vessel formation in mouse brains. However, the underlying mechanism of sENG-induced vascular malformations is not clear. The evidence suggests the role of sENG as a pro-inflammatory modulator, and increased microglial accumulation and inflammation have been observed in bAVMs. Therefore, we hypothesized that microglia mediate sENG-induced inflammation and endothelial cell (EC) dysfunction in bAVMs. In this study, we confirmed that the presence of sENG along with VEGF-A overexpression induced dysplastic vessel formation. Remarkably, we observed increased microglial activation around dysplastic vessels with the expression of NLRP3, an inflammasome marker. We found that sENG increased the gene expression of VEGF-A, pro-inflammatory cytokines/inflammasome mediators (TNF-α, IL-6, NLRP3, ASC, Caspase-1, and IL-1β), and proteolytic enzyme (MMP-9) in BV2 microglia. The conditioned media from sENG-treated BV2 (BV2-sENG-CM) significantly increased levels of angiogenic factors (Notch-1 and TGFβ) and pERK1/2 in ECs but it decreased the level of IL-17RD, an anti-angiogenic mediator. Finally, the BV2-sENG-CM significantly increased EC migration and tube formation. Together, our study demonstrates that sENG provokes microglia to express angiogenic/inflammatory molecules which may be involved in EC dysfunction. Our study corroborates the contribution of microglia to the pathology of sENG-associated vascular malformations.
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