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Sesen J, Ghalali A, Driscoll J, Martinez T, Lupieri A, Zurakowski D, Alexandrescu S, Smith ER, Fehnel KP. Discovery and Characterization of Ephrin B2 and EphB4 Dysregulation and Novel Mutations in Cerebral Cavernous Malformations: In Vitro and Patient-Derived Evidence of Ephrin-Mediated Endothelial Cell Pathophysiology. Cell Mol Neurobiol 2023; 44:12. [PMID: 38150042 DOI: 10.1007/s10571-023-01447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023]
Abstract
Intracranial vascular malformations manifest on a continuum ranging from predominantly arterial to predominantly venous in pathology. Cerebral cavernous malformations (CCMs) are capillary malformations that exist at the midpoint of this continuum. The axon guidance factor Ephrin B2 and its receptor EphB4 are critical regulators of vasculogenesis in the developing central nervous system. Ephrin B2/EphB4 dysregulation has been implicated in the pathogenesis of arterial-derived arteriovenous malformations and vein-based vein of Galen malformations. Increasing evidence supports the hypothesis that aberrant Ephrin B2/EphB4 signaling may contribute to developing vascular malformations, but their role in CCMs remains largely uncharacterized. Evidence of Ephrin dysregulation in CCMs would be important to establish a common link in the pathogenic spectrum of EphrinB2/Ephb4 dysregulation. By studying patient-derived primary CCM endothelial cells (CCMECs), we established that CCMECs are functionally distinct from healthy endothelial cell controls; CCMECs demonstrated altered patterns of migration, motility, and impaired tube formation. In addition to the altered phenotype, the CCMECs also displayed an increased ratio of EphrinB2/EphB4 compared to the healthy endothelial control cells. Furthermore, whole exome sequencing identified mutations in both EphrinB2 and EphB4 in the CCMECs. These findings identify functional alterations in the EphrinB2/EphB4 ratio as a feature linking pathophysiology across the spectrum of arterial, capillary, and venous structural malformations in the central nervous system while revealing a putative therapeutic target.
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Affiliation(s)
- Julie Sesen
- Vascular Biology Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Aram Ghalali
- Vascular Biology Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Jessica Driscoll
- Vascular Biology Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Tyra Martinez
- Vascular Biology Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Adrien Lupieri
- Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
| | | | | | - Edward R Smith
- Vascular Biology Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Katie P Fehnel
- Vascular Biology Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
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2
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Phillips CM, Johnson AM, Stamatovic SM, Keep RF, Andjelkovic AV. 20 kDa isoform of connexin-43 augments spatial reorganization of the brain endothelial junctional complex and lesion leakage in cerebral cavernous malformation type-3. Neurobiol Dis 2023; 186:106277. [PMID: 37652184 DOI: 10.1016/j.nbd.2023.106277] [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: 07/10/2023] [Revised: 08/14/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023] Open
Abstract
Cerebral cavernous malformation type-3 (CCM3) is a type of brain vascular malformation caused by mutations in programmed cell death protein-10 (PDCD10). It is characterized by early life occurrence of hemorrhagic stroke and profound blood-brain barrier defects. The pathogenic mechanisms responsible for microvascular hyperpermeability and lesion progression in CCM3 are still largely unknown. The current study examined brain endothelial barrier structural defects formed in the absence of CCM3 in vivo and in vitro that may lead to CCM3 lesion leakage. We found significant upregulation of a 20 kDa isoform of connexin 43 (GJA1-20 k) in brain endothelial cells (BEC) in both non-leaky and leaky lesions, as well as in an in vitro CCM3 knockdown model (CCM3KD-BEC). Morphological, biochemical, FRET, and FRAP analyses of CCM3KD-BEC found GJA1-20 k regulates full-length GJA1 biogenesis, prompting uncontrolled gap junction growth. Furthermore, by binding to a tight junction scaffolding protein, ZO-1, GJA1-20 k interferes with Cx43/ZO-1 interactions and gap junction/tight junction crosstalk, promoting ZO-1 dissociation from tight junction complexes and diminishing claudin-5/ZO-1 interaction. As a consequence, the tight junction complex is destabilized, allowing "replacement" of tight junctions with gap junctions leading to increased brain endothelial barrier permeability. Modifying cellular levels of GJA1-20 k rescued brain endothelial barrier integrity re-establishing the spatial organization of gap and tight junctional complexes. This study highlights generation of potential defects at the CCM3-affected brain endothelial barrier which may underlie prolonged vascular leakiness.
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Affiliation(s)
- Chelsea M Phillips
- Neuroscience Graduate program, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Richard F Keep
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA; Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Anuska V Andjelkovic
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
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3
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Bustuchina Vlaicu M. New approaches for brain arteriovenous malformations-related epilepsy. Rev Neurol (Paris) 2023; 179:188-200. [PMID: 36180290 DOI: 10.1016/j.neurol.2022.05.011] [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: 09/23/2021] [Revised: 02/21/2022] [Accepted: 05/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of this review is to present the current literature and to highlight the most recent findings in brain arteriovenous malformations (bAVM)-related epilepsy research. METHODS We searched Medline, PubMed, Biblioinserm, Cochrane Central to study the latest research reports about the different factors that could be responsible for the genesis of bAVM-related epilepsy. We analyzed if epileptogenesis has any characteristics traits and its relation with the vascular malformation. The results of different treatments on epilepsy were considered. Typical errors that may lead towards incorrect or worse management of the seizures for these patients were also examined. RESULTS The development of bAVM results from multifactorial etiologies and bAVM-related epileptogenesis is likely specific for this pathology. Different types of evidence demonstrate a bidirectional relationship between bAVM and epilepsy. Currently, there is not enough published data to determine what may be the right management for these patients. CONCLUSIONS A better understanding of epileptogenesis in conjunction with knowledge of the complex alterations of structures and functions following bAVM-related seizures is necessary. Identification of biomarkers that can identify subgroups most likely to benefit from a specific intervention are needed to help guide clinical management. A new concept for the treatment of epilepsy related to an unruptured bAVM that cannot be treated invasively is proposed as well as new therapeutic perspectives. The next necessary step will be to propose additional algorithms to improve the development of future trials.
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Affiliation(s)
- M Bustuchina Vlaicu
- Pitié-Salpêtrière Hospital, Department of Neurosurgery, Paris, France; Inserm U0955, Translational Neuro-Psychiatry team, Créteil, France.
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4
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Winkler EA, Pacult MA, Catapano JS, Scherschinski L, Srinivasan VM, Graffeo CS, Oh SP, Lawton MT. Emerging pathogenic mechanisms in human brain arteriovenous malformations: a contemporary review in the multiomics era. Neurosurg Focus 2022; 53:E2. [DOI: 10.3171/2022.4.focus2291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/18/2022] [Indexed: 11/06/2022]
Abstract
A variety of pathogenic mechanisms have been described in the formation, maturation, and rupture of brain arteriovenous malformations (bAVMs). While the understanding of bAVMs has largely been formulated based on animal models of rare hereditary diseases in which AVMs form, a new era of “omics” has permitted large-scale examinations of contributory genetic variations in human sporadic bAVMs. New findings regarding the pathogenesis of bAVMs implicate changes to endothelial and mural cells that result in increased angiogenesis, proinflammatory recruitment, and breakdown of vascular barrier properties that may result in hemorrhage; a greater diversity of cell populations that compose the bAVM microenvironment may also be implicated and complicate traditional models. Genomic sequencing of human bAVMs has uncovered inherited, de novo, and somatic activating mutations, such as KRAS, which contribute to the pathogenesis of bAVMs. New droplet-based, single-cell sequencing technologies have generated atlases of cell-specific molecular derangements. Herein, the authors review emerging genomic and transcriptomic findings underlying pathologic cell transformations in bAVMs derived from human tissues. The application of multiple sequencing modalities to bAVM tissues is a natural next step for researchers, although the potential therapeutic benefits or clinical applications remain unknown.
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Affiliation(s)
- Ethan A. Winkler
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix; and
| | - Mark A. Pacult
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix; and
| | - Joshua S. Catapano
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix; and
| | - Lea Scherschinski
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix; and
| | - Visish M. Srinivasan
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix; and
| | - Christopher S. Graffeo
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix; and
| | - S. Paul Oh
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix; and
- Barrow Aneurysm and AVM Research Center, Department of Translational Neuroscience, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Michael T. Lawton
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix; and
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Tu T, Peng Z, Ren J, Zhang H. Cerebral Cavernous Malformation: Immune and Inflammatory Perspectives. Front Immunol 2022; 13:922281. [PMID: 35844490 PMCID: PMC9280619 DOI: 10.3389/fimmu.2022.922281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/18/2022] [Indexed: 12/03/2022] Open
Abstract
Cerebral cavernous malformation (CCM) is a type of vascular anomaly that arises due to the dyshomeostasis of brain capillary networks. In the past two decades, many advances have been made in this research field. Notably, as a more reasonable current view, the CCM lesions should be attributed to the results of a great number of additional events related to the homeostasis disorder of the endothelial cell. Indeed, one of the most fascinating concerns in the research field is the inflammatory perturbation in the immune microenvironment, which would affect the disease progression as well as the patients’ outcomes. In this work, we focused on this topic, and underlined the immune-related factors’ contribution to the CCM pathologic progression.
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Affiliation(s)
- Tianqi Tu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenghong Peng
- Health Management Department, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jian Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Hongqi Zhang,
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Winkler EA, Lu AY, Raygor KP, Linzey JR, Jonzzon S, Lien BV, Rutledge WC, Abla AA. Defective vascular signaling & prospective therapeutic targets in brain arteriovenous malformations. Neurochem Int 2019; 126:126-138. [PMID: 30858016 DOI: 10.1016/j.neuint.2019.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 02/08/2023]
Abstract
The neurovascular unit is composed of endothelial cells, vascular smooth muscle cells, pericytes, astrocytes and neurons. Through tightly regulated multi-directional cell signaling, the neurovascular unit is responsible for the numerous functionalities of the cerebrovasculature - including the regulation of molecular and cellular transport across the blood-brain barrier, angiogenesis, blood flow responses to brain activation and neuroinflammation. Historically, the study of the brain vasculature focused on endothelial cells; however, recent work has demonstrated that pericytes and vascular smooth muscle cells - collectively known as mural cells - play critical roles in many of these functions. Given this emerging data, a more complete mechanistic understanding of the cellular basis of brain vascular malformations is needed. In this review, we examine the integrated functions and signaling within the neurovascular unit necessary for normal cerebrovascular structure and function. We then describe the role of aberrant cell signaling within the neurovascular unit in brain arteriovenous malformations and identify how these pathways may be targeted therapeutically to eradicate or stabilize these lesions.
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Affiliation(s)
- Ethan A Winkler
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
| | - Alex Y Lu
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Kunal P Raygor
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Joseph R Linzey
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Soren Jonzzon
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Brian V Lien
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - W Caleb Rutledge
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Adib A Abla
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
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7
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Scimone C, Donato L, Marino S, Alafaci C, D’Angelo R, Sidoti A. Vis-à-vis: a focus on genetic features of cerebral cavernous malformations and brain arteriovenous malformations pathogenesis. Neurol Sci 2018; 40:243-251. [DOI: 10.1007/s10072-018-3674-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/01/2018] [Indexed: 01/07/2023]
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8
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De Luca E, Pedone D, Moglianetti M, Pulcini D, Perrelli A, Retta SF, Pompa PP. Multifunctional Platinum@BSA-Rapamycin Nanocarriers for the Combinatorial Therapy of Cerebral Cavernous Malformation. ACS OMEGA 2018; 3:15389-15398. [PMID: 30556006 PMCID: PMC6288776 DOI: 10.1021/acsomega.8b01653] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/24/2018] [Indexed: 05/20/2023]
Abstract
Platinum nanoparticles (PtNPs) are antioxidant enzyme-mimetic nanomaterials with significant potential for the treatment of complex diseases related to oxidative stress. Among such diseases, Cerebral Cavernous Malformation (CCM) is a major cerebrovascular disorder of genetic origin, which affects at least 0.5% of the general population. Accumulated evidence indicates that loss-of-function mutations of the three known CCM genes predispose endothelial cells to oxidative stress-mediated dysfunctions by affecting distinct redox-sensitive signaling pathways and mechanisms, including pro-oxidant and antioxidant pathways and autophagy. A multitargeted combinatorial therapy might thereby represent a promising strategy for the effective treatment of this disease. Herein, we developed a multifunctional nanocarrier by combining the radical scavenging activity of PtNPs with the autophagy-stimulating activity of rapamycin (Rapa). Our results show that the combinatorial targeting of redox signaling and autophagy dysfunctions is effective in rescuing major molecular and cellular hallmarks of CCM disease, suggesting its potential for the treatment of this and other oxidative stress-related diseases.
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Affiliation(s)
- Elisa De Luca
- Nanobiointeractions
& Nanodiagnostics, Center for Biomolecular Nanotechnologies, Istituto Italiano di Tecnologia, Via Barsanti 14, Arnesano Lecce 73010, Italy
| | - Deborah Pedone
- Nanobiointeractions
& Nanodiagnostics, Center for Biomolecular Nanotechnologies, Istituto Italiano di Tecnologia, Via Barsanti 14, Arnesano Lecce 73010, Italy
- Department
of Engineering for Innovation, University
of Salento, Via per Monteroni, Lecce 73100, Italy
| | - Mauro Moglianetti
- Nanobiointeractions
& Nanodiagnostics, Center for Biomolecular Nanotechnologies, Istituto Italiano di Tecnologia, Via Barsanti 14, Arnesano Lecce 73010, Italy
| | - Daniele Pulcini
- Nanobiointeractions
& Nanodiagnostics, Center for Biomolecular Nanotechnologies, Istituto Italiano di Tecnologia, Via Barsanti 14, Arnesano Lecce 73010, Italy
| | - Andrea Perrelli
- Department
of Clinical and Biological Sciences, University
of Torino, Regione Gonzole
10, Orbassano (Torino) 10043, Italy
- CCM
Italia Research NetworkUniversity of Torino, Regione Gonzole 10, Orbassano (Torino) 10043, Italy
| | - Saverio Francesco Retta
- Department
of Clinical and Biological Sciences, University
of Torino, Regione Gonzole
10, Orbassano (Torino) 10043, Italy
- CCM
Italia Research NetworkUniversity of Torino, Regione Gonzole 10, Orbassano (Torino) 10043, Italy
- E-mail: . Web: www.ccmitalia.unito.it (S.F.R.)
| | - Pier Paolo Pompa
- Nanobiointeractions
& Nanodiagnostics, Center for Biomolecular Nanotechnologies, Istituto Italiano di Tecnologia, Via Barsanti 14, Arnesano Lecce 73010, Italy
- Nanobiointeractions
& Nanodiagnostics, Istituto Italiano
di Tecnologia, Via Morego
30, Genova 16163, Italy
- E-mail: (P.P.P.)
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9
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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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10
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Chen GZ, Ke Y, Qin K, Dong MQ, Zeng SJ, Lin XF, Zhan SQ, Tang K, Peng C, Ding XW, Zhou D. Analysis of the Expression of Angioarchitecture-related Factors in Patients with Cerebral Arteriovenous Malformation. Chin Med J (Engl) 2018; 130:2465-2472. [PMID: 29052569 PMCID: PMC5684641 DOI: 10.4103/0366-6999.216413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Cerebral arteriovenous malformation (cAVM) is a type of vascular malformation associated with vascular remodeling, hemodynamic imbalance, and inflammation. We detected four angioarchitecture-related cytokines to make a better understanding of the potential aberrant signaling in the pathogenesis of cAVM and found useful proteins in predicting the risk of cerebral hemorrhage. Methods: Immunohistochemical analysis was conducted on specimens from twenty patients with cAVM diagnosed via magnetic resonance imaging and digital subtraction angiography and twenty primary epilepsy controls using antibodies against vascular endothelial growth factor receptor-2 (VEGFR-2), matrix metalloproteinase-9 (MMP-9), vascular cell adhesion molecule (VCAM-1), and endothelial nitric oxide synthase (eNOS). Western blotting and real-time fluorescent quantitative polymerase chain reaction (PCR) were performed to determine protein and mRNA expression levels. Student's t-test was used for statistical analysis. Results: VEGFR-2, MMP-9, VCAM-1, and eNOS expression levels increased in patients with cAVM compared with those in normal cerebral vascular tissue, as determined by immunohistochemical analysis. In addition, Western blotting and real-time PCR showed that the protein and mRNA expression levels of VEGFR-2, MMP-9, VCAM-1, and eNOS were higher in the cAVM group than in the control group, all the differences mentioned were statistically significant (P < 0.05). Conclusions: VEGFR-2, MMP-9, VCAM-1, and eNOS are upregulated in patients with cAVM and might play important roles in angiogenesis, vascular remodeling, and migration in patients with cAVM. MMP-9, VEGFR-2, VCAM-1, and eNOS might be potential excellent group proteins in predicting the risk of cerebral hemorrhage at arteriovenous malformation.
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Affiliation(s)
- Guang-Zhong Chen
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Yu Ke
- Department of Biomedical Engineering, Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, College of Life Science and Technology, Jinan University, Guangzhou, Guangdong 510632, China
| | - Kun Qin
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Meng-Qi Dong
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Shao-Jian Zeng
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Xiao-Feng Lin
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Sheng-Quan Zhan
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Kai Tang
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Chao Peng
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Xiao-Wen Ding
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Dong Zhou
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
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11
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Takada S, Hojo M, Takebe N, Tanigaki K, Miyamoto S. Role of Endothelial-to-Mesenchymal Transition in the Pathogenesis of Central Nervous System Hemangioblastomas. World Neurosurg 2018; 117:e187-e193. [PMID: 29886300 DOI: 10.1016/j.wneu.2018.05.235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Hemangioblastomas (HBs) are benign vascular tumors of the central nervous system and histologically contain abundant microvessels. Therefore, they clinically exhibit vascular malformation-like characteristics. It has been described that endothelial-to-mesenchymal transition (EndMT) contributes to the pathogenesis of cerebral cavernous malformations. However, it remains unknown whether EndMT contributes to the pathogenesis of central nervous system HBs. The aim of our study was to investigate whether EndMT occurs in central nervous system HBs. METHODS Ten central nervous system HBs were immunohistochemically investigated. RESULTS Cluster of differentiation (CD) 31 (an endothelial marker) and EndMT markers, such as α-smooth muscle actin (a mesenchymal marker) and CD44 (a mesenchymal stem cell marker), were expressed in the endothelial layer of microvessels in all cases. These findings suggest that endothelial cells (ECs) of microvessels in central nervous system HBs have acquired mesenchymal and stem cell-like characteristics and undergone EndMT. In all cases, both ephrin-B2 and EphB4, which are not detected in adult normal brain vessels, were expressed in the endothelial layer of microvessels. These data suggest that ECs of microvessels in central nervous system HBs are immature or malformed cells and have both arterial and venous characteristics. CONCLUSIONS To our knowledge, this is the first report showing the possibility that EndMT contributes to the pathogenesis of central nervous system HBs. It is likely that ECs of microvessels in central nervous system HBs are immature or malformed cells and have both arterial and venous characteristics. EndMT is expected to be a new therapeutic target in central nervous system HBs.
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Affiliation(s)
- Shigeki Takada
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Research Institute, Shiga Medical Center, Moriyama, Shiga, Japan
| | - Masato Hojo
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurosurgery, Shiga Medical Center for Adults, Moriyama, Shiga, Japan.
| | - Noriyoshi Takebe
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Research Institute, Shiga Medical Center, Moriyama, Shiga, Japan
| | - Kenji Tanigaki
- Research Institute, Shiga Medical Center, Moriyama, Shiga, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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12
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Takada S, Hojo M, Tanigaki K, Miyamoto S. Contribution of Endothelial-to-Mesenchymal Transition to the Pathogenesis of Human Cerebral and Orbital Cavernous Malformations. Neurosurgery 2018; 81:176-183. [PMID: 28368503 DOI: 10.1093/neuros/nyx078] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 01/31/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The analysis of gene-targeted mouse mutants has demonstrated that endothelial-to-mesenchymal transition (EndMT) is crucial to the onset and progression of cerebral cavernous malformations (CMs). It has also been shown that Notch and ephrin/Eph signaling are involved in EndMT. However, their roles in the pathogenesis of human intracranial CMs remain unclear. OBJECTIVE To elucidate the contribution of EndMT, the Notch pathway, and ephrin-B2/EphB4 signaling to the pathogenesis of human intracranial CMs. METHODS Eight human intracranial CMs (5 cerebral and 3 orbital CMs) were immunohistochemically investigated. RESULTS CD31 (an endothelial marker) and EndMT markers, such as α-smooth muscle actin (a mesenchymal marker) and CD44 (a mesenchymal stem cell marker), were expressed in the endothelial layer of vascular sinusoids in all cases, suggesting that endothelial cells (ECs) have acquired mesenchymal and stem-cell-like characteristics and undergone EndMT in all cerebral and orbital CMs. EndMT was observed in about 70% and 35% of ECs in cerebral and orbital CMs, respectively. In all cases, Notch3 was expressed in the endothelial layer, indicating that ECs of vascular sinusoids have acquired mesenchymal features. In all cases, both ephrin-B2 and EphB4 were detected in the endothelial layer, suggesting that ECs of vascular sinusoids are immature or malformed cells and have both arterial and venous characteristics. CONCLUSION EndMT plays a critical role in the pathogenesis of human cerebral and orbital CMs. Modulating EndMT is expected to be a new therapeutic strategy for cerebral and orbital CMs.
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Affiliation(s)
- Shigeki Takada
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Research Institute, Shiga Medical Center, Shiga, Japan
| | - Masato Hojo
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Neurosurgery, Shiga Medical Center for Adults, Shiga, Japan
| | | | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Retta SF, Glading AJ. Oxidative stress and inflammation in cerebral cavernous malformation disease pathogenesis: Two sides of the same coin. Int J Biochem Cell Biol 2016; 81:254-270. [PMID: 27639680 PMCID: PMC5155701 DOI: 10.1016/j.biocel.2016.09.011] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 12/14/2022]
Abstract
CCM proteins play pleiotropic roles in various redox-sensitive signaling pathways. CCM proteins modulate the crosstalk between redox signaling and autophagy that govern cell homeostasis and stress responses. Oxidative stress and inflammation are emerging as key focal determinants of CCM lesion formation, progression and severity. The pleiotropic functions of CCM proteins may prevent vascular dysfunctions triggered by local oxidative stress and inflammatory events. The distinct therapeutic compounds proposed so far for CCM disease share the ability to modulate redox signaling and autophagy.
Cerebral Cavernous Malformation (CCM) is a vascular disease of proven genetic origin, which may arise sporadically or is inherited as an autosomal dominant condition with incomplete penetrance and highly variable expressivity. CCM lesions exhibit a range of different phenotypes, including wide inter-individual differences in lesion number, size, and susceptibility to intracerebral hemorrhage (ICH). Lesions may remain asymptomatic or result in pathological conditions of various type and severity at any age, with symptoms ranging from recurrent headaches to severe neurological deficits, seizures, and stroke. To date there are no direct therapeutic approaches for CCM disease besides the surgical removal of accessible lesions. Novel pharmacological strategies are particularly needed to limit disease progression and severity and prevent de novo formation of CCM lesions in susceptible individuals. Useful insights into innovative approaches for CCM disease prevention and treatment are emerging from a growing understanding of the biological functions of the three known CCM proteins, CCM1/KRIT1, CCM2 and CCM3/PDCD10. In particular, accumulating evidence indicates that these proteins play major roles in distinct signaling pathways, including those involved in cellular responses to oxidative stress, inflammation and angiogenesis, pointing to pathophysiological mechanisms whereby the function of CCM proteins may be relevant in preventing vascular dysfunctions triggered by these events. Indeed, emerging findings demonstrate that the pleiotropic roles of CCM proteins reflect their critical capacity to modulate the fine-tuned crosstalk between redox signaling and autophagy that govern cell homeostasis and stress responses, providing a novel mechanistic scenario that reconciles both the multiple signaling pathways linked to CCM proteins and the distinct therapeutic approaches proposed so far. In addition, recent studies in CCM patient cohorts suggest that genetic susceptibility factors related to differences in vascular sensitivity to oxidative stress and inflammation contribute to inter-individual differences in CCM disease susceptibility and severity. This review discusses recent progress into the understanding of the molecular basis and mechanisms of CCM disease pathogenesis, with specific emphasis on the potential contribution of altered cell responses to oxidative stress and inflammatory events occurring locally in the microvascular environment, and consequent implications for the development of novel, safe, and effective preventive and therapeutic strategies.
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Affiliation(s)
- Saverio Francesco Retta
- Department of Clinical and Biological Sciences, School of Medicine and Surgery, University of Torino, Regione Gonzole 10, 10043 Orbassano, Torino, Italy; CCM Italia Research Network(1).
| | - Angela J Glading
- University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Ave, 14642 Rochester, NY, USA.
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Endo T, Takahashi Y, Nakagawa A, Niizuma K, Fujimura M, Tominaga T. Use of Actuator-Driven Pulsed Water Jet in Brain and Spinal Cord Cavernous Malformations Resection. Neurosurgery 2016; 11 Suppl 3:394-403; discussion 403. [PMID: 26284350 DOI: 10.1227/neu.0000000000000867] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A piezo actuator-driven pulsed water jet (ADPJ) system is a novel surgical instrument that enables dissection of tissue without thermal damage. It can potentially resect intra-axial lesions while preserving neurological function. OBJECTIVE To report our first experience of applying an ADPJ system to brain and spinal cord cavernous malformations. METHODS Four patients (2 women and 2 men, mean age 44.5 years) with brain (n = 3) and spinal cord (n = 1) cavernous malformations were enrolled in the study. All surgeries were performed with the aid of the ADPJ system. Postoperative neurological function and radiological findings were evaluated. RESULTS The ADPJ system was useful in dissecting boundaries between the lesion and surrounding brain/spinal cord tissues. The pulsed water jet provided a clear surgical view and helped surgeons follow the margins. Water jet dissection peeled off the brain and spinal cord tissues from the lesion wall. Surrounding gliotic tissue was preserved. As a consequence, the cavernous malformations were successfully removed. Postoperative magnetic resonance imaging confirmed total removal of lesions in all cases. Preoperative neurological symptoms completely resolved in 2 patients. The others experienced partial recovery. No patients developed new postoperative neurological deficits; facial palsy temporarily worsened in 1 patient who underwent a suprafacial colliculus approach for the brainstem lesion. CONCLUSION The ADPJ provided a clear surgical field and enabled surgeons to dissect boundaries between lesions and surrounding brain and spinal cord gliotic tissue. The ADPJ system is a feasible option for cavernous malformation surgery, enabling successful tumor removal and preservation of neurological function.
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Affiliation(s)
- Toshiki Endo
- Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Japan
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Choquet H, Trapani E, Goitre L, Trabalzini L, Akers A, Fontanella M, Hart BL, Morrison LA, Pawlikowska L, Kim H, Retta SF. Cytochrome P450 and matrix metalloproteinase genetic modifiers of disease severity in Cerebral Cavernous Malformation type 1. Free Radic Biol Med 2016; 92:100-109. [PMID: 26795600 PMCID: PMC4774945 DOI: 10.1016/j.freeradbiomed.2016.01.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/13/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Familial Cerebral Cavernous Malformation type 1 (CCM1) is an autosomal dominant disease caused by mutations in the Krev Interaction Trapped 1 (KRIT1/CCM1) gene, and characterized by multiple brain lesions. CCM lesions manifest across a range of different phenotypes, including wide differences in lesion number, size and susceptibility to intracerebral hemorrhage (ICH). Oxidative stress plays an important role in cerebrovascular disease pathogenesis, raising the possibility that inter-individual variability in genes related to oxidative stress may contribute to the phenotypic differences observed in CCM1 disease. Here, we investigated whether candidate oxidative stress-related cytochrome P450 (CYP) and matrix metalloproteinase (MMP) genetic markers grouped by superfamilies, families or genes, or analyzed individually influence the severity of CCM1 disease. METHODS Clinical assessment and cerebral susceptibility-weighted magnetic resonance imaging (SWI) were performed to determine total and large (≥5mm in diameter) lesion counts as well as ICH in 188 Hispanic CCM1 patients harboring the founder KRIT1/CCM1 'common Hispanic mutation' (CCM1-CHM). Samples were genotyped on the Affymetrix Axiom Genome-Wide LAT1 Human Array. We analyzed 1,122 genetic markers (both single nucleotide polymorphisms (SNPs) and insertion/deletions) grouped by CYP and MMP superfamily, family or gene for association with total or large lesion count and ICH adjusted for age at enrollment and gender. Genetic markers bearing the associations were then analyzed individually. RESULTS The CYP superfamily showed a trend toward association with total lesion count (P=0.057) and large lesion count (P=0.088) in contrast to the MMP superfamily. The CYP4 and CYP8 families were associated with either large lesion count or total lesion count (P=0.014), and two other families (CYP46 and the MMP Stromelysins) were associated with ICH (P=0.011 and 0.007, respectively). CYP4F12 rs11085971, CYP8A1 rs5628, CYP46A1 rs10151332, and MMP3 rs117153070 single SNPs, mainly bearing the above-mentioned associations, were also individually associated with CCM1 disease severity. CONCLUSIONS Overall, our candidate oxidative stress-related genetic markers set approach outlined CYP and MMP families and identified suggestive SNPs that may impact the severity of CCM1 disease, including the development of numerous and large CCM lesions and ICH. These novel genetic risk factors of prognostic value could serve as early objective predictors of disease outcome and might ultimately provide better options for disease prevention and treatment.
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Affiliation(s)
- Hélène Choquet
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | - Eliana Trapani
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, TO, Italy; CCM Italia Research Network (www.ccmitalia.unito.it)
| | - Luca Goitre
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, TO, Italy; CCM Italia Research Network (www.ccmitalia.unito.it)
| | - Lorenza Trabalzini
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy; CCM Italia Research Network (www.ccmitalia.unito.it)
| | | | - Marco Fontanella
- Department of Neurosurgery, Spedali Civili and University of Brescia, Brescia, Italy; CCM Italia Research Network (www.ccmitalia.unito.it)
| | - Blaine L Hart
- Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Leslie A Morrison
- Department of Neurology University of New Mexico, Albuquerque, NM, USA; Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Ludmila Pawlikowska
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA; Institute for Human Genetics, University of California, San Francisco, CA, USA
| | - Helen Kim
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA; Institute for Human Genetics, University of California, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Saverio Francesco Retta
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, TO, Italy; CCM Italia Research Network (www.ccmitalia.unito.it).
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Stamatovic SM, Sladojevic N, Keep RF, Andjelkovic AV. PDCD10 (CCM3) regulates brain endothelial barrier integrity in cerebral cavernous malformation type 3: role of CCM3-ERK1/2-cortactin cross-talk. Acta Neuropathol 2015; 130:731-50. [PMID: 26385474 DOI: 10.1007/s00401-015-1479-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 09/09/2015] [Accepted: 09/10/2015] [Indexed: 10/25/2022]
Abstract
Impairment of brain endothelial barrier integrity is critical for cerebral cavernous malformation (CCM) lesion development. The current study investigates changes in tight junction (TJ) complex organization when PDCD10 (CCM3) is mutated/depleted in human brain endothelial cells. Analysis of lesions with CCM3 mutation and brain endothelial cells transfected with CCM3 siRNA (CCM3-knockdown) showed little or no increase in TJ transmembrane and scaffolding proteins mRNA expression, but proteins levels were generally decreased. CCM3-knockdown cells had a redistribution of claudin-5 and occludin from the membrane to the cytosol with no alterations in protein turnover but with diminished protein-protein interactions with ZO-1 and ZO-1 interaction with the actin cytoskeleton. The most profound effect of CCM3 mutation/depletion was on an actin-binding protein, cortactin. CCM3 depletion caused cortactin Ser-phosphorylation, dissociation from ZO-1 and actin, redistribution to the cytosol and degradation. This affected cortical actin ring organization, TJ complex stability and consequently barrier integrity, with constant hyperpermeability to inulin. A potential link between CCM3 depletion and altered cortactin was tonic activation of MAP kinase ERK1/2. ERK1/2 inhibition increased cortactin expression and incorporation into the TJ complex and improved barrier integrity. This study highlights the potential role of CCM3 in regulating TJ complex organization and brain endothelial barrier permeability.
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Boone CE, Caplan JM, Yang W, Ye X, Colby GP, Coon AL, Tamargo RJ, Huang J. Hemorrhage risk and clinical features of multiple intracranial arteriovenous malformations. J Clin Neurosci 2015; 23:51-57. [PMID: 26461910 DOI: 10.1016/j.jocn.2015.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 07/19/2015] [Indexed: 11/29/2022]
Abstract
The aim of this report is to examine clinical characteristics, treatment strategies, and annual hemorrhage incidence rate for patients with multiple arteriovenous malformations (MAVM). The PubMed and EMBASE databases and the arteriovenous malformations (AVM) database at The Johns Hopkins Hospital were searched to identify patients with MAVM. Data related to demographics, clinical features, management, and treatment outcomes were analyzed with descriptive statistics. Thirty-eight patients met the inclusion criteria. The annual hemorrhage incidence rate was 6.7%. Surgical intervention remained the most common single-modality treatment from 1949-2011. Between 1990 and 2011, multiple-modality treatment strategies (36% of cases) were employed more frequently. The most common presenting features were neurological deficit (74%) and hemorrhage (63%). In patients undergoing staged treatment of MAVM, hemorrhage of an untreated nidus (n=5), visualization of a new nidus (n=9), and disappearance of an untreated nidus (n=2) were observed. Limitations of this study include small sample size and reporting bias. The annual hemorrhage incidence rate for MAVM patients was approximately two- to three-fold greater than the reported annual hemorrhage rates for solitary AVM. Combining different treatment modalities has become the most common management strategy. The potential instability of remaining nidi with staged or incomplete treatment necessitates close follow-up in these cases.
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Affiliation(s)
- Christine E Boone
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Justin M Caplan
- Department of Neurosurgery, Johns Hopkins School of Medicine, 1800 Orleans Street, Zayed 6115F, Baltimore, MD 21287, USA
| | - Wuyang Yang
- Department of Neurosurgery, Johns Hopkins School of Medicine, 1800 Orleans Street, Zayed 6115F, Baltimore, MD 21287, USA
| | - Xiaobu Ye
- Department of Neurosurgery, Johns Hopkins School of Medicine, 1800 Orleans Street, Zayed 6115F, Baltimore, MD 21287, USA
| | - Geoffrey P Colby
- Department of Neurosurgery, Johns Hopkins School of Medicine, 1800 Orleans Street, Zayed 6115F, Baltimore, MD 21287, USA
| | - Alexander L Coon
- Department of Neurosurgery, Johns Hopkins School of Medicine, 1800 Orleans Street, Zayed 6115F, Baltimore, MD 21287, USA
| | - Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins School of Medicine, 1800 Orleans Street, Zayed 6115F, Baltimore, MD 21287, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins School of Medicine, 1800 Orleans Street, Zayed 6115F, Baltimore, MD 21287, USA.
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Chalouhi N, Dumont AS, Randazzo C, Tjoumakaris S, Gonzalez LF, Rosenwasser R, Jabbour P. Management of incidentally discovered intracranial vascular abnormalities. Neurosurg Focus 2011; 31:E1. [DOI: 10.3171/2011.9.focus11200] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
With the widespread use of brain imaging studies, neurosurgeons have seen a marked increase in the number of incidental intracranial lesions, including vascular abnormalities. Specifically, the detection of incidentally discovered aneurysms, arteriovenous malformations, cavernous angiomas, developmental venous anomalies, and capillary telangiectasias has increased. The best management strategy for most of these lesions is controversial. Treatment options include observation, open surgery, endovascular procedures, and radiosurgery. Multiple factors should be taken into account when discussing treatment indications, including the natural history of the disease and the risk of the treatment. In this article, the authors focus on the natural history of these lesions and the risk of the treatment, and they give recommendations regarding the most appropriate management strategy based on the current evidence in the literature and their experience with intracranial vascular abnormalities.
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Dalyai RT, Ghobrial G, Awad I, Tjoumakaris S, Gonzalez LF, Dumont AS, Chalouhi N, Randazzo C, Rosenwasser R, Jabbour P. Management of incidental cavernous malformations: a review. Neurosurg Focus 2011; 31:E5. [DOI: 10.3171/2011.9.focus11211] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cavernous malformations (CMs) are angiographically occult vascular malformations that are frequently found incidentally on MR imaging. Despite this benign presentation, these lesions could cause symptomatic intracranial hemorrhage, seizures, and focal neurological deficits. Cavernomas can be managed conservatively with neuroimaging studies, surgically with lesion removal, or with radiosurgery. Considering recent studies examining the CM's natural history, imaging techniques, and possible therapeutic interventions, the authors provide a concise review of the literature and discuss the optimal management of incidental CMs.
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Affiliation(s)
- Richard T. Dalyai
- 1Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania and
| | - George Ghobrial
- 1Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania and
| | - Issam Awad
- 2Department of Neurosurgery, University of Chicago, Illinois
| | - Stavropoula Tjoumakaris
- 1Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania and
| | - L. Fernando Gonzalez
- 1Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania and
| | - Aaron S. Dumont
- 1Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania and
| | - Nohra Chalouhi
- 1Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania and
| | - Ciro Randazzo
- 1Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania and
| | - Robert Rosenwasser
- 1Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania and
| | - Pascal Jabbour
- 1Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania and
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Campbell PG, Jabbour P, Yadla S, Awad IA. Emerging clinical imaging techniques for cerebral cavernous malformations: a systematic review. Neurosurg Focus 2010; 29:E6. [PMID: 20809764 DOI: 10.3171/2010.5.focus10120] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cerebral cavernous malformations (CCMs) are divided into sporadic and familial forms. For clinical imaging, T2-weighted gradient-echo sequences have been shown to be more sensitive than conventional sequences. Recently more advanced imaging techniques such as high-field and susceptibility-weighted MR imaging have been employed for the evaluation of CCMs. Furthermore, diffusion tensor imaging and functional MR imaging have been applied to the preoperative and intraoperative management of these lesions. In this paper, the authors attempt to provide a concise review of the emerging imaging methods used in the clinical diagnosis and treatment of CCMs.
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Affiliation(s)
- Peter G Campbell
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
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21
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Gault J, Awad IA, Recksiek P, Shenkar R, Breeze R, Handler M, Kleinschmidt-DeMasters BK. Cerebral cavernous malformations: somatic mutations in vascular endothelial cells. Neurosurgery 2009; 65:138-44; discussion 144-5. [PMID: 19574835 DOI: 10.1227/01.neu.0000348049.81121.c1] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Germline mutations in 3 genes have been found in familial cases of cerebral cavernous malformations (CCMs). We previously discovered somatic and germline truncating mutations in the KRIT1 gene, supporting the "2-hit" mechanism of CCM lesion formation in a single lesion. The purpose of this study was to screen for somatic, nonheritable mutations in 3 more lesions from different patients and identify the cell type(s) in which somatic mutations occur. METHODS Somatic mutations were sought in DNA from 3 surgically excised, fresh-frozen CCM lesions by cloning and screening polymerase chain reaction products generated from KRIT1 or PDCD10 coding regions. Laser capture microdissection was used on isolated endothelial and nonendothelial cells to determine whether somatic mutations were found in endothelial cells. RESULTS CCM lesions harbor somatic and germline KRIT1 mutations on different chromosomes and are therefore biallelic. Both mutations are predicted to truncate the protein. The KRIT1 somatic mutations (novel c.1800delG mutation and previously identified 34 nucleotide deletion) in CCMs from 2 different patients were found only in the vascular endothelial cells lining caverns. No obvious somatic mutations were identified in the 2 other lesions; however, the results were inconclusive, possibly owing to the technical limitations or the fact that these specimens had a small proportion of vascular endothelial cells lining pristine caverns. CONCLUSION The "2-hit" mechanism occurs in vascular endothelial cells lining CCM caverns from 2 patients with somatic and Hispanic-American KRIT1 germline mutations. Methods for somatic mutation detection should focus on vascular endothelial cells lining pristine caverns.
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Affiliation(s)
- Judith Gault
- Department of Neurosurgery, University of Colorado, Denver, Aurora, Colorado, USA.
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Chang EF, Gabriel RA, Potts MB, Garcia PA, Barbaro NM, Lawton MT. Seizure characteristics and control after microsurgical resection of supratentorial cerebral cavernous malformations. Neurosurgery 2009; 65:31-7; discussion 37-8. [PMID: 19574823 DOI: 10.1227/01.neu.0000346648.03272.07] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The optimal management of seizures associated with cerebral cavernous malformations (CCMs) is unclear. The aim of this study was to determine the efficacy of surgery in the management of CCM-associated seizures. METHODS We conducted a retrospective review with follow-up of 164 patients who underwent microsurgical resection of supratentorial CCMs. Clinical and radiographic data were collected and then analyzed to determine predictors of developing epilepsy and predictors of postoperative seizure control after microsurgical resection. RESULTS Of the patients, 61.5% presented with seizures, and 34.7% had clinically defined epilepsy. The development of epilepsy was associated with CCMs located in the temporal lobe and the absence of symptomatic hemorrhage. After microsurgical resection in 44 patients with intractable epilepsy, 72.7% were completely seizure-free (Engel class 1), 11.4% had rare seizures (Engel class 2), 4.5% had meaningful improvement (Engel class 3), and 11.4% had no improvement (Engel class 4). Predictors of complete seizure freedom were gross total resection, smaller CCMs, and the absence of secondary generalized seizures (94% of patients were seizure-free with all 3 predictors). CONCLUSION Surgery is a safe and effective treatment for seizures associated with CCMs.
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Affiliation(s)
- Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California 94143, USA.
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Moftakhar P, Hauptman JS, Malkasian D, Martin NA. Cerebral arteriovenous malformations. Part 1: cellular and molecular biology. Neurosurg Focus 2009; 26:E10. [PMID: 19408988 DOI: 10.3171/2009.2.focus09316] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ObjectThe scientific understanding of the nature of arteriovenous malformations (AVMs) in the brain is evolving. It is clear from current work that AVMs can undergo a variety of phenomena, including growth, remodeling, and/or regression—and the responsible processes are both molecular and physiological. A review of these complex processes is critical to directing future therapeutic approaches. The authors performed a comprehensive review of the literature to evaluate current information regarding the genetics, pathophysiology, and behavior of AVMs.MethodsA comprehensive literature review was conducted using PubMed to reveal the molecular biology of AVMs as it relates to their complex growth and behavior patterns.ResultsGrowth factors involved in AVMs include vascular endothelial growth factor, fibroblast growth factor, transforming growth factor β, angiopoietins, fibronectin, laminin, integrin, and matrix metalloproteinases.ConclusionsUnderstanding the complicated molecular milieu of developing AVMs is essential for defining their natural history. Growth factors, extracellular matrix proteins, and other molecular markers will be the key to unlocking novel targeted drug treatments for these brain malformations.
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Affiliation(s)
| | - Jason S. Hauptman
- 2Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Dennis Malkasian
- 2Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Neil A. Martin
- 2Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, California
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Shenkar R, Venkatasubramanian PN, Zhao JC, Batjer HH, Wyrwicz AM, Awad IA. Advanced magnetic resonance imaging of cerebral cavernous malformations: part I. High-field imaging of excised human lesions. Neurosurgery 2009; 63:782-9; discussion 789. [PMID: 18981890 DOI: 10.1227/01.neu.0000325490.80694.a2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We hypothesized that structural details that have not been described previously would be revealed in cerebral cavernous malformations (CCM) through the use of high-field magnetic resonance and confocal microscopy. The structural details of CCMs excised from patients were sought by examination with high-field magnetic resonance imaging (MRI) and correlated with confocal microscopy of the same specimens. Novel features of CCM structure are outlined, including methodological limitations, venues for future research, and possible clinical implications. METHODS CCM lesions excised from 4 patients were fixed in 2% paraformaldehyde and subjected to high-resolution MRI at 9.4 or 14.1-T by spin echo and gradient recalled echo methods. Histological validation of angioarchitecture was conducted on thick sections of CCM lesions using fluorescent probes to endothelium under confocal microscopy. RESULTS Images of excised human CCM lesions were acquired with proton density-weighted, T1-weighted, T2-weighted spin echo, and T2*-weighted gradient recalled echo MRI. These images revealed large "bland" regions with thin-walled caverns and "honeycombed" regions with notable capillary proliferation and smaller caverns surrounding larger caverns. Proliferating capillaries and caverns of various sizes were also associated with the walls of apparent larger blood vessels in the lesions. Similar features were confirmed within thick sections of CCMs by confocal microscopy. MRI relaxation times in different regions of interest suggested the presence of different states of blood breakdown products in areas with apparent angiogenic proliferative activity. CONCLUSION High-field MRI techniques demonstrate novel features of CCM angioarchitecture, visible at near histological resolution, including regions with apparently different biological activity. These preliminary observations will motivate future research, correlating lesion biological and clinical activity with features of MRI at higher field strength.
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Affiliation(s)
- Robert Shenkar
- Division of Neurosurgery, Evanston Northwestern Healthcare, Evanston, Illinois 60201, USA.
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Jabbour MN, Elder JB, Samuelson CG, Khashabi S, Hofman FM, Giannotta SL, Liu CY. ABERRANT ANGIOGENIC CHARACTERISTICS OF HUMAN BRAIN ARTERIOVENOUS MALFORMATION ENDOTHELIAL CELLS. Neurosurgery 2009; 64:139-46; discussion 146-8. [PMID: 19145162 DOI: 10.1227/01.neu.0000334417.56742.24] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
OBJECTIVE
To identify and characterize the phenotypic and functional differences of endothelial cells derived from cerebral arteriovenous malformations (AVM), as compared with endothelial cells derived from a normal brain.
METHODS
Isolated AVM brain endothelial cells and control brain endothelial cells were evaluated immunohistochemically for expression of the endothelial cell markers von Willebrand factor and CD31, as well as angiogenic factors including vascular endothelial growth factor A, interleukin-8, and endothelin-1. Vascular endothelial growth factor receptors 1 and 2 were also evaluated using immunohistochemistry techniques. Functional assays evaluated cell proliferation, cytokine production, tubule formation, and cell migration using the modified Boyden chamber technique.
RESULTS
Endothelial cells derived from AVMs expressed high levels of vascular endothelial growth factor A and significantly overexpressed the vascular endothelial growth factor receptors 1 and 2 (P < 0.05), as compared with control endothelial cells. In addition, comparison to control brain endothelial cells demonstrated that AVM brain endothelial cells proliferated faster, migrated more quickly, and produced aberrant tubule-like structures.
CONCLUSION
Endothelial cells derived from cerebral AVMs are highly activated cells overexpressing proangiogenic growth factors and exhibiting abnormal functions consistent with highly activated endothelial cells.
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Affiliation(s)
- Mark N. Jabbour
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - James B. Elder
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Shabnam Khashabi
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Florence M. Hofman
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Steven L. Giannotta
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Charles Y. Liu
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, California
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26
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Hashimoto N, Nozaki K, Takagi Y, Kikuta KI, Mikuni N. Surgery of cerebral arteriovenous malformations. Neurosurgery 2008; 61:375-87; discussion 387-9. [PMID: 18813152 DOI: 10.1227/01.neu.0000255491.95944.eb] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Despite remarkable progress, the microsurgical extirpation of cerebral arteriovenous malformations (AVMs) even by experienced neurosurgeons is not always easy or safe. This article focuses on how to render AVM surgery safer, and offers strategies and tactics for avoiding perilous bleeding and preserving postoperative neurological function. Our treatment strategies and surgical techniques are offered from the operating surgeon's perspective. An understanding of pathophysiology of cerebral AVMs is important for their appropriate surgical treatment. Sophisticated neuroimaging techniques and scrupulous neurophysiological examinations alert to possible complications, and improved surgical approaches help to minimize the sequelae of unanticipated complications. At the early stage of cerebral AVM surgery, extensive dissection of the sulci, fissures, and subarachnoid cistern should be performed to expose feeders, nidus, and drainers. Problems with the surgery of large and/or deep-seated lesions are exacerbated when arterial bleeding from the nidus continues even after all major feeders are thought to have been occluded. We routinely place catheters for angiography at the surgery of complex AVMs to find missing feeding arteries or to identify the real-time hemodynamic status of the lesion. Temporary clip application on feeders and less coagulation of the nidus is necessary to control intranidal pressure and to avoid uncontrollable bleeding from the nidus and adjacent brain. Intraoperative navigation images superimposed on tractography images can provide us with valuable information to minimize neurological deficits. Deeper insight into AVM nature and into events that occur during AVM surgery as well as the inclusion of molecular biological approaches will open new horizons for the safe and effective treatment of AVMs.
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Affiliation(s)
- Nobuo Hashimoto
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
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27
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Shenkar R, Shi C, Check IJ, Lipton HL, Awad IA. Concepts and hypotheses: inflammatory hypothesis in the pathogenesis of cerebral cavernous malformations. Neurosurgery 2007; 61:693-702; discussion 702-3. [PMID: 17986930 DOI: 10.1227/01.neu.0000298897.38979.07] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Cerebral cavernous malformations (CCMs) affect more than one million Americans, predisposing them to a lifetime risk of hemorrhagic stroke and epilepsy. A potential role of the immune response in this disease has not been postulated previously but is compelling given the unique antigenic milieu of CCM lesions with sequestered thrombi and a leaky blood-brain barrier and the numerous examples of immune modulation of angiogenesis in other disease states. The objective of this article is to reveal novel observations about apparent immune responses in CCM lesions excised from human patients and to outline the potential pathobiological significance of these observations, specific hypotheses for future research, and potential clinical implications. METHODS We reviewed data from differential gene expression revealing several immunoglobulin and other related genes markedly upregulated within human CCM lesions. Other observations are presented revealing infiltration of antibody-producing B lymphocytes and plasma cells in CCM lesions. We also present recent data demonstrating fivefold enrichment of gamma globulin to albumin ratio in a human lesion compared with serum from the same patient and oligoclonality of IgG in four of five CCM lesions, but not in paired sera from the same patients or in control specimens. RESULTS We describe ongoing research aiming to characterize cellular and humoral components of the immune response in CCMs and initiating investigation into its clonality by isoelectric focusing on the predominant immunoglobulin isotypes isolated from the lesion, in comparison to the patient's serum, and by the distribution of lengths of complementary-determining region 3 of the immunoglobulin heavy chain genes in messenger ribonucleic acid isolated from lesions and from pooled plasma cells and B cells laser captured from CCMs in comparison to peripheral lymphocytes from the blood of the same patients. CONCLUSION Immune response could play a role in or represent a potential marker of CCM lesion proliferation and hemorrhage or could otherwise contribute to lesion phenotype. The ongoing studies will generate preliminary data for future research aimed at comparing the immune response in quiescent versus clinically aggressive CCM lesions. An oligoclonal immune response shown in this research would stimulate future experiments to identify autoimmune or extrinsic antigenic triggers involved in CCM disease.
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Affiliation(s)
- Robert Shenkar
- Department of Neurological Surgery, Evanston Northwestern Healthcare, Evanston, IL 60201, USA.
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28
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Pozzati E, Marliani AF, Zucchelli M, Foschini MP, Dall'Olio M, Lanzino G. The neurovascular triad: mixed cavernous, capillary, and venous malformations of the brainstem. J Neurosurg 2007; 107:1113-9. [DOI: 10.3171/jns-07/12/1113] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The four types of cerebrovascular malformations may sometimes be combined and more often occur in pairs; triads are exceptional. The authors present six patients with the clinicoradiographic profile of mixed vascular malformations of the brainstem, including cavernous malformation (CM), capillary telangiectasia, and developmental venous anomaly (DVA).
Methods
Five patients (one of whom was a child) suffered from hemorrhage, suggesting that this complex association has a high bleeding potential. Progressive growth, rebleeding, and de novo occurrence of the associated CM were documented in three cases. Magnetic resonance imaging of the brain was obtained in all patients by using one or more of the following modalities: T1-weighted sequences before and after gadolinium administration; T2-weighted sequences; T2-weighted fluid attenuated inversion recovery; T1-weighted fast spin echo; and diffusion weighted, diffusion tensor, and perfusion imaging in three cases.
Results
Three patients were surgically treated with the intention of excising the hemorrhagic lesion, but only two patients had their malformations successfully removed. In the third case, diffuse pontine telangiectasia precluded the safe excision of the CM. Histological examination demonstrated a blended pathological milieu characterized by coalescent telangiectasia and venules associated with loculated endothelial chambers resembling an immature or de novo CM. Three patients were treated conservatively; recurrent minor hemorrhage occurred in one case. The authors found these malformations to be arranged in two basic relationships: CM inside the telangiectasia and CM in the radicles of the DVA. Stenosis of the main venous collector and dilation of the medullary veins were important findings.
Conclusions
The pathogenesis of this malformation may be referred to a developmental deviance of the brainstem capillary–venous network associated with transitional vessels and loculated endothelial vascular spaces related to genetic and acquired origins, probably in a restrictive venous outflow milieu.
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Affiliation(s)
- Eugenio Pozzati
- 1Department of Neurosurgery, Sections of Neuroradiology and Pathology, Bellaria Hospital, Bologna, Italy; and
| | - Anna Federica Marliani
- 1Department of Neurosurgery, Sections of Neuroradiology and Pathology, Bellaria Hospital, Bologna, Italy; and
| | - Mino Zucchelli
- 1Department of Neurosurgery, Sections of Neuroradiology and Pathology, Bellaria Hospital, Bologna, Italy; and
| | - Maria Pia Foschini
- 1Department of Neurosurgery, Sections of Neuroradiology and Pathology, Bellaria Hospital, Bologna, Italy; and
| | - Massimo Dall'Olio
- 1Department of Neurosurgery, Sections of Neuroradiology and Pathology, Bellaria Hospital, Bologna, Italy; and
| | - Giuseppe Lanzino
- 2Department of Neurosurgery, Illinois Neurological Institute, University of Illinois College of Medicine, Peoria, Illinois
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29
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Posters. Interv Neuroradiol 2007. [DOI: 10.1177/15910199070130s210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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30
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Kiliç K, Konya D, Kurtkaya O, Sav A, Pamir MN, Kiliç T. Inhibition of angiogenesis induced by cerebral arteriovenous malformations using Gamma Knife irradiation. J Neurosurg 2007; 106:463-9. [PMID: 17367070 DOI: 10.3171/jns.2007.106.3.463] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors studied the effect of Gamma Knife irradiation on angiogenesis induced by cerebral arteriovenous malformation (AVM) tissues implanted in the corneas of rats.
Methods
Ten AVM specimens obtained from tissue resections performed at Marmara University between 1998 and 2004 were used. A uniform amount of tissue was implanted into the micropocket between the two epithelial layers of the cornea. Gamma Knife irradiation was applied with dose prescriptions of 15 or 30 Gy to one cornea at 100% iso-dose. Dosing was adjusted so that the implanted cornea of one eye received 1.5 Gy when 15 Gy was applied to the other cornea. Similarly, one cornea received 3 Gy when 30 Gy was applied to the other cornea. Angiogenic activity was graded daily by biomicroscopic observations. Forty-eight other rats were used for microvessel counting and vascularendothelial growth factor (VEGF) staining portions of the experiment. Micropieces of the specimens were again used for corneal implantation. Rats from each group were killed on Days 5, 10, 15, and 20, and four corneas from each group were examined.
Gamma Knife irradiation dose dependently decreased AVM-induced neovascularization in the rat cornea as determined by biomicroscopic grading of angiogenesis, microvessel count, and VEGF expression.
Conclusions
The results suggest that Gamma Knife irradiation inhibits angiogenesis induced by AVM tissue in the cornea angiogenesis model. The data are not directly related to understanding how Gamma Knife irradiation occludes existing AVM vasculature, but to understanding why properly treated AVMs do not recur and do not show neovascularization after Gamma Knife irradiation.
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Affiliation(s)
- Kaya Kiliç
- Laboratory of Molecular Neurosurgery, Marmara University Institute of Neurological Sciences, Istanbul, Turkey
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31
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Gault J, Sain S, Hu LJ, Awad IA. Spectrum of genotype and clinical manifestations in cerebral cavernous malformations. Neurosurgery 2007; 59:1278-84; discussion 1284-5. [PMID: 17277691 DOI: 10.1227/01.neu.0000249188.38409.03] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Cerebral cavernous malformations (CCMs) are focal dysmorphic blood vessel anomalies predisposing individuals to hemorrhagic stroke and epilepsy. CCMs are sporadic or inherited as autosomal dominant disease with three known genes. The hypothesis that genetic heterogeneity would account for the remarkable variability in CCM manifestations was tested. METHODS CCM cases were prospectively enrolled. Germline CCM1 gene mutations were sought in 89 CCM samples. Associations with clinical manifestations and lesion characteristics were made among 41 symptomatic familial cases, including one cohort of 26 cases with CCM1 mutations and a second cohort of 15 cases without identifiable CCM1 mutations. The 15 cases were screened for CCM2 and CCM3 mutations. RESULTS CCM1 mutations were found in 34 out of 50 subjects with familial disease and in none of 39 sporadic CCM cases. CCM2 and CCM3 mutations were found in three out of 10 families screened without CCM1 mutations. Clinical manifestations in 22 Hispanic-American cases with identical CCM1 mutations were highly variable. Fewer CCM1 patients experienced hemorrhage than others with familial disease (P = 0.0139 for all cases and P = 0.0442 for symptomatic cases). Adjusting for sex and age improved the logistic regression model, suggesting decreased numbers of patients with hemorrhage in CCM1 familial disease (P = 0.003 for all cases and P = 0.014 for symptomatic cases). Hemorrhage differences were not related to size or number of lesions. CONCLUSION Factors in addition to CCM1 germline mutation contribute to CCM clinical manifestations. However, this evidence suggests that familial cases with CCM1 mutations may have less severe clinical manifestations than other familial cases.
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Affiliation(s)
- Judith Gault
- Department of Neurosurgery, University of Colorado at Denver and Health Sciences Center, Denver, Colorado 80262, USA.
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32
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Takagi Y, Kikuta KI, Nozaki K, Fujimoto M, Hayashi J, Hashimoto N. Neuronal expression of Fas-associated death domain protein and caspase-8 in the perinidal parenchyma of cerebral arteriovenous malformations. J Neurosurg 2007; 106:275-82. [PMID: 17410712 DOI: 10.3171/jns.2007.106.2.275] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The expression and localization of phosphorylated Fas-associated death domain protein (pFADD) and cleaved caspase-8 was examined in human cerebral arteriovenous malformations (AVMs). The authors focused on the perinidal parenchyma to clarify the effect of AVMs on perinidal brain tissue.
Methods
Seventeen cerebral AVMs were analyzed using immunohistochemical methods. Specimens were removed from patients during surgical procedures. The characteristics of the areas that stained positively for pFADD or cleaved caspase-8 were also assessed using an image analysis system. Eleven (65%) of the 17 lesions demonstrated anti-pFADD immunoreactivity and 12 (71%) showed anti–cleaved caspase-8 immunoreactivity. The immunoreactive cells in the perinidal parenchyma demonstrated obvious neuronal morphological characteristics.
The characteristics of pFADD-positive and cleaved caspase-8–positive areas were assessed using the image analysis system. The mean distance from the nidus adjacent to either area was not affected by preoperative hemorrhage. The neuronal densities of pFADD-positive and cleaved caspase-8–positive areas were analyzed using the same system. The density of the control area (samples that were pFADD-negative and cleaved caspase-8 negative) was significantly higher when compared with that of pFADD-positive and cleaved caspase-8–positive areas (p < 0.05). The expressions of cleaved caspase-9, cleaved poly(adenosine diphosphate–ribose) polymerase, and apoptotic cells were analyzed using the terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate nick-end labeling method.
Conclusions
Neuronal areas that stained positively for pFADD and cleaved caspase-8 existed around the nidus of AVMs. In these areas, the neuronal density was lower than that in the other parenchyma around the AVM. Neuronal loss around the nidus may be the origin of brain dysfunction around AVMs.
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Affiliation(s)
- Yasushi Takagi
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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33
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Valavanis A, Pangalu A, Tanaka M. Endovascular treatment of cerebral arteriovenous malformations with emphasis on the curative role of embolisation. Interv Neuroradiol 2005; 11:37-43. [PMID: 20584458 DOI: 10.1177/15910199050110s107] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Accepted: 07/20/2005] [Indexed: 11/17/2022] Open
Abstract
SUMMARY Valavanis A, Pangalu A, Tanaka M. Endovascular treatment of cerebral arteriovenous malformations with emphasis on the curative role of embolisation. Schweiz Arch Neurol Psychiatr 2004;155:341-7. Cerebral arteriovenous malformations are complex and only partially understood vascular lesions of the central nervous system with a natural history characterised by significant morbidity and mortality mainly due to an increased hemorrhagic risk, Microneurosurgical removal, radiosurgical obliteration and neuroendovascular embolisation are the principal therapeutic modalities applied individually or in various combinations according to varying selection criteria for the treatment of cerebral arteriovenous malformations. In this context embolisation plays a central role cither as a complementary or as the sole treatment technique. This report summarises the evolutive 18 years of continuous experience of the senior author with the neuroradiological evaluation and endovascular treatment of 644 patients with a cerebral arteriovenous malformation. Special emphasis is given to the underlying concepts and specific endovascular techniques developed for the complete, i.e. curative embolisation of cerebral arteriovenous malformations. Precise angiographic analysis of the vascular composition and intrinsic angioarchitecture of the nidus of the arteriovenous malformation by super-selective microcatheterisation is required to identify the types of feeding arteries and patterns of their supply, the number and vascular connections of nidal compartments, the types of arteriovenous shunts, the morphology of the vascular spaces composing the nidus and the number and exit patterns of draining veins. Complete angiographic investigation for recognition of secondarily induced phenomena of the cerebral vasculature, such as arterial and venous high-flow angiopathy and so-called perinidal angiogenesis is essential for a comprehensive evaluation and assessment of the associated haemorrhagic risk. Based on a precise topographic classification, detailed angioarchitectural analysis, application of superselective multimicrocatheterisation techniques along with a controlled intranidal injection of non-absorbable liquid embolic materials, nearly 40% of cerebral arteriovenous malformations can be completely and stably obliterated and therefore curatively treated by single session or multistaged embolisation with a morbidity of 1.3% and a mortality of 13%. which arc lower than the known natural history of this disease.
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Affiliation(s)
- A Valavanis
- Institute of Neuroradiology, University Hospital of Zurich; Swiss
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