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Samaniego EA, Dabus G, Meyers PM, Kan PT, Frösen J, Lanzino G, Welch BG, Volovici V, Gonzalez F, Fifi J, Charbel FT, Hoh BL, Khalessi A, Marks MP, Berenstein A, Pereira VM, Bain M, Colby GP, Narayanan S, Tateshima S, Siddiqui AH, Wakhloo AK, Arthur AS, Lawton MT. Most Promising Approaches to Improve Brain AVM Management: ARISE I Consensus Recommendations. Stroke 2024; 55:1449-1463. [PMID: 38648282 DOI: 10.1161/strokeaha.124.046725] [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: 10/21/2023] [Accepted: 03/01/2024] [Indexed: 04/25/2024]
Abstract
Brain arteriovenous malformations (bAVMs) are complex, and rare arteriovenous shunts that present with a wide range of signs and symptoms, with intracerebral hemorrhage being the most severe. Despite prior societal position statements, there is no consensus on the management of these lesions. ARISE (Aneurysm/bAVM/cSDH Roundtable Discussion With Industry and Stroke Experts) was convened to discuss evidence-based approaches and enhance our understanding of these complex lesions. ARISE identified the need to develop scales to predict the risk of rupture of bAVMs, and the use of common data elements to perform prospective registries and clinical studies. Additionally, the group underscored the need for comprehensive patient management with specialized centers with expertise in cranial and spinal microsurgery, neurological endovascular surgery, and stereotactic radiosurgery. The collection of prospective multicenter data and gross specimens was deemed essential for improving bAVM characterization, genetic evaluation, and phenotyping. Finally, bAVMs should be managed within a multidisciplinary framework, with clinical studies and research conducted collaboratively across multiple centers, harnessing the collective expertise and centralization of resources.
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Affiliation(s)
- Edgar A Samaniego
- Department of Neurology, Neurosurgery and Radiology, University of Iowa (E.A.S.)
| | - Guilherme Dabus
- Department of Neurosurgery, Baptist Health, Miami, FL (G.D.)
| | - Philip M Meyers
- Department of Radiology and Neurological Surgery, Columbia University, New York (P.M.M.)
| | - Peter T Kan
- Department of Neurological Surgery, University of Texas Medical Branch Galveston (P.T.K.)
| | - Juhana Frösen
- Department of Rehabilitation, Tampere University Hospital, Finland (J.F.)
| | | | - Babu G Welch
- Departments of Neurological Surgery and Radiology; The University of Texas Southwestern, Dallas (B.G.W.)
| | - Victor Volovici
- Department of Neurosurgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands (V.V.)
| | - Fernando Gonzalez
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD (F.G.)
| | - Johana Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York (J.F., A.B.)
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago (F.T.C.)
| | - Brian L Hoh
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville (B.L.H.)
| | | | - Michael P Marks
- Interventional Neuroradiology Division, Stanford University Medical Center, Palo Alto, CA (M.P.M.)
| | - Alejandro Berenstein
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York (J.F., A.B.)
| | - Victor M Pereira
- Department of Neurosurgery, St. Michael's Hospital, Toronto, Canada (V.M.P.)
| | - Mark Bain
- Department of Neurological Surgery, Cleveland Clinic, OH (M.B.)
| | - Geoffrey P Colby
- Department of Neurosurgery, University of California Los Angeles (G.P.C.)
| | - Sandra Narayanan
- Neurointerventional Program and Comprehensive Stroke Program, Pacific Neuroscience Institute, Santa Monica, CA (S.N.)
| | - Satoshi Tateshima
- Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles (S.T.)
| | - Adnan H Siddiqui
- Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York (A.H.S.)
| | - Ajay K Wakhloo
- Department of Radiology, Tufts University School of Medicine, Boston, MA (A.K.W.)
| | - Adam S Arthur
- Department of Neurosurgery, Semmes-Murphey Clinic, University of Tennessee Health Science Center, Memphis (A.S.A.)
| | - Michael T Lawton
- Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (M.T.L.)
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2
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Astudillo Potes MD, Bauman MMJ, Shoushtari A, Winter BM, Singh R, Rahmani R, Catapano J, Lawton MT. Elucidating the pathogenesis behind arteriovenous malformations of the central nervous system: a bibliometric analysis. Neurosurg Rev 2024; 47:133. [PMID: 38556597 DOI: 10.1007/s10143-024-02367-3] [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: 11/18/2023] [Revised: 02/20/2024] [Accepted: 03/20/2024] [Indexed: 04/02/2024]
Abstract
Arteriovenous malformations (AVMs) are vascular malformations of the central nervous system (CNS) with potential for significant consequences. The exact pathophysiologic mechanism of AVM formation is not fully understood. This study aims to evaluate bibliometric parameters and citations of the literature of AVMs to provide an overview of how the field has evolved. We performed an electronic search on Web of Science to identify the top 100 published and indexed articles with the highest number of citations discussing the pathogenesis of AVMs. This study yielded 1863 articles, of which the top 100 were selected based on the highest total citation count. These articles included 24% basic science, 46% clinical, and 30% review articles. The most-cited article was a clinical article from 2003, and the most recent was published in 2022. The median number of authors was 6, with the highest being 46 for a clinical article. The top 5 journals were identified, with the highest impact factor being 20.1. 13 countries were identified, with the US contributing the most articles (approximately 70%). Regarding genes of investigation, VEGF was one of the early genes investigated, while more interested in RAS/MAPK has been garnered since 2015. There is a growing interest in AVM genomics and pathogenesis research. While progress has been made in understanding clinical aspects and risk factors, the exact pathophysiological mechanisms and genetic basis of AVM formation remain incompletely understood. Further investigation of key genes in AVM pathogenesis can allow identification of potential therapeutic targets.
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Affiliation(s)
- Maria D Astudillo Potes
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
- Department of Neurological Surgery, Rochester, Minnesota, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA
| | - Megan M J Bauman
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
- Department of Neurological Surgery, Rochester, Minnesota, USA
| | - Ali Shoushtari
- Department of Neurological Surgery, Rochester, Minnesota, USA
| | - Bailey M Winter
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
- Department of Neurological Surgery, Rochester, Minnesota, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA
| | - Rohin Singh
- Department of Neurosurgery, University of Rochester, Rochester, NY, USA.
| | - Redi Rahmani
- Department of Neurosurgery, University of Rochester, Rochester, NY, USA
- Barrow Neurological Institute, Phoenix, AZ, USA
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3
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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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Tanzadehpanah H, Modaghegh MHS, Mahaki H. Key biomarkers in cerebral arteriovenous malformations: Updated review. J Gene Med 2023; 25:e3559. [PMID: 37380428 DOI: 10.1002/jgm.3559] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/02/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023] Open
Abstract
The formation of vascular networks consisting of arteries, capillaries, and veins is vital in embryogenesis. It is also crucial in adulthood for the formation of a functional vasculature. Cerebral arteriovenous malformations (CAVMs) are linked with a remarkable risk of intracerebral hemorrhage because arterial blood is directly shunted into the veins before the arterial blood pressure is dissipated. The underlying mechanisms responsible for arteriovenous malformation (AVM) growth, progression, and rupture are not fully known, yet the critical role of inflammation in AVM pathogenesis has been noted. The proinflammatory cytokines are upregulated in CAVM, which stimulates overexpression of cell adhesion molecules in endothelial cells (ECs), leading to improved leukocyte recruitment. It is well-known that metalloproteinase-9 secretion by leukocytes disrupts CAVM walls resulting in rupture. Moreover, inflammation alters the angioarchitecture of CAVMs by upregulating angiogenic factors impacting the apoptosis, migration, and proliferation of ECs. A better understanding of the molecular signature of CAVM might allow us to identify biomarkers predicting this complication, acting as a goal for further investigations that may be potentially targeted in gene therapy. The present review is focused on the numerous studies conducted on the molecular signature of CAVM and the associated hemorrhage. The association of numerous molecular signatures with a higher risk of CAVM rupture is shown through inducing proinflammatory mediators, as well as growth factors signaling, Ras-mitogen-activated protein kinase-extracellular signal-regulated kinase, and NOTCH pathways, which are accompanied by cellular level inflammation and endothelial alterations resulting in vascular wall instability. According to the studies, it is assumed that matrix metalloproteinase, interleukin-6, and vascular endothelial growth factor are the biomarkers most associated with CAVM and the rate of hemorrhage, as well as diagnostic methods, with respect to enhancing the patient-specific risk estimation and improving treatment choices.
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Affiliation(s)
- Hamid Tanzadehpanah
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Hanie Mahaki
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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5
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Genetics of brain arteriovenous malformations and cerebral cavernous malformations. J Hum Genet 2023; 68:157-167. [PMID: 35831630 DOI: 10.1038/s10038-022-01063-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/13/2022] [Accepted: 06/26/2022] [Indexed: 11/08/2022]
Abstract
Cerebrovascular malformations comprise abnormal development of cerebral vasculature. They can result in hemorrhagic stroke due to rupture of lesions as well as seizures and neurological defects. The most common forms of cerebrovascular malformations are brain arteriovenous malformations (bAVMs) and cerebral cavernous malformations (CCMs). They occur in both sporadic and inherited forms. Rapidly evolving molecular genetic methodologies have helped to identify causative or associated genes involved in genesis of bAVMs and CCMs. In this review, we highlight the current knowledge regarding the genetic basis of these malformations.
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Brain AVMs-Related microRNAs: Machine Learning Algorithm for Expression Profiles of Target Genes. Brain Sci 2022; 12:brainsci12121628. [PMID: 36552089 PMCID: PMC9775264 DOI: 10.3390/brainsci12121628] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION microRNAs (miRNAs) are a class of non-coding RNAs playing a myriad of important roles in regulating gene expression. Of note, recent work demonstrated a critical role of miRNAs in the genesis and progression of brain arteriovenous malformations (bAVMs). Accordingly, here we examine miRNA signatures related to bAVMs and associated gene expression. In so doing we expound on the potential prognostic, diagnostic, and therapeutic significance of miRNAs in the clinical management of bAVMs. METHODS A PRISMA-based literature review was performed using PubMed/Medline database with the following search terms: "brain arteriovenous malformations", "cerebral arteriovenous malformations", "microRNA", and "miRNA". All preclinical and clinical studies written in English, regardless of date, were selected. For our bioinformatic analyses, miRWalk and miRTarBase machine learning algorithms were employed; the Kyoto Encyclopedia of Genes and Genomes (KEGG) database was quired for associated pathways/functions. RESULTS four studies were ultimately included in the final analyses. Sequencing data consistently revealed the decreased expression of miR-18a in bAVM-endothelial cells, resulting in increased levels of vascular endodermal growth factor (VEGF), Id-1, matrix metalloproteinase, and growth signals. Our analyses also suggest that the downregulation of miR-137 and miR-195* within vascular smooth muscle cells (VSMCs) may foster the activation of inflammation, aberrant angiogenesis, and phenotypic switching. In the peripheral blood, the overexpression of miR-7-5p, miR-629-5p, miR-199a-5p, miR-200b-3p, and let-7b-5p may contribute to endothelial proliferation and nidus development. The machine learning algorithms employed confirmed associations between miRNA-related target networks, vascular rearrangement, and bAVM progression. CONCLUSION miRNAs expression appears to be critical in managing bAVMs' post-transcriptional signals. Targets of microRNAs regulate canonical vascular proliferation and reshaping. Although additional scientific evidence is needed, the identification of bAVM miRNA signatures may facilitate the development of novel prognostic/diagnostic tools and molecular therapies for 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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Vetiska S, Wälchli T, Radovanovic I, Berhouma M. Molecular and genetic mechanisms in brain arteriovenous malformations: new insights and future perspectives. Neurosurg Rev 2022; 45:3573-3593. [PMID: 36219361 DOI: 10.1007/s10143-022-01883-4] [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: 05/27/2022] [Revised: 07/30/2022] [Accepted: 10/05/2022] [Indexed: 10/17/2022]
Abstract
Brain arteriovenous malformations (bAVMs) are rare vascular lesions made of shunts between cerebral arteries and veins without the interposition of a capillary bed. The majority of bAVMs are asymptomatic, but some may be revealed by seizures and potentially life-threatening brain hemorrhage. The management of unruptured bAVMs remains a matter of debate. Significant progress in the understanding of their pathogenesis has been made during the last decade, particularly using genome sequencing and biomolecular analysis. Herein, we comprehensively review the recent molecular and genetic advances in the study of bAVMs that not only allow a better understanding of the genesis and growth of bAVMs, but also open new insights in medical treatment perspectives.
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Affiliation(s)
- Sandra Vetiska
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Thomas Wälchli
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Group of CNS Angiogenesis and Neurovascular Link, Neuroscience Center Zurich, and Division of Neurosurgery, University and University Hospital Zurich, and Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland.,Division of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Ivan Radovanovic
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Moncef Berhouma
- Department of Neurosurgery, University Hospital of Dijon Bourgogne, Dijon, France. .,CREATIS Lab, CNRS UMR 5220, INSERM U1294, Lyon 1, University, Lyon, France.
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Abbas R, Al-Saiegh F, Atallah E, Naamani KE, Tjoumakaris S, Gooch MR, Herial NA, Jabbour P, Rosenwasser RH. Treatment of Intracerebral Vascular Malformations: When to Intervene. Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00739-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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10
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Liu J, Li Y, Zhang H, Luo C, Yuan D, Jiang W, Yan J. Associated genetic variants and potential pathogenic mechanisms of brain arteriovenous malformation. J Neurointerv Surg 2022; 15:572-578. [PMID: 35470246 DOI: 10.1136/neurintsurg-2022-018776] [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: 02/08/2022] [Accepted: 04/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The pathogenic mechanism of brain arteriovenous malformation (bAVM) is poorly understood. A growing body of evidence indicates that genetic factors play crucial roles in bAVM. This study examined genetic variants associated with bAVM through quantitative synthesis and qualitative description of literature. METHODS Five databases were searched to gather potentially relevant articles published up to January 2022. STATA 14.0 software was used for statistical analyses. Pooled odds ratios and 95% confidence intervals were calculated with random effect models, and heterogeneity was assessed using the Cochran Q test and quantified with the I 2 test. Sensitivity and publication bias were analyzed to test the robustness of the associations. Variants identified in only one study or with great heterogeneity were not suitable for pooling association analysis, and therefore a qualitative systematic review was performed. RESULTS In total, 30 papers were included in a systematic review involving 4709 cases and 7832 controls, where 17 papers were in a meta-analysis. A suggested association of bAVM was observed with ACVRL1 rs2071219 in the additive model and CDKN2B-AS1 rs1333040 in the recessive and additive models. Other variants of genes that could not be analyzed were summarized by qualitative description. These genes were mostly involved in bone morphogenic protein/transforming growth factor beta (BMP/TGF-β), vascular endothelial growth factor/vascular endothelial growth factor receptor (VEGF/VEGFR), and RAS-mitogen activated protein kinase (MAPK) signaling and inflammation. CONCLUSIONS According to our meta-analysis, ACVRL1 rs2071219 and CDKN2B-AS1 rs1333040 were potentially associated with bAVM. Multiple pathological signaling pathways could affect disease development. Future studies should aim to determine the interaction of candidate genes with environmental risk factors and to elucidate detailed mechanisms of action of variants and genes.1.
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Affiliation(s)
- Junyu Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China.,Department of Pharmacology, Kyoto University Graduate School of Medicine, Kyoto 606-8501, Japan
| | - Yifeng Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Hao Zhang
- Interventional Medical Center, Hunan Province People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha 410005, China
| | - Chun Luo
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South university, Changsha 410078, China
| | - Dun Yuan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Weixi Jiang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Junxia Yan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South university, Changsha 410078, China .,Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha 410078, China
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Genetics and Emerging Therapies for Brain Arteriovenous Malformations. World Neurosurg 2022; 159:327-337. [PMID: 35255632 DOI: 10.1016/j.wneu.2021.10.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/27/2022]
Abstract
Brain arteriovenous malformations (AVMs) are characterized by a high-pressure, low-resistance vascular nidus created by direct shunting of blood from feeding arteries into arterialized veins, bypassing intervening capillaries. AVMs pose a risk of spontaneous rupture because the vessel walls are continuously exposed to increased shear stress and abnormal flow phenomena, which lead to vessel wall inflammation and distinct morphologic changes. The annual rupture rate is estimated at 2%, and once an AVM ruptures, the risk of rerupture increases 5-fold. The ability of AVMs to grow, regress, recur, and undergo remodeling shows their dynamic nature. Identifying the underlying cellular and molecular pathways of AVMs not only helps us understand their natural physiology but also allows us to directly block vital pathways, thus preventing AVM development and progression. Management of AVMs is challenging and often necessitates a multidisciplinary approach, including neurosurgical, endovascular, and radiosurgical expertise. Because many of these procedures are invasive, carry a risk of inciting hemorrhage, or are controversial, the demand for pharmacologic treatment options is increasing. In this review, we introduce novel findings of cellular and molecular AVM physiology and highlight key signaling mediators that are potential targets for AVM treatment. Furthermore, we give an overview of syndromes associated with hereditary and nonhereditary AVM formation and discuss causative genetic alterations.
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Pérez-Alfayate R, Grasso G. State of the Art and Future Direction in Diagnosis, Molecular Biology, Genetics, and Treatment of Brain Arteriovenous Malformations. World Neurosurg 2022; 159:362-372. [PMID: 35255635 DOI: 10.1016/j.wneu.2021.08.111] [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: 07/19/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
Brain arteriovenous malformations (bAVMs) are uncommon and represent a heterogeneous group of lesions. Although these 2 facts have delayed research on this topic, knowledge about the pathophysiology, diagnosis, and treatment of bAVMs has evolved in recent years. We conducted a review of the literature to update the knowledge about diagnosis, molecular biology, genetic, pathology, and treatment by searching for the following terms: "Epidemiology AND Natural History," "risk of hemorrhage," "intracranial hemorrhage," "diagnosis," "angiogenesis," "molecular genetics," "VEGF," "KRAS," "radiosurgery," "endovascular," "microsurgery," or "surgical resection." Our understanding of bAVMs has significantly evolved in recent years. The latest investigations have helped in defining some molecular pathways involved in the pathology of bAVM. Although there is still more to learn and discover, describing these pathways will allow the creation of targeted treatments that could improve the prognosis of patients with bAVMs.
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Affiliation(s)
- Rebeca Pérez-Alfayate
- Department of Neurosurgery, Neuroscience Institute, Hospital Clínico San Carlos, Madrid, Spain.
| | - Giovanni Grasso
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
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13
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Genetics and Vascular Biology of Brain Vascular Malformations. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Li L, Liu X, Zhao M, Guo P, Zhang H. Effects of serum starvation and vascular endothelial growth factor stimulation on the expression of Notch signalling pathway components. Sci Prog 2021; 104:368504211028387. [PMID: 34231445 PMCID: PMC10450735 DOI: 10.1177/00368504211028387] [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] [Indexed: 11/17/2022]
Abstract
Brain arteriovenous malformation (BAVM) is an abnormality in the cerebral vascular system. Although the upregulation of the Notch signalling pathway is a deterministic factor in BAVM, the mechanism by which this pathway is upregulated in patients with BAVM is uncertain. The effects of serum starvation and vascular endothelial growth factor (VEGF) stimulation on the Notch signalling pathway in brain microvascular endothelial cells (MECs) and mouse embryonic stem (mES)/embryoid body (EB)-derived endothelial cells were investigated in this study. The duration of serum starvation and VEGF concentration were changed, cell viability was measured, and reasonable time and concentration gradients were selected for subsequent studies. Protein and mRNA expression levels of Notch signalling pathway components in both MECs and mES/EB-derived endothelial cells were detected using western blotting and real-time PCR, respectively. Expression levels of the Notch1, Notch4, Jagged1, delta-like ligand 4 (Dll4) and Hes1 proteins and mRNAs were upregulated by lower VEGF concentrations and shorter-term serum starvation but inhibited by higher VEGF concentrations and longer-term serum starvation. This study revealed effects of changes in the duration of serum starvation and VEGF concentration on the expression of Notch signalling pathway components in both MECs and mES/EB-derived endothelial cells, potentially contributing to BAVM formation.
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Affiliation(s)
- Liming Li
- Institute of Biotechnology, College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Xiaqing Liu
- Institute of Biotechnology, College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Mingguang Zhao
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Peng Guo
- Institute of Biotechnology, College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Haifeng Zhang
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
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15
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Takagi Y, Kanematsu Y, Mizobuchi Y, Mure H, Shimada K, Tada Y, Morigaki R, Sogabe S, Fujihara T, Miyamoto T, Miyake K. Basic research and surgical techniques for brain arteriovenous malformations. THE JOURNAL OF MEDICAL INVESTIGATION 2020; 67:222-228. [PMID: 33148892 DOI: 10.2152/jmi.67.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Arteriovenous malformations (AVMs) are hemorrhagic vascular diseases in which arteries and veins are directly connected with no capillary bed between the two. We herein introduce the results of basic research of this disease and surgical techniques based on our data and experiences. The results obtained from our research show that cell death- and inflammation-related molecules changed or became activated compared with control specimens. These findings indicate that chronic inflammation occurs in and around the nidus of AVMs. Various molecules are involved in the mechanisms of cell death and angiogenesis during this process. Confirmation of blood flow in the nidus is very important to avoid hemorrhagic complications during surgical removal of the nidus. The risk of hemorrhage increases when the blood flow in the nidus is not reduced. We reported the advantages of serial indocyanine green videoangiography, which is used to assess the blood flow during AVM nidus removal. Since publication of the ARUBA trial and Scottish Audit, treatments with high morbidity have not been allowed. It is especially important for neurosurgeons to treat low Spetzler-Martin grade AVMs with low morbidity. J. Med. Invest. 67 : 222-228, August, 2020.
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Affiliation(s)
- Yasushi Takagi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yasuhisa Kanematsu
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yoshifumi Mizobuchi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hideo Mure
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kenji Shimada
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yoshiteru Tada
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Ryoma Morigaki
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Shu Sogabe
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Toshitaka Fujihara
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Takeshi Miyamoto
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kazuhisa Miyake
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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16
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Zhang S, Zhou C, Liu D, Piao Y, Zhang F, Hu J, Ma Z, Wei Z, Zhu W, Lv M. Is smoking a risk factor for bleeding in adult men with cerebral arteriovenous malformations? A single-center regression study from China. J Stroke Cerebrovasc Dis 2020; 29:105084. [PMID: 32807480 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/21/2020] [Accepted: 06/21/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess whether smoking increases the risk of bleeding in patients with cerebral arteriovenous malformations (CAVM). MATERIAL AND METHODS According to our research plan, 385 CAVM patients admitted to Beijing Tiantan Hospital from December 2015 to January 2018 were included in this study, including 210 bleeding patients and 175 non-bleeding patients. We divided patients into three subgroups of current smokers, ex-smokers (those who quit smoking for one year or more) and non-smokers. The relationship between smoking and the risk of CAVM rupture was assessed by univariate and multivariate regression analysis. RESULTS Multivariate regression analysis showed that there was a statistically significant difference between current smoker and non-smoker (OR = 1.87, p = 0.019). Among the covariates of the multivariate regression analysis, the location, combined with blood flow-related intracranial aneurysms and size were related to the risk of CAVM bleeding. CONCLUSION Current smoking may increase the risk of CAVM bleeding; however, there was no significant correlation between ex-smoking and CAVM bleeding.
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Affiliation(s)
- Shuai Zhang
- Department of Neurosurgery, Beijing Jingmei Group General Hospital, Beijing 102300, PR China
| | - Chenguang Zhou
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, PR China
| | - Dong Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
| | - Yongjun Piao
- Department of Neurosurgery, Beijing Jingmei Group General Hospital, Beijing 102300, PR China
| | - Fuqiang Zhang
- Department of Neurosurgery, Beijing Jingmei Group General Hospital, Beijing 102300, PR China
| | - Jie Hu
- Department of Neurosurgery, Beijing Jingmei Group General Hospital, Beijing 102300, PR China
| | - Zongqian Ma
- Department of Neurosurgery, Beijing Jingmei Group General Hospital, Beijing 102300, PR China
| | - Zhanyang Wei
- Department of Neurosurgery, Beijing Jingmei Group General Hospital, Beijing 102300, PR China
| | - Weisheng Zhu
- Department of Neurosurgery, Beijing Jingmei Group General Hospital, Beijing 102300, PR China.
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing 100070, PR China.
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17
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Florian IA, Timiș TL, Ungureanu G, Florian IS, Bălașa A, Berindan-Neagoe I. Deciphering the vascular labyrinth: role of microRNAs and candidate gene SNPs in brain AVM development - literature review. Neurol Res 2020; 42:1043-1054. [PMID: 32723034 DOI: 10.1080/01616412.2020.1796380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Brain arteriovenous malformations (AVMs) are a relatively infrequent vascular pathology of unknown etiology that, despite their rarity, cause the highest number of hemorrhagic strokes under the age of 30 years. They pose a challenge to all forms of treatment due to their variable morphology, location, size, and, last but not least, evolving nature. MicroRNAs (miRNAs) are non-coding RNA strands that may suppress the expression of target genes by binding completely or partially to their complementary sequences. Single nucleotide polymorphisms (SNPs), as the name implies, are variations in a single nucleotide in the DNA, usually found in the non-coding segments. Although the majority of SNPs are harmless, some located in the proximity of candidate genes may result in altered expression or function of these genes and cause diseases or affect how different pathologies react to treatment. The roles miRNAs and certain SNPs play in the development and growth of AVMs are currently uncertain, yet progress in deciphering the minutiae of this pathology is already visible. Methods and Results: We performed an electronic Medline (PubMed, PubMed Central) and Google Academic exploration using permutations of the terms: "arteriovenous malformations," "single nucleotide polymorphisms," "microRNA," "non-coding RNA," and "genetic mutations." The findings were then divided into two categories, namely the miRNAs and the candidate gene SNPs associated with AVMs respectively. 6 miRNAs and 12 candidate gene SNPs were identified and discussed. Conclusions: The following literature review focuses on the discoveries made in ascertaining the different implications of miRNAs and candidate gene SNPs in the formation and evolution of brain AVMs, as well as highlighting the possible directions of future research and biological treatment. Abbreviations: ACVRL1/ALK1: activin receptor-like kinase 1; Akt: protein kinase B; ANGPTL4: angiopoietin-like 4; ANRIL: antisense noncoding RNA in the INK4 locus; AVM: arteriovenous malformation; AVM-BEC: arteriovenous malformation brain endothelial cell; BRCA1: breast cancer type 1 susceptibility protein; CCS: case-control study; CDKN2A/B: cyclin-dependent kinase inhibitor 2A/B; CLTC: clathrin heavy chain; DNA: deoxyribonucleic acid; ERK: extracellular signal-regulated kinase; GPR124: probable G-protein coupled receptor 124; GWAS: genome-wide association study; HHT: hereditary hemorrhagic telangiectasia; HIF1A: hypoxia-inducible factor 1A; IA: intracranial aneurysm; ICH: intracranial hemorrhage; Id-1: inhibitor of DNA-binding protein A; IL-17: interleukin 17; MAP4K3: mitogen-activated protein kinase kinase kinase kinase 3; miRNA: microRNA; MMP: matrix metalloproteinase; NFkB: nuclear factor kappa-light-chain of activated B cells; NOTCH: neurogenic locus notch homolog; p38MAPK: p38 mitogen-activated protein kinase; PI3K: phosphoinositide 3-kinase; RBBP8: retinoblastoma-binding protein 8; RNA: ribonucleic acid; SNAI1: Snail Family Transcriptional Repressor 1; SNP: single nucleotide polymorphism; SOX-17: SRY-related HMG-box; TGF-β: transformation growth factor β; TGFR: transformation growth factor receptor; TIMP-4, tissue inhibitor of metalloproteinase 4; TSP-1: thrombospondin-1; UTR: untranslated region; VEGF: Vascular Endothelial Growth Factor; VSMC: vascular smooth muscle cell; Wnt1: Wnt family member 1.
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Affiliation(s)
- Ioan Alexandru Florian
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital , Cluj-Napoca, Romania.,Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | - Teodora Larisa Timiș
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | - Gheorghe Ungureanu
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital , Cluj-Napoca, Romania.,Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | - Ioan Stefan Florian
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital , Cluj-Napoca, Romania.,Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | - Adrian Bălașa
- Clinic of Neurosurgery, Tîrgu Mureș County Clinical Emergency Hospital , Tîrgu Mureș, Romania.,Department of Neurosurgery, Tîrgu Mureș University of Medicine, Pharmacy, Science and Technology , Tîrgu Mureș, Romania
| | - Ioana Berindan-Neagoe
- The Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania.,Functional Genomics and Experimental Pathology Department, The Oncology Institute "Prof. Dr. Ion Chiricuta" , Cluj-Napoca, Romania
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18
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Hong JM, Hu YD, Chai XQ, Tang CL. Role of activin receptor-like kinase 1 in vascular development and cerebrovascular diseases. Neural Regen Res 2020; 15:1807-1813. [PMID: 32246621 PMCID: PMC7513971 DOI: 10.4103/1673-5374.280305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Activin receptor-like kinase 1 (ALK1) is a transmembrane serine/threonine receptor kinase of the transforming growth factor beta (TGFβ) receptor superfamily. ALK1 is specifically expressed in vascular endothelial cells, and its dynamic changes are closely related to the proliferation of endothelial cells, the recruitment of pericytes to blood vessels, and functional differentiation during embryonic vascular development. The pathophysiology of many cerebrovascular diseases is today understood as a disorder of endothelial cell function and an imbalance in the proportion of vascular cells. Indeed, mutations in ALK1 and its co-receptor endoglin are major genetic risk factors for vascular arteriovenous malformation. Many studies have shown that ALK1 is closely related to the development of cerebral aneurysms, arteriovenous malformations, and cerebral atherosclerosis. In this review, we describe the various roles of ALK1 in the regulation of angiogenesis and in the maintenance of cerebral vascular homeostasis, and we discuss its relationship to functional dysregulation in cerebrovascular diseases. This review should provide new perspectives for basic research on cerebrovascular diseases and offer more effective targets and strategies for clinical diagnosis, treatment, and prevention.
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Affiliation(s)
- Jun-Mou Hong
- Department of Vascular Surgery, Zhongshan Hospital, Xiamen University, Xiamen, Fujian Province, China
| | - Yi-Da Hu
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xiao-Qing Chai
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China
| | - Chao-Liang Tang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China
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19
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Rozhchenko LV. [Molecular mechanisms of growth and relapse of cerebral arteriovenous malformations]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2020; 84:94-100. [PMID: 32207748 DOI: 10.17116/neiro20208401194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cerebral AVMs are not static congenital formations, they may grow, recur, and even appear de novo after complete resection, embolization, or radiosurgery. The author analyzes modern literature on the molecular mechanisms of AVM growth. The AVM intranidal vessels are exposed to abnormally high blood flows, which leads to the activation of molecular pathways in endothelial cells, causing proliferation and remodeling of AVM vessels. The existence of cerebral AVM is determined by more than 860 genes, the most important among them are the genetic mutations (SNPs) of VEGF, TGF-β, IL-6, MMP, ANG, ENG. The possible causes of AVM relapse after removal or total embolization are described, as well as the mechanisms of stimulation of angiogenesis after partial embolization: hemodynamic changes in AVM, aseptic inflammation in response to embolizate and the local regional hypoxia inside the AVM. In response to this, growth factors are expressed in the endothelium that further stimulate angiogenesis in AVM. Understanding the complex molecular biology of AVMs is critical to identifying and predicting their behavior, developing new treatments that improve the results of endovascular and surgical treatment.
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Affiliation(s)
- L V Rozhchenko
- A.L. Polenov Russian Neurosurgical Research Institute - branch of V.A. Almazov National Medical Research Center, St. Petersburg, Russia
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20
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Tasiou A, Tzerefos C, Alleyne CH, Boccardi E, Karlsson B, Kitchen N, Spetzler RF, Tolias CM, Fountas KN. Arteriovenous Malformations: Congenital or Acquired Lesions? World Neurosurg 2019; 134:e799-e807. [PMID: 31715403 DOI: 10.1016/j.wneu.2019.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Arteriovenous malformations (AVMs) were believed to be congenital. However, an increasing number of de novo AVM cases have questioned this doctrine. METHODS A consensus meeting of international experts attempted to establish a consensus on the nature of these relatively rare but challenging vascular lesions. In addition, an extensive search of the subject was performed using the PubMed medical database. RESULTS All participants agreed that genetic factors may play a role in the pathogenesis of AVMs. All but 1 participant believed that an underlying genetic predisposition may be detected later on in a patient's life, whereas genetic variations may contribute to sporadic AVM formation. The presence of genetic variations alone may not be enough for an AVM formation. A second hit is probably required. This consensus opinion is also supported by our literature search. CONCLUSIONS We discuss the literature on the genetics of AVMs and compare it with the consensus meeting outcomes. The congenital or noncongenital character of intracranial AVMs has an impact on the understanding their biological behavior, as well as their efficient short-term and long-term management.
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Affiliation(s)
- Anastasia Tasiou
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece.
| | - Christos Tzerefos
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | | | - Edoardo Boccardi
- Department of Diagnostic and Interventional Neuroradiology, Niguarda Hospital, Milan, Italy
| | - Bengt Karlsson
- Department of Surgery, Division of Neurosurgery, National University Hospital, Singapore
| | - Neil Kitchen
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Christos M Tolias
- Department of Neurovascular Surgery, Kings College Hospital, London, United Kingdom
| | - Kostas N Fountas
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
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21
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Piao J, Ji T, Guo Y, Xu K, Yu J. Brain arteriovenous malformation with transdural blood supply: Current status. Exp Ther Med 2019; 18:2363-2368. [PMID: 31555346 PMCID: PMC6755268 DOI: 10.3892/etm.2019.7731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/31/2019] [Indexed: 12/15/2022] Open
Abstract
Arterial blood supply to a brain arteriovenous malformation (BAVM) is mainly derived from the internal carotid artery (ICA) and vertebral basilar artery (VBA) system. However, in certain cases, arteries supplying the meninges may also contribute to the blood supply of the BAVM, resulting in the formation of a BAVM with transdural blood supply (TBS). To review the current status of BAVM with TBS, a literature search was performed in the PubMed database. Articles were screened for relevance and suitability of data. According to recent studies, the mechanisms by which TBS to a BAVM forms are mainly classified into the congenital and acquired type. BAVM with TBS is common in elderly patients and is characterized by intracranial hemorrhage, epilepsy, chronic headache and increased intracranial pressure. Digital subtraction angiography is the gold standard for diagnosing BAVM with TBS. Superselective angiography is also important. Treatments for BAVM with TBS include surgical resection, endovascular treatment (EVT), stereotactic radiosurgery and combined treatment. Surgical resection is difficult to perform. EVT has become the major therapy for treating BAVM with TBS due to its low procedural invasiveness. Combination of surgical resection and EVT may be a good option. In addition, stereotactic radiosurgery is frequently used as a complementary treatment to surgical and endovascular interventions. The prognosis of BAVM with TBS is not favorable, as the defect involves a complex arterial supply system.
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Affiliation(s)
- Jianmin Piao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Tiefeng Ji
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yunbao Guo
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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22
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Methylation of the CDKN2A Gene Increases the Risk of Brain Arteriovenous Malformations. J Mol Neurosci 2019; 69:316-323. [DOI: 10.1007/s12031-019-01360-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/18/2019] [Indexed: 12/19/2022]
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23
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Sturiale CL, Pignotti F, Giordano M, Porfidia A, Albanese A, Giarretta I, Puca A, Gaetani E, D'Arrigo S, Truma A, Olivi A, Pola R. Antithrombotic therapy and intracranial bleeding in subjects with sporadic brain arteriovenous malformations: preliminary results from a retrospective study. Intern Emerg Med 2018; 13:1227-1232. [PMID: 30062529 DOI: 10.1007/s11739-018-1918-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
Whether antithrombotic treatment is safe and/or affects the risk of intracranial bleeding in subjects with sporadic brain arteriovenous malformations (AVMs) is unknown. We conducted a retrospective analysis on the use of antithrombotics among patients affected by brain AVMs in follow-up at our institution. Attention was paid to the type of antithrombotic drug (either antiplatelets or anticoagulants), current or past use, dosage, and duration of treatment. Several clinical and angioarchitectural features of brain AVMs were also taken into consideration. The association between the use of antithrombotics and haemorrhagic onset was analyzed. A total of 77 patients were included in this study. Among them, ten patients were taking antithrombotic drugs at the time of AVM diagnosis. The rate of haemorrhagic onset was not significantly different between subjects who were and were not taking antithrombotic drugs (40 vs 55.2%, p = ns). Among the many clinical and angioarchitectural features analyzed, the only parameter that showed a statistically significant association with haemorrhagic onset was the size of the nidus. Patients who took antithrombotic treatments after being diagnosed with a brain AVM did not show an increased rate of intracranial haemorrhage over time considering a mean follow-up 4 years. In our study, antithrombotic treatment was not associated with increased intracranial bleeding among subjects with brain AVMs. In the presence of a strong clinical indication, antiplatelet and anticoagulant medications should not be denied a priori to patients with brain AVMs. Studies on larger populations are necessary to confirm these data.
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Affiliation(s)
- Carmelo Lucio Sturiale
- Institute of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Fabrizio Pignotti
- Institute of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Marzia Giordano
- Institute of Medicine, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Porfidia
- Institute of Medicine, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio Albanese
- Institute of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Igor Giarretta
- Institute of Medicine, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfredo Puca
- Institute of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Eleonora Gaetani
- Institute of Medicine, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sonia D'Arrigo
- Institute of Anesthesiology and Intensive Care, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ada Truma
- Institute of Medicine, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Roberto Pola
- Institute of Medicine, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Griessenauer CJ, Farrell S, Sarkar A, Zand R, Abedi V, Holland N, Michael A, Cummings CL, Metpally R, Carey DJ, Goren O, Martin N, Hendrix P, Schirmer CM. Genetic susceptibility to cerebrovascular disease: A systematic review. J Cereb Blood Flow Metab 2018; 38:1853-1871. [PMID: 30182779 PMCID: PMC6259318 DOI: 10.1177/0271678x18797958] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Investigation of genetic susceptibility to cerebrovascular disease has been of growing interest. A systematic review of human studies assessing neurogenomic aspects of cerebrovascular disease was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Any association study exploring genetic variants located in the exome associated with one of the major cerebrovascular diseases with at least 500 subjects was eligible for inclusion. Of 6874 manuscripts identified, 35 studies met the inclusion criteria. Most studies of interest focused on ischemic stroke and cerebrovascular occlusive disease. Large cohort genetic association studies on hemorrhagic cerebrovascular disease were less common. In addition to rare, well-established monogenic conditions with significant risk for cerebrovascular disease, a number of genetic variants are also relevant to cerebrovascular pathogenesis as part of a multifactorial process. The 45 polymorphisms identified were located in genes involved in processes related to endothelial and vascular health (15 (33.4%) variants), plasma lipid metabolism (10 (22.2%) variants), inflammation (9 (20%) variants), coagulation (3 (6.7%) variants), and blood pressure modulation (2 (4.4%) variants), and other (6 (13.3%) variants). This work represents a comprehensive overview of genetic variants in the exome relevant to ischemic and hemorrhagic stroke pathophysiology.
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Affiliation(s)
- Christoph J Griessenauer
- 1 Department of Neurosurgery, Geisinger Commonwealth School of Medicine, Geisinger, Danville, PA, USA.,2 Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Sean Farrell
- 3 Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Atom Sarkar
- 1 Department of Neurosurgery, Geisinger Commonwealth School of Medicine, Geisinger, Danville, PA, USA
| | - Ramin Zand
- 4 Department of Neurology, Geisinger Commonwealth School of Medicine, Geisinger, Danville, PA, USA
| | - Vida Abedi
- 5 Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA
| | - Neil Holland
- 4 Department of Neurology, Geisinger Commonwealth School of Medicine, Geisinger, Danville, PA, USA
| | - Andrew Michael
- 6 Neuroimaging Analytics Laboratory, Autism & Developmental Medicine Institute, Geisinger, Lewisburg, PA, USA
| | - Christopher L Cummings
- 4 Department of Neurology, Geisinger Commonwealth School of Medicine, Geisinger, Danville, PA, USA
| | | | | | - Oded Goren
- 1 Department of Neurosurgery, Geisinger Commonwealth School of Medicine, Geisinger, Danville, PA, USA
| | - Neil Martin
- 1 Department of Neurosurgery, Geisinger Commonwealth School of Medicine, Geisinger, Danville, PA, USA
| | - Philipp Hendrix
- 8 Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Clemens M Schirmer
- 1 Department of Neurosurgery, Geisinger Commonwealth School of Medicine, Geisinger, Danville, PA, USA
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25
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Dalton A, Dobson G, Prasad M, Mukerji N. De novo intracerebral arteriovenous malformations and a review of the theories of their formation. Br J Neurosurg 2018; 32:305-311. [DOI: 10.1080/02688697.2018.1478060] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- A. Dalton
- James Cook University Hospital, Middlesbrough, UK
| | - G. Dobson
- James Cook University Hospital, Middlesbrough, UK
| | - M. Prasad
- James Cook University Hospital, Middlesbrough, UK
| | - N. Mukerji
- James Cook University Hospital, Middlesbrough, UK
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26
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Tsuei YS, Chou YE, Chen WH, Luo CB, Yang SF. Polymorphism in dural arteriovenous fistula: matrix metalloproteinase-2-1306 C/T as a potential risk factor for sinus thrombosis. J Thromb Haemost 2018; 16:802-808. [PMID: 29431912 DOI: 10.1111/jth.13973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Indexed: 11/28/2022]
Abstract
Essentials Sinus thrombosis may play a crucial role in development of dural arteriovenous fistula (DAVF). Little is known about the association between gene polymorphism and the development of DAVF. MMP-2-1306 C/T showed a higher prevalence rate in DAVF cases with sinus thrombosis. MMP-2-1306C/T polymorphism is likely a potential risk factor for sinus thrombosis in DAVF. SUMMARY Background Dural arteriovenous fistula (DAVF) is a rare but important cerebrovascular disorder in adults. Little is known about the molecular genetic pathogenesis underlying DAVF development. Objectives To investigate the associations of gene polymorphisms and DAVF. Materials and Methods By the use of real-time PCR genotyping, seven single-nucleotide polymorphisms (SNPs) of angiogenesis-related genes were analyzed in 72 DAVF patients. Pertinent clinical and imaging data were subgrouped on the basis of location (cavernous sinus versus lateral sinus), lesions (single versus multiple), cerebral venous reflux (CVR) grading (Borden I versus Borden II/III), and sinus thrombosis (with versus without). Results We found that individuals carrying the polymorphic allele of matrix metalloproteinase (MMP)-2-1306 C/T (rs243865) had a significantly increased risk of sinus thrombosis in DAVF (odds ratio 6.2; 95% confidence interval 1.7-22.9). There was a weak difference in associations of tissue inhibitor of metalloproteinase (TIMP)-2 (rs2277698) gene polymorphism and DAVF patients subgrouped by CVR grading. Conclusions These preliminary results indicate that MMP-2-1306 C/T, but not MMP-9, TIMP-1, TIMP-2, and vascular endothelial growth factor A SNP variants, is a risk factor for the development of sinus thrombosis in DAVF patients.
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Affiliation(s)
- Y-S Tsuei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Neurosurgery, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Y-E Chou
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - W-H Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - C-B Luo
- Institute of Biomedical Engineering, Yuanpei University, Hsinchu, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Radiology, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - S-F Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
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27
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Walcott BP, Winkler EA, Zhou S, Birk H, Guo D, Koch MJ, Stapleton CJ, Spiegelman D, Dionne-Laporte A, Dion PA, Kahle KT, Rouleau GA, Lawton MT. Identification of a rare BMP pathway mutation in a non-syndromic human brain arteriovenous malformation via exome sequencing. Hum Genome Var 2018; 5:18001. [PMID: 29844917 PMCID: PMC5966745 DOI: 10.1038/hgv.2018.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/22/2017] [Accepted: 12/11/2017] [Indexed: 01/21/2023] Open
Abstract
Brain arteriovenous malformations (AVMs) are abnormal connections between arteries and veins that can result in hemorrhagic stroke. A genetic basis for AVMs is suspected, and we investigated potential mutations in a 14-year-old girl who developed a recurrent brain AVM. Whole-exome sequencing (WES) of AVM lesion tissue and blood was performed accompanied by in silico modeling, protein expression observation in lesion tissue and zebrafish modeling. A stop-gain mutation (c.C739T:p.R247X) in the gene SMAD family member 9 (SMAD9) was discovered. In the human brain tissue, immunofluorescent staining demonstrated a vascular predominance of SMAD9 at the protein level. Vascular SMAD9 was markedly reduced in AVM peri-nidal blood vessels, which was accompanied by a decrease in phosphorylated SMAD4, a downstream effector protein of the bone morphogenic protein signaling pathway. Zebrafish modeling (Tg kdrl:eGFP) of the morpholino splice site and translation-blocking knockdown of SMAD9 resulted in abnormal cerebral artery-to-vein connections with morphologic similarities to human AVMs. Orthogonal trajectories of evidence established a relationship between the candidate mutation discovered in SMAD9 via WES and the clinical phenotype. Replication in similar rare cases of recurrent AVM, or even more broadly sporadic AVM, may be informative in building a more comprehensive understanding of AVM pathogenesis.
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Affiliation(s)
- Brian P Walcott
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA, USA
| | - Ethan A Winkler
- Center for Cerebrovascular Research, University of California, San Francisco, CA, USA.,Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Sirui Zhou
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.,Montreal Neurological Institute, Montreal, QC, Canada
| | - Harjus Birk
- Center for Cerebrovascular Research, University of California, San Francisco, CA, USA.,Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Diana Guo
- Center for Cerebrovascular Research, University of California, San Francisco, CA, USA.,Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Matthew J Koch
- Department of Neurological Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Christopher J Stapleton
- Department of Neurological Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Dan Spiegelman
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.,Montreal Neurological Institute, Montreal, QC, Canada
| | - Alexandre Dionne-Laporte
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.,Montreal Neurological Institute, Montreal, QC, Canada
| | - Patrick A Dion
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.,Montreal Neurological Institute, Montreal, QC, Canada
| | - Kristopher T Kahle
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT USA
| | - Guy A Rouleau
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.,Montreal Neurological Institute, Montreal, QC, Canada
| | - Michael T Lawton
- Center for Cerebrovascular Research, University of California, San Francisco, CA, USA.,Department of Neurological Surgery, University of California, San Francisco, CA, USA
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28
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Gamboa NT, Taussky P, Park MS, Couldwell WT, Mahan MA, Kalani MYS. Neurovascular patterning cues and implications for central and peripheral neurological disease. Surg Neurol Int 2017; 8:208. [PMID: 28966815 PMCID: PMC5609400 DOI: 10.4103/sni.sni_475_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 06/28/2017] [Indexed: 12/20/2022] Open
Abstract
The highly branched nervous and vascular systems run along parallel trajectories throughout the human body. This stereotyped pattern of branching shared by the nervous and vascular systems stems from a common reliance on specific cues critical to both neurogenesis and angiogenesis. Continually emerging evidence supports the notion of later-evolving vascular networks co-opting neural molecular mechanisms to ensure close proximity and adequate delivery of oxygen and nutrients to nervous tissue. As our understanding of these biologic pathways and their phenotypic manifestations continues to advance, identification of where pathways go awry will provide critical insight into central and peripheral nervous system pathology.
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Affiliation(s)
- Nicholas T Gamboa
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Philipp Taussky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Min S Park
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Mark A Mahan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - M Yashar S Kalani
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah School of Medicine, Salt Lake City, Utah, USA
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29
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Zhou S, Gao X, Sun J, Lin Z, Huang Y. DNA Methylation of thePDGFDGene Promoter Increases the Risk for Intracranial Aneurysms and Brain Arteriovenous Malformations. DNA Cell Biol 2017; 36:436-442. [PMID: 28346846 DOI: 10.1089/dna.2016.3499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Shengjun Zhou
- Department of Neurosurgery, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, China
| | - Xiang Gao
- Department of Neurosurgery, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, China
| | - Jie Sun
- Department of Neurosurgery, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, China
| | - Zhiqing Lin
- Department of Neurosurgery, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, China
| | - Yi Huang
- Department of Neurosurgery, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, China
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30
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Delev D, Pavlova A, Grote A, Boström A, Höllig A, Schramm J, Fimmers R, Oldenburg J, Simon M. NOTCH4 gene polymorphisms as potential risk factors for brain arteriovenous malformation development and hemorrhagic presentation. J Neurosurg 2017; 126:1552-1559. [DOI: 10.3171/2016.3.jns151731] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVEArteriovenous malformations (AVMs) of the brain are a frequent and important cause of intracranial hemorrhage in young adults. Little is known about the molecular-genetic pathomechanisms underlying AVM development. Genes of the NOTCH family control the normal development of vessels and proper arteriovenous specification. Transgenic mice with constitutive expression of active NOTCH4 frequently develop AVMs. Here, the authors report a genetic association study investigating possible associations between NOTCH4 gene polymorphisms and formation and clinical presentation of AVMs.METHODSAfter PCR amplification and direct DNA sequencing or restriction digests, 10 single-nucleotide polymorphisms (SNPs) of the NOTCH4 gene were used for genotyping 153 AVM patients and 192 healthy controls (i.e., blood donors). Pertinent clinical data were available for 129 patients. Uni- and multivariate single-marker and explorative haplotype analyses were performed to identify potential genetic risk factors for AVM development and for hemorrhagic or epileptic presentation.RESULTSEleven calculated haplotypes consisting of 3–4 SNPs (most of which were located in the epidermal growth factor–like domain of the NOTCH4 gene) were observed significantly more often among AVM patients than among controls. Univariate analysis indicated that rs443198_TT and rs915895_AA genotypes both were significantly associated with hemorrhage and that an rs1109771_GG genotype was associated with epilepsy. The association between rs443198_TT and AVM bleeding remained significant in the multivariate regression analysis.CONCLUSIONSThe authors' results suggest NOTCH4 SNPs as possible genetic risk factors for the development and clinical presentation of AVMs and a role of NOTCH4 in the pathogenesis of this disease.
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Affiliation(s)
| | - Anna Pavlova
- 2Institute for Experimental Haematology and Transfusion Medicine, and
| | | | | | - Anke Höllig
- 3Department of Neurosurgery, University Hospital, RWTH Aachen University, Aachen, Germany
| | | | - Rolf Fimmers
- 4Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, University Medical Center, Bonn; and
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31
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Ozpinar A, Mendez G, Abla AA. Epidemiology, genetics, pathophysiology, and prognostic classifications of cerebral arteriovenous malformations. HANDBOOK OF CLINICAL NEUROLOGY 2017; 143:5-13. [PMID: 28552158 DOI: 10.1016/b978-0-444-63640-9.00001-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Arteriovenous malformations (AVMs) are vascular deformities involving fistula formation of arterial to venous structures without an intervening capillary bed. Such anomalies can prove fatal as the high arterial flow can disrupt the integrity of venous walls, thus leading to dangerous sequelae such as hemorrhage. Diagnosis of these lesions in the central nervous system can often prove challenging as intracranial AVMs represent a heterogeneous vascular pathology with various presentations and symptomatology. The literature suggests that most brain AVMs (bAVMs) are identified following evaluation of the etiology of acute cerebral hemorrhage, or incidentally on imaging associated with seizure or headache workup. Given the low incidence of this disease, most of the data accrued on this pathology comes from single-center experiences. This chapter aims to distill the most important information from these studies as well as examine meta-analyses on bAVMs in order to provide a comprehensive introduction into the natural history, classification, genetic underpinnings of disease, and proposed pathophysiology. While there is yet much to be elucidated about AVMs of the central nervous system, we aim to provide an overview of bAVM etiology, classification, genetics, and pathophysiology inherent to the disease process.
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Affiliation(s)
- Alp Ozpinar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Gustavo Mendez
- Department of General Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Adib A Abla
- Department of Neurological Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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32
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Thomas JM, Surendran S, Abraham M, Rajavelu A, Kartha CC. Genetic and epigenetic mechanisms in the development of arteriovenous malformations in the brain. Clin Epigenetics 2016; 8:78. [PMID: 27453762 PMCID: PMC4957361 DOI: 10.1186/s13148-016-0248-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/12/2016] [Indexed: 12/05/2022] Open
Abstract
Vascular malformations are developmental congenital abnormalities of the vascular system which may involve any segment of the vascular tree such as capillaries, veins, arteries, or lymphatics. Arteriovenous malformations (AVMs) are congenital vascular lesions, initially described as “erectile tumors,” characterized by atypical aggregation of dilated arteries and veins. They may occur in any part of the body, including the brain, heart, liver, and skin. Severe clinical manifestations occur only in the brain. There is absence of normal vascular structure at the subarteriolar level and dearth of capillary bed resulting in aberrant arteriovenous shunting. The causative factor and pathogenic mechanisms of AVMs are unknown. Importantly, no marker proteins have been identified for AVM. AVM is a high flow vascular malformation and is considered to develop because of variability in the hemodynamic forces of blood flow. Altered local hemodynamics in the blood vessels can affect cellular metabolism and may trigger epigenetic factors of the endothelial cell. The genes that are recognized to be associated with AVM might be modulated by various epigenetic factors. We propose that AVMs result from a series of changes in the DNA methylation and histone modifications in the genes connected to vascular development. Aberrant epigenetic modifications in the genome of endothelial cells may drive the artery or vein to an aberrant phenotype. This review focuses on the molecular pathways of arterial and venous development and discusses the role of hemodynamic forces in the development of AVM and possible link between hemodynamic forces and epigenetic mechanisms in the pathogenesis of AVM.
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Affiliation(s)
- Jaya Mary Thomas
- Cardiovascular Disease Biology Program, Rajiv Gandhi Centre for Biotechnology, Poojapura, Thycaud, Thiruvananthapuram, Kerala India
| | - Sumi Surendran
- Cardiovascular Disease Biology Program, Rajiv Gandhi Centre for Biotechnology, Poojapura, Thycaud, Thiruvananthapuram, Kerala India
| | - Mathew Abraham
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala India
| | - Arumugam Rajavelu
- Cardiovascular Disease Biology Program, Rajiv Gandhi Centre for Biotechnology, Poojapura, Thycaud, Thiruvananthapuram, Kerala India ; Tropical Disease Biology Program, Rajiv Gandhi Centre for Biotechnology, Poojapura, Thycaud, Thiruvananthapuram, Kerala India
| | - Chandrasekharan C Kartha
- Cardiovascular Disease Biology Program, Rajiv Gandhi Centre for Biotechnology, Poojapura, Thycaud, Thiruvananthapuram, Kerala India
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33
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Kremer PHC, Koeleman BPC, Rinkel GJ, Diekstra FP, van den Berg LH, Veldink JH, Klijn CJM. Susceptibility loci for sporadic brain arteriovenous malformation; a replication study and meta-analysis. J Neurol Neurosurg Psychiatry 2016; 87:693-6. [PMID: 26272027 DOI: 10.1136/jnnp-2014-310094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 07/28/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Case-control studies have reported multiple genetic loci to be associated with sporadic brain arteriovenous malformations (AVMs) but most of these have not been replicated in independent populations. The aim of this study was to find additional evidence for these reported associations and perform a meta-analysis including all previously published results. METHODS We included 167 Dutch patients and 1038 Dutch controls. Case genotyping was performed by KASPar assays. Controls had been previously genotyped with a genome wide single nucleotide polymorphisms (SNP) array. Differences in genotype frequencies between cases and controls were estimated by χ(2) testing in Plink V.1.07. Meta-analysis was performed in RevMan V.5.3. RESULTS In our case-control study we found no significant association with brain AVM (BAVM) for previously discovered SNPs near ANGPTL4, IL-1β, GPR124, VEGFA and MMP-3. The meta-analysis revealed a statistically significant association with BAVMs for the polymorphism rs11672433 near ANGPTL4 (OR 1.39; 95% CI 1.10 to 1.75, p value 0.005). CONCLUSIONS The results of this study support a role for the previously identified SNP near ANGPTL4 in the pathogenesis of AVMs. Previously found associations with SNPs near IL-1β, GPR124, VEGFA and MMP-3 genes could not be substantiated in our replication cohort or in the meta-analysis.
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Affiliation(s)
- P H C Kremer
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B P C Koeleman
- Department of Biomedical Genetics and Complex Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G Je Rinkel
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F P Diekstra
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L H van den Berg
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J H Veldink
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C J M Klijn
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
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34
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Koch MJ, Agarwalla PK, Stapleton CJ, Ogilvy CS, Loeffler JS. De novo development of a cerebral arteriovenous malformation following radiation therapy: Case report and an update to classical arteriovenous malformation nomenclature. J Clin Neurosci 2016; 28:162-7. [DOI: 10.1016/j.jocn.2015.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 11/29/2015] [Indexed: 12/27/2022]
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Abstract
Brain arteriovenous malformations (bAVMs) represent a high risk of intracranial hemorrhages, which are substantial causes of morbidity and mortality of bAVMs, especially in children and young adults. Although a variety of factors leading to hemorrhages of bAVMs are investigated extensively, their pathogenesis is still not well elucidated. The author has reviewed the updated data of genetic aspects of bAVMs, especially focusing on clinical and experimental knowledge from hereditary hemorrhagic telangiectasia, which is the representative genetic disease presenting with bAVMs caused by loss-of-function in one of the two genes: endoglin and activin receptor-like kinase 1. This knowledge may allow us to infer the pathogensis of sporadic bAVMs and in the development of new medical therapies for them.
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Affiliation(s)
- Masaki Komiyama
- Department of Neuro-Intervention, Osaka City General Hospital
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36
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Papagiannaki C, Clarençon F, Ponsonnard S, Couquet C, Maizeroi-Eugène F, Bresson D, Yardin C, Mounayer C. Development of an angiogenesis animal model featuring brain arteriovenous malformation histological characteristics. J Neurointerv Surg 2016; 9:204-210. [PMID: 27013231 DOI: 10.1136/neurintsurg-2015-012173] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/28/2016] [Accepted: 03/01/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Angiogenesis has a key role in the formation and evolution of brain arteriovenous malformations (AVMs). Numerous models have been developed aiming to recreate configuration of brain AVMs. OBJECTIVE To develop an animal model sharing the same pathological characteristics as human brain AVMs. MATERIALS AND METHODS Ten pigs were divided into two groups. Five animals underwent endovascular left common carotid artery (CCA) and external carotid artery (ECA) occlusion and five animals served as controls. DSA, associated with 3D-rotational angiography, was performed at day 0 and at 3 months in both groups. The volume of the retia was calculated. Vascular endothelial growth factor (VEGF)-A serum levels were measured in both groups at the same time intervals. Finally, the animals were sacrificed at 3 months and the retia were harvested for pathological and immunohistochemistry examinations. RESULTS At 3 months, a significantly higher rete volume was seen in group A than in group B (2.92±0.33 mL vs 1.87±0.69 mL, respectively; p=0.016). There was a trend for increased VEGF-A levels in group A at 3 months. In the occlusion group, histological findings showed significant reduction of media thickness and disrupted internal elastic lamina; immunohistochemistry findings showed strong reactivity for VEGF receptors and interleukin 6. CONCLUSIONS Unilateral endovascular occlusion of the CCA-ECA results in angiogenesis triggering of the rete mirabile with both significant augmentation of the rete volume and histological evidence of pro-angiogenic stimulation.
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Affiliation(s)
- Chrysanthi Papagiannaki
- ERMA (Equipe de Recherche Medicale Appliquée), Limoges University Hospital, Limoges, France.,Interventional Neuroradiology Department, Rouen University Hospital, Rouen, France
| | - Frédéric Clarençon
- ERMA (Equipe de Recherche Medicale Appliquée), Limoges University Hospital, Limoges, France.,Interventional Neuroradiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Sébastien Ponsonnard
- ERMA (Equipe de Recherche Medicale Appliquée), Limoges University Hospital, Limoges, France.,Anesthesiology Department, Limoges University Hospital, Limoges, France
| | - Claude Couquet
- Haute Vienne Departmental Laboratory for Research and Analysis, Limoges, France
| | | | - Damien Bresson
- Department of Neurosurgery, Lariboisière University Hospital, Paris, France
| | - Catherine Yardin
- ERMA (Equipe de Recherche Medicale Appliquée), Limoges University Hospital, Limoges, France.,Department of Histology, Cytology, Cellular Biology and Cytogenetics, Limoges University Hospital, Limoges, France
| | - Charbel Mounayer
- ERMA (Equipe de Recherche Medicale Appliquée), Limoges University Hospital, Limoges, France.,Department of Interventional Neuroradiology, Limoges University Hospital, Limoges, France
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37
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Maruno M, Kiyosue H, Tanoue S, Hongo N, Matsumoto S, Mori H, Sagara Y, Kashiwagi J. Renal Arteriovenous Shunts: Clinical Features, Imaging Appearance, and Transcatheter Embolization Based on Angioarchitecture. Radiographics 2016; 36:580-95. [PMID: 26871987 DOI: 10.1148/rg.2016150124] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Renal arteriovenous (AV) shunt, a rare pathologic condition, is divided into two categories, traumatic and nontraumatic, and can cause massive hematuria, retroperitoneal hemorrhage, pain, and high-output heart failure. Although transcatheter embolization is a less-invasive and effective treatment option, it has a potential risk of complications, including renal infarction and pulmonary embolism, and a potential risk of recanalization. The successful embolization of renal AV shunt requires a complete occlusion of the shunted vessel while preventing the migration of embolic materials and preserving normal renal arterial branches, which depends on the selection of adequate techniques and embolic materials for individual cases, based on the etiology and imaging angioarchitecture of the renal AV shunts. A classification of AV malformations in the extremities and body trunk could precisely correspond with the angioarchitecture of the nontraumatic renal AV shunts. The selection of techniques and choice of adequate embolic materials such as coils, vascular plugs, and liquid materials are determined on the basis of cause (eg, traumatic vs nontraumatic), the classification, and some other aspects of the angioarchitecture of renal AV shunts, including the flow and size of the fistulas, multiplicity of the feeders, and endovascular accessibility to the target lesions. Computed tomographic angiography and selective digital subtraction angiography can provide precise information about the angioarchitecture of renal AV shunts before treatment. Color Doppler ultrasonography and time-resolved three-dimensional contrast-enhanced magnetic resonance angiography represent useful tools for screening and follow-up examinations of renal AV shunts after embolization. In this article, the classifications, imaging features, and an endovascular treatment strategy based on the angioarchitecture of renal AV shunts are described.
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Affiliation(s)
- Miyuki Maruno
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Hiro Kiyosue
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Shuichi Tanoue
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Norio Hongo
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Shunro Matsumoto
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Hiromu Mori
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Yoshiko Sagara
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Junji Kashiwagi
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
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Kim H, Pawlikowska L, Su H, Young WL. Genetics and Vascular Biology of Angiogenesis and Vascular Malformations. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00012-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
An arteriovenous malformation is a tangle of dysplastic vessels (nidus) fed by arteries and drained by veins without intervening capillaries, forming a high-flow, low-resistance shunt between the arterial and venous systems. Arteriovenous malformations in the brain have a low estimated prevalence but are an important cause of intracerebral haemorrhage in young adults. For previously unruptured malformations, bleeding rates are approximately 1% per year. Once ruptured, the subsequent risk increases fivefold, depending on associated aneurysms, deep locations, deep drainage and increasing age. Recent findings from novel animal models and genetic studies suggest that arteriovenous malformations, which were long considered congenital, arise from aberrant vasculogenesis, genetic mutations and/or angiogenesis after injury. The phenotypical characteristics of arteriovenous malformations differ among age groups, with fistulous lesions in children and nidal lesions in adults. Diagnosis mainly involves imaging techniques, including CT, MRI and angiography. Management includes observation, microsurgical resection, endovascular embolization and stereotactic radiosurgery, alone or in any combination. There is little consensus on how to manage patients with unruptured malformations; recent studies have shown that patients managed medically fared better than those with intervention at short-term follow-up. By contrast, interventional treatment is preferred following a ruptured malformation to prevent rehaemorrhage. Management continues to evolve as new mechanistic discoveries and reliable animal models raise the possibility of developing drugs that might prevent the formation of arteriovenous malformations, induce obliteration and/or stabilize vessels to reduce rupture risk. For an illustrated summary of this Primer, visit: http://go.nature.com/TMoAdn.
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Rangel-Castilla L, Russin JJ, Martinez-Del-Campo E, Soriano-Baron H, Spetzler RF, Nakaji P. Molecular and cellular biology of cerebral arteriovenous malformations: a review of current concepts and future trends in treatment. Neurosurg Focus 2015; 37:E1. [PMID: 25175428 DOI: 10.3171/2014.7.focus14214] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Arteriovenous malformations (AVMs) are classically described as congenital static lesions. However, in addition to rupturing, AVMs can undergo growth, remodeling, and regression. These phenomena are directly related to cellular, molecular, and physiological processes. Understanding these relationships is essential to direct future diagnostic and therapeutic strategies. The authors performed a search of the contemporary literature to review current information regarding the molecular and cellular biology of AVMs and how this biology will impact their potential future management. METHODS A PubMed search was performed using the key words "genetic," "molecular," "brain," "cerebral," "arteriovenous," "malformation," "rupture," "management," "embolization," and "radiosurgery." Only English-language papers were considered. The reference lists of all papers selected for full-text assessment were reviewed. RESULTS Current concepts in genetic polymorphisms, growth factors, angiopoietins, apoptosis, endothelial cells, pathophysiology, clinical syndromes, medical treatment (including tetracycline and microRNA-18a), radiation therapy, endovascular embolization, and surgical treatment as they apply to AVMs are discussed. CONCLUSIONS Understanding the complex cellular biology, physiology, hemodynamics, and flow-related phenomena of AVMs is critical for defining and predicting their behavior, developing novel drug treatments, and improving endovascular and surgical therapies.
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Affiliation(s)
- Leonardo Rangel-Castilla
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Kremer PHC, Koeleman BPC, Pawlikowska L, Weinsheimer S, Bendjilali N, Sidney S, Zaroff JG, Rinkel GJE, van den Berg LH, Ruigrok YM, de Kort GAP, Veldink JH, Kim H, Klijn CJM. Evaluation of genetic risk loci for intracranial aneurysms in sporadic arteriovenous malformations of the brain. J Neurol Neurosurg Psychiatry 2015; 86:524-9. [PMID: 25053769 PMCID: PMC4302044 DOI: 10.1136/jnnp-2013-307276] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 07/01/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND In genome-wide association studies (GWAS) five putative risk loci are associated with intracranial aneurysm. As brain arteriovenous malformations (AVM) and intracranial aneurysms are both intracranial vascular diseases and AVMs often have associated aneurysms, we investigated whether these loci are also associated with sporadic brain AVM. METHODS We included 506 patients (168 Dutch, 338 American) and 1548 controls, all Caucasians. Controls had been recruited as part of previous GWAS. Dutch patients were genotyped by KASPar assay and US patients by Affymetrix SNP 6.0 array. Associations in each cohort were tested by univariable logistic regression modelling, with subgroup analysis in 205 American cases with aneurysm data. Meta-analysis was performed by a Mantel-Haenszel fixed-effect method. RESULTS In the Dutch cohort none of the single nucleotide polymorphisms (SNPs) were associated with AVMs. In the American cohort, genotyped SNPs near SOX-17 (OR 0.74; 95% CI 0.56-0.98), RBBP8 (OR 0.76; 95% CI 0.62-0.94) and an imputed SNP near CDKN2B-AS1 (OR 0.79; 95% CI 0.64-0.98) were significantly associated with AVM. The association with SNPs near SOX-17 and CDKN2B-AS1 but not RBBP8 were strongest in patients with AVM with associated aneurysms. In the meta-analysis we found no significant associations between allele frequencies and AVM occurrence, but rs9298506, near SOX-17 approached statistical significance (OR 0.77; 95% CI 0.57-1.03, p=0.08). CONCLUSIONS Our meta-analysis of two Caucasian cohorts did not show an association between five aneurysm-associated loci and sporadic brain AVM. Possible involvement of SOX-17 and RBBP8, genes involved in cell cycle progression, deserves further investigation.
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Affiliation(s)
- P H C Kremer
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B P C Koeleman
- Department of Biomedical Genetics and Complex Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Pawlikowska
- Department of Anesthesia, Center for Cerebrovascular Research, University of California-San Francisco, San Francisco, California, USA Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
| | - S Weinsheimer
- Department of Anesthesia, Center for Cerebrovascular Research, University of California-San Francisco, San Francisco, California, USA
| | - N Bendjilali
- Department of Anesthesia, Center for Cerebrovascular Research, University of California-San Francisco, San Francisco, California, USA
| | - S Sidney
- Division of Research, Kaiser Permanente of Northern California, Oakland, California, USA
| | - J G Zaroff
- Division of Research, Kaiser Permanente of Northern California, Oakland, California, USA
| | - G J E Rinkel
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L H van den Berg
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Y M Ruigrok
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G A P de Kort
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J H Veldink
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H Kim
- Department of Anesthesia, Center for Cerebrovascular Research, University of California-San Francisco, San Francisco, California, USA Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - C J M Klijn
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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Mouchtouris N, Jabbour PM, Starke RM, Hasan DM, Zanaty M, Theofanis T, Ding D, Tjoumakaris SI, Dumont AS, Ghobrial GM, Kung D, Rosenwasser RH, Chalouhi N. Biology of cerebral arteriovenous malformations with a focus on inflammation. J Cereb Blood Flow Metab 2015; 35:167-75. [PMID: 25407267 PMCID: PMC4426734 DOI: 10.1038/jcbfm.2014.179] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 09/05/2014] [Accepted: 09/22/2014] [Indexed: 01/01/2023]
Abstract
Cerebral arteriovenous malformations (AVMs) entail a significant risk of intracerebral hemorrhage owing to the direct shunting of arterial blood into the venous vasculature without the dissipation of the arterial blood pressure. The mechanisms involved in the growth, progression and rupture of AVMs are not clearly understood, but a number of studies point to inflammation as a major contributor to their pathogenesis. The upregulation of proinflammatory cytokines induces the overexpression of cell adhesion molecules in AVM endothelial cells, resulting in enhanced recruitment of leukocytes. The increased leukocyte-derived release of metalloproteinase-9 is known to damage AVM walls and lead to rupture. Inflammation is also involved in altering the AVM angioarchitecture via the upregulation of angiogenic factors that affect endothelial cell proliferation, migration and apoptosis. The effects of inflammation on AVM pathogenesis are potentiated by certain single-nucleotide polymorphisms in the genes of proinflammatory cytokines, increasing their protein levels in the AVM tissue. Furthermore, studies on metalloproteinase-9 inhibitors and on the involvement of Notch signaling in AVMs provide promising data for a potential basis for pharmacological treatment of AVMs. Potential therapeutic targets and areas requiring further investigation are highlighted.
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Affiliation(s)
- Nikolaos Mouchtouris
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Pascal M Jabbour
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - David M Hasan
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA
| | - Mario Zanaty
- 1] Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA [2] Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA
| | - Thana Theofanis
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Dale Ding
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Stavropoula I Tjoumakaris
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Aaron S Dumont
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - George M Ghobrial
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - David Kung
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Nohra Chalouhi
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
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Wu T, Xiao X, Gu F, Zhao M. Sensitive discrimination of stable mismatched base pairs by an abasic site modified fluorescent probe and lambda exonuclease. Chem Commun (Camb) 2015; 51:17402-5. [DOI: 10.1039/c5cc05749c] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
An abasic site modified fluorescent probe has been developed which enabled the rapid discrimination of stable single mismatched base pairs by lambda exonuclease with remarkably high discrimination factors (447 for T:G and 238 for A:G).
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Affiliation(s)
- Tongbo Wu
- Beijing National Laboratory for Molecular Sciences
- MOE Key Laboratory of Bioorganic Chemistry and Molecular Engineering
- College of Chemistry and Molecular Engineering
- Peking University
- Beijing, 100871
| | - Xianjin Xiao
- Beijing National Laboratory for Molecular Sciences
- MOE Key Laboratory of Bioorganic Chemistry and Molecular Engineering
- College of Chemistry and Molecular Engineering
- Peking University
- Beijing, 100871
| | - Feidan Gu
- Beijing National Laboratory for Molecular Sciences
- MOE Key Laboratory of Bioorganic Chemistry and Molecular Engineering
- College of Chemistry and Molecular Engineering
- Peking University
- Beijing, 100871
| | - Meiping Zhao
- Beijing National Laboratory for Molecular Sciences
- MOE Key Laboratory of Bioorganic Chemistry and Molecular Engineering
- College of Chemistry and Molecular Engineering
- Peking University
- Beijing, 100871
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Helgeland Ø, Hertel JK, Molven A, Ræder H, Platou CGP, Midthjell K, Hveem K, Nygård O, Njølstad PR, Johansson S. The Chromosome 9p21 CVD- and T2D-Associated Regions in a Norwegian Population (The HUNT2 Survey). Int J Endocrinol 2015; 2015:164652. [PMID: 26089876 PMCID: PMC4451520 DOI: 10.1155/2015/164652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 08/17/2014] [Indexed: 12/21/2022] Open
Abstract
Background. Two adjacent regions upstream CDKN2B on chromosome 9p21 have been associated with type 2 diabetes (T2D) and progression of cardiovascular disease (CVD). The precise location and number of risk variants have not been completely delineated and a possible synergistic relationship between the adjacent regions is not fully addressed. By a population based cross-sectional case-control design, we genotyped 18 SNPs upstream of CDKN2B tagging 138 kb in and around two LD-blocks associated with CVD and T2D and investigated associations with T2D, angina pectoris (AP), myocardial infarction (MI), coronary heart disease (CHD; AP or AMI), and stroke using 5,564 subjects from HUNT2. Results. Single point and haplotype analysis showed evidence for only one common T2D risk haplotype (rs10757282∣rs10811661: OR = 1.19, P = 2.0 × 10(-3)) in the region. We confirmed the strong association between SNPs in the 60 kb CVD region with AP, MI, and CHD (P < 0.01). Conditioning on the lead SNPs in the region, we observed two suggestive independent single SNP association signals for MI, rs2065501 (P = 0.03) and rs3217986 (P = 0.04). Conclusions. We confirmed the association of known variants within the 9p21 interval with T2D and CHD. Our results further suggest that additional CHD susceptibility variants exist in this region.
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Affiliation(s)
- Øyvind Helgeland
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, 5021 Bergen, Norway
- *Øyvind Helgeland:
| | - Jens K. Hertel
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, 5021 Bergen, Norway
- Morbid Obesity Center, Vestfold Hospital Trust, 3116 Tønsberg, Norway
- Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway
| | - Anders Molven
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway
- Department of Pathology, Haukeland University Hospital, 5021 Bergen, Norway
| | - Helge Ræder
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, 5021 Bergen, Norway
| | - Carl G. P. Platou
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, 7600 Levanger, Norway
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, 7600 Levanger, Norway
| | - Kristian Midthjell
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, 7600 Levanger, Norway
| | - Kristian Hveem
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, 7600 Levanger, Norway
| | - Ottar Nygård
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway
| | - Pål R. Njølstad
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, 5021 Bergen, Norway
| | - Stefan Johansson
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, 5021 Bergen, Norway
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Ramey WL, Martirosyan NL, Zabramski JM, Spetzler RF, Kalani MYS. A hierarchical model for the development of cerebral arteriovenous malformations. Clin Neurol Neurosurg 2014; 126:126-9. [DOI: 10.1016/j.clineuro.2014.08.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 08/24/2014] [Indexed: 11/26/2022]
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van Beijnum J, van der Worp HB, Algra A, Vandertop WP, van den Berg R, Brouwer PA, van der Sprenkel JWB, Kappelle LJ, Rinkel GJ, Klijn CJ. Prevalence of Brain Arteriovenous Malformations in First-Degree Relatives of Patients With a Brain Arteriovenous Malformation. Stroke 2014; 45:3231-5. [DOI: 10.1161/strokeaha.114.005442] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Janneke van Beijnum
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (J.v.B., H.B.v.d.W., A.A., J.W.B.v.d.S., L.J.K., G.J.E.R., C.J.M.K.), and the Julius Centre for Health Science and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Neurosurgery (W.P.V.) and Radiology (R.v.d.B.), Neurosurgical Center Amsterdam, VU University Medical Center and Amsterdam Medical Center, Amsterdam, The Netherlands; and Departments of Neurosurgery (J.v.B.) and
| | - H. Bart van der Worp
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (J.v.B., H.B.v.d.W., A.A., J.W.B.v.d.S., L.J.K., G.J.E.R., C.J.M.K.), and the Julius Centre for Health Science and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Neurosurgery (W.P.V.) and Radiology (R.v.d.B.), Neurosurgical Center Amsterdam, VU University Medical Center and Amsterdam Medical Center, Amsterdam, The Netherlands; and Departments of Neurosurgery (J.v.B.) and
| | - Ale Algra
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (J.v.B., H.B.v.d.W., A.A., J.W.B.v.d.S., L.J.K., G.J.E.R., C.J.M.K.), and the Julius Centre for Health Science and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Neurosurgery (W.P.V.) and Radiology (R.v.d.B.), Neurosurgical Center Amsterdam, VU University Medical Center and Amsterdam Medical Center, Amsterdam, The Netherlands; and Departments of Neurosurgery (J.v.B.) and
| | - W. Peter Vandertop
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (J.v.B., H.B.v.d.W., A.A., J.W.B.v.d.S., L.J.K., G.J.E.R., C.J.M.K.), and the Julius Centre for Health Science and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Neurosurgery (W.P.V.) and Radiology (R.v.d.B.), Neurosurgical Center Amsterdam, VU University Medical Center and Amsterdam Medical Center, Amsterdam, The Netherlands; and Departments of Neurosurgery (J.v.B.) and
| | - René van den Berg
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (J.v.B., H.B.v.d.W., A.A., J.W.B.v.d.S., L.J.K., G.J.E.R., C.J.M.K.), and the Julius Centre for Health Science and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Neurosurgery (W.P.V.) and Radiology (R.v.d.B.), Neurosurgical Center Amsterdam, VU University Medical Center and Amsterdam Medical Center, Amsterdam, The Netherlands; and Departments of Neurosurgery (J.v.B.) and
| | - Patrick A. Brouwer
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (J.v.B., H.B.v.d.W., A.A., J.W.B.v.d.S., L.J.K., G.J.E.R., C.J.M.K.), and the Julius Centre for Health Science and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Neurosurgery (W.P.V.) and Radiology (R.v.d.B.), Neurosurgical Center Amsterdam, VU University Medical Center and Amsterdam Medical Center, Amsterdam, The Netherlands; and Departments of Neurosurgery (J.v.B.) and
| | - Jan Willem Berkelbach van der Sprenkel
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (J.v.B., H.B.v.d.W., A.A., J.W.B.v.d.S., L.J.K., G.J.E.R., C.J.M.K.), and the Julius Centre for Health Science and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Neurosurgery (W.P.V.) and Radiology (R.v.d.B.), Neurosurgical Center Amsterdam, VU University Medical Center and Amsterdam Medical Center, Amsterdam, The Netherlands; and Departments of Neurosurgery (J.v.B.) and
| | - L. Jaap Kappelle
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (J.v.B., H.B.v.d.W., A.A., J.W.B.v.d.S., L.J.K., G.J.E.R., C.J.M.K.), and the Julius Centre for Health Science and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Neurosurgery (W.P.V.) and Radiology (R.v.d.B.), Neurosurgical Center Amsterdam, VU University Medical Center and Amsterdam Medical Center, Amsterdam, The Netherlands; and Departments of Neurosurgery (J.v.B.) and
| | - Gabriël J.E. Rinkel
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (J.v.B., H.B.v.d.W., A.A., J.W.B.v.d.S., L.J.K., G.J.E.R., C.J.M.K.), and the Julius Centre for Health Science and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Neurosurgery (W.P.V.) and Radiology (R.v.d.B.), Neurosurgical Center Amsterdam, VU University Medical Center and Amsterdam Medical Center, Amsterdam, The Netherlands; and Departments of Neurosurgery (J.v.B.) and
| | - Catharina J.M. Klijn
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (J.v.B., H.B.v.d.W., A.A., J.W.B.v.d.S., L.J.K., G.J.E.R., C.J.M.K.), and the Julius Centre for Health Science and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Neurosurgery (W.P.V.) and Radiology (R.v.d.B.), Neurosurgical Center Amsterdam, VU University Medical Center and Amsterdam Medical Center, Amsterdam, The Netherlands; and Departments of Neurosurgery (J.v.B.) and
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Neil JA, Li D, Stiefel MF, Hu YC. Symptomatic de novo arteriovenous malformation in an adult: Case report and review of the literature. Surg Neurol Int 2014; 5:148. [PMID: 25371848 PMCID: PMC4209707 DOI: 10.4103/2152-7806.142796] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 07/02/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Cerebral arteriovenous malformations (AVMs) have been long thought to be a congenital anomaly of vasculogenesis in which arteries and veins form direct connections forming a vascular nidus without an intervening capillary bed or neural tissue. Scattered case reports have described that AVMs may form de novo suggesting they can become an acquired lesion. CASE DESCRIPTION The current case report describes a patient who presented with new-onset seizures with an initial negative magnetic resonance imaging (MRI) of the brain and subsequently developed an AVM on a MRI 9 years later. CONCLUSION This case joins a small, but growing body of literature that challenges the notion that all AVMs are congenital.
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Affiliation(s)
- Jayson A Neil
- Department of Neurological Surgery, New York Medical College, Valhalla, New York, USA
| | - Daphne Li
- Department of Neurological Surgery, New York Medical College, Valhalla, New York, USA
| | - Michael F Stiefel
- Department of Neurological Surgery, New York Medical College, Valhalla, New York, USA
| | - Yin C Hu
- Department of Neurological Surgery, New York Medical College, Valhalla, New York, USA
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BMP signaling modulation attenuates cerebral arteriovenous malformation formation in a vertebrate model. J Cereb Blood Flow Metab 2014; 34:1688-94. [PMID: 25052553 PMCID: PMC4269730 DOI: 10.1038/jcbfm.2014.134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/02/2014] [Accepted: 06/30/2014] [Indexed: 12/22/2022]
Abstract
Cerebral arteriovenous malformations (AVMs) are vascular anomalies that carry a high risk of stroke and death. To test potential AVM therapies, a reverse genetics approach was used to model AVMs in zebrafish. Antisense morpholino oligonucleotides were used to knockdown activin receptor-like kinase I (alk1), which encodes a transforming growth factor (TGF)-beta family type I receptor implicated in a subset of human AVMs. Knockdown of alk1 caused a spectrum of morphologic, functional, and molecular defects that resemble those seen in humans with AVMs. It was found that losartan, an angiotensin II receptor antagonist, attenuated abnormal blood vessel morphology and systemic manifestations of high-output arteriovenous shunting in vivo. SMAD1 phosphorylation was significantly decreased in alk1 morphants compared with uninjected organisms (0.189±0.0201, 0.429±0.0164, P=0.0002). After treatment, morphant SMAD1 levels approached uninjected levels (0.326±0.0360, P=0.0355) and were significantly higher than those seen in the morphant-control group (P=0.0294). These data suggest that modulating the BMP signaling pathway with losartan, a drug in widespread clinical use in humans as an antihypertensive, may have the potential to be further evaluated as a therapeutic strategy for patients with AVMs.
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Morales-Valero SF, Bortolotti C, Sturiale C, Lanzino G. Are parenchymal AVMs congenital lesions? Neurosurg Focus 2014; 37:E2. [DOI: 10.3171/2014.6.focus14234] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A long-held dogma in neurosurgery is that parenchymal arteriovenous malformations (AVMs) are congenital. However, there is no strong evidence supporting this theory. An increasing number of documented cases of de novo formation of parenchymal AVMs cast doubt on their congenital nature and suggest that indeed the majority of these lesions may form after birth. Further evidence suggesting the postnatal development of parenchymal AVMs comes from the exceedingly rare diagnosis of these lesions in utero despite the widespread availability of high-resolution imaging modalities such as ultrasound and fetal MRI. The exact mechanism of AVM formation has yet to be elucidated, but most likely involves genetic susceptibility and environmental triggering factors. In this review, the authors report 2 cases of de novo AVM formation and analyze the evidence suggesting that they represent an acquired condition.
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Affiliation(s)
- Saul F. Morales-Valero
- 1Department of Neurologic Surgery, Mayo Clinic, Mayo Medical School, Rochester, Minnesota; and
| | - Carlo Bortolotti
- 2Department of Neurosurgery, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Carmelo Sturiale
- 2Department of Neurosurgery, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Giuseppe Lanzino
- 1Department of Neurologic Surgery, Mayo Clinic, Mayo Medical School, Rochester, Minnesota; and
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Fujimura M, Kimura N, Ezura M, Niizuma K, Uenohara H, Tominaga T. Development of a de novo arteriovenous malformation after bilateral revascularization surgery in a child with moyamoya disease. J Neurosurg Pediatr 2014; 13:647-9. [PMID: 24745340 DOI: 10.3171/2014.3.peds13610] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The development of a de novo arteriovenous malformation (AVM) in patients with moyamoya disease is extremely rare. A 14-year-old girl developed an AVM in the right occipital lobe during the 4-year postoperative period following successful bilateral revascularization surgeries. She suffered a transient ischemic attack with hemodynamic compromise of the bilateral hemispheres at the age of 10 years. Results of an initial examination by 1.5-T MRI and MR angiography satisfied the diagnostic criteria of moyamoya disease but failed to detect any vascular malformation. Bilateral direct and indirect revascularization surgeries in the anterior circulation relieved her symptoms, and she underwent MRI and MR angiography follow-up every year after surgery. Serial T2-weighted MRI revealed the gradual appearance of flow voids in the right occipital lobe during the follow-up period. Magnetic resonance angiography ultimately indicated the development of an AVM 4 years after these surgeries when catheter angiography confirmed the diagnosis of an AVM in the right occipital lobe. The AVM remained asymptomatic, and the patient remained free of cerebrovascular events during the time she was observed by the authors. Acquired AVM in moyamoya disease is extremely rare, with only 3 pediatric cases including the present case being reported in the literature. The development of a de novo AVM in a postoperative patient with moyamoya disease appears to be unique, and this case may provide insight into the dynamic pathology of AVMs.
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Affiliation(s)
- Miki Fujimura
- Department of Neurosurgery, Tohoku University Graduate School of Medicine; and
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